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Ren Y, Maselko J, Tan X, Olshan AF, Stover AM, Bennett AV, Reeder-Hayes KE, Edwards JK, Reeve BB, Troester MA, Emerson MA. Emotional and functional well-being in long-term breast cancer survivorship. Cancer Causes Control 2024:10.1007/s10552-024-01877-1. [PMID: 38642278 DOI: 10.1007/s10552-024-01877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/26/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Emotional and functional well-being (EWB and FWB) are important components of mental health and quality of life. This study aims to evaluate long-term EWB and FWB in breast cancer (BC) survivors. METHODS The Carolina Breast Cancer Study Phase 3 oversampled Black and younger (< 50 years in age) women so that they each represent approximately 50% of the study population and assessed participants' EWB and FWB with the Functional Assessment of Cancer Therapy-Breast (FACT-B) at 5- (baseline), 25-, and 84-months post diagnosis. Multinomial logit models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between demographic and clinical characteristics and well-being change relative to baseline. RESULTS Among 2,781 participants with BC, average EWB and FWB improved with time since diagnosis. Persistent FWB decrements were associated with Black race [OR 1.4 (95% CI 1.2-1.7) and 1.3 (95% CI 1.1-1.6), at 25-months and 84-months respectively], older age [OR 1.4 (95% CI 1.1-1.7) and 1.5 (95% CI 1.2-1.8), respectively], no chemotherapy, and recurrence [OR 2.9 (95% CI 1.8-4.8) and 3.1 (95% CI 2.1-4.6), respectively]. EWB decrements were associated with advanced stage and recurrence. Decrements in combined (FWB+EWB) well-being were associated with recurrence at both follow-up survey timepoints [ORs 4.7 (95% CI 2.7-8.0) and 4.3 (95% CI 2.8-6.6), respectively]. CONCLUSIONS Long-term well-being varies by demographics and clinical features, with Black women and women with aggressive disease at greatest risk of long-term decrements.
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Affiliation(s)
- Yumeng Ren
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Angela M Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Antonia V Bennett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Marc A Emerson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Aiyegbusi OL, Cruz Rivera S, Roydhouse J, Kamudoni P, Alder Y, Anderson N, Baldwin RM, Bhatnagar V, Black J, Bottomley A, Brundage M, Cella D, Collis P, Davies EH, Denniston AK, Efficace F, Gardner A, Gnanasakthy A, Golub RM, Hughes SE, Jeyes F, Kern S, King-Kallimanis BL, Martin A, McMullan C, Mercieca-Bebber R, Monteiro J, Peipert JD, Quijano-Campos JC, Quinten C, Rantell KR, Regnault A, Sasseville M, Schougaard LMV, Sherafat-Kazemzadeh R, Snyder C, Stover AM, Verdi R, Wilson R, Calvert MJ. Recommendations to address respondent burden associated with patient-reported outcome assessment. Nat Med 2024; 30:650-659. [PMID: 38424214 DOI: 10.1038/s41591-024-02827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
Patient-reported outcomes (PROs) are increasingly used in healthcare research to provide evidence of the benefits and risks of interventions from the patient perspective and to inform regulatory decisions and health policy. The use of PROs in clinical practice can facilitate symptom monitoring, tailor care to individual needs, aid clinical decision-making and inform value-based healthcare initiatives. Despite their benefits, there are concerns that the potential burden on respondents may reduce their willingness to complete PROs, with potential impact on the completeness and quality of the data for decision-making. We therefore conducted an initial literature review to generate a list of candidate recommendations aimed at reducing respondent burden. This was followed by a two-stage Delphi survey by an international multi-stakeholder group. A consensus meeting was held to finalize the recommendations. The final consensus statement includes 19 recommendations to address PRO respondent burden in healthcare research and clinical practice. If implemented, these recommendations may reduce PRO respondent burden.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK.
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
| | - Samantha Cruz Rivera
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | | | - Yvonne Alder
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Anderson
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Vishal Bhatnagar
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Philip Collis
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Alastair K Denniston
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston University, Birmingham, UK
| | | | - Robert M Golub
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Hughes
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Flic Jeyes
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Christel McMullan
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Rebecca Mercieca-Bebber
- The NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Juan Carlos Quijano-Campos
- William Harvey Research Institute, Queen Mary University of London, London, UK
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | | | | | - Claire Snyder
- Johns Hopkins Schools of Medicine and Public Health, Baltimore, MD, USA
| | - Angela M Stover
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Rav Verdi
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Cancer Research Advocacy Forum, London, UK
| | - Melanie J Calvert
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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Rohweder CL, Morrison A, Mottus K, Young A, Caton L, Booth R, Reed C, Shea CM, Stover AM. Virtual quality improvement collaborative with primary care practices during COVID-19: a case study within a clinically integrated network. BMJ Open Qual 2024; 13:e002400. [PMID: 38351031 PMCID: PMC10868276 DOI: 10.1136/bmjoq-2023-002400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Quality improvement collaboratives (QICs) are a common approach to facilitate practice change and improve care delivery. Attention to QIC implementation processes and outcomes can inform best practices for designing and delivering collaborative content. In partnership with a clinically integrated network, we evaluated implementation outcomes for a virtual QIC with independent primary care practices delivered during COVID-19. METHODS We conducted a longitudinal case study evaluation of a virtual QIC in which practices participated in bimonthly online meetings and monthly tailored QI coaching sessions from July 2020 to June 2021. Implementation outcomes included: (1) level of engagement (meeting attendance and poll questions), (2) QI capacity (assessments completed by QI coaches), (3) use of QI tools (plan-do-check-act (PDCA) cycles started and completed) and (4) participant perceptions of acceptability (interviews and surveys). RESULTS Seven clinics from five primary care practices participated in the virtual QIC. Of the seven sites, five were community health centres, three were in rural counties and clinic size ranged from 1 to 7 physicians. For engagement, all practices had at least one member attend all online QIC meetings and most (9/11 (82%)) poll respondents reported meeting with their QI coach at least once per month. For QI capacity, practice-level scores showed improvements in foundational, intermediate and advanced QI work. For QI tools used, 26 PDCA cycles were initiated with 9 completed. Most (10/11 (91%)) survey respondents were satisfied with their virtual QIC experience. Twelve interviews revealed additional themes such as challenges in obtaining real-time data and working with multiple electronic medical record systems. DISCUSSION A virtual QIC conducted with independent primary care practices during COVID-19 resulted in high participation and satisfaction. QI capacity and use of QI tools increased over 1 year. These implementation outcomes suggest that virtual QICs may be an attractive alternative to engage independent practices in QI work.
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Affiliation(s)
- Catherine L Rohweder
- Center for Women's Health Research, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Abigail Morrison
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kathleen Mottus
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alexa Young
- Center for Health Promotion and Disease Prevention, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lauren Caton
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Maternal and Child Health, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Ronni Booth
- UNC Health Alliance, UNC Health Care System, Chapel Hill, North Carolina, USA
| | - Christine Reed
- UNC Health Alliance, UNC Health Care System, Chapel Hill, North Carolina, USA
| | - Christopher M Shea
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Angela M Stover
- The North Carolina Translational and Clinical Sciences Institute (NC TraCS), The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Xu S, Tan X, Ma C, McElyea RS, Shieh K, Stover AM, Smith A, Stitzenberg K, Basch E, Song L. An eHealth symptom and complication management program for cancer patients with newly created ostomies and their caregivers (Alliance): a pilot feasibility randomized trial. BMC Cancer 2023; 23:532. [PMID: 37301841 PMCID: PMC10257159 DOI: 10.1186/s12885-023-10919-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/04/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Cancer patients with newly created ostomies face complications that reduce quality of life (QOL) and increase morbidity and mortality. This proof-of-concept study examined the feasibility, usability, acceptability, and initial efficacy of an eHealth program titled the "Patient Reported Outcomes-Informed Symptom Management System" (PRISMS) during post-ostomy creation care transition. METHODS We conducted a 2-arm pilot randomized controlled trial among 23 patients who received surgical treatment with curative intent for bladder and colorectal cancer and their caregivers. After assessing QOL, general symptoms, and caregiver burden at baseline, participants were randomly assigned to PRISMS (n = 16 dyads) or usual care (UC) (n = 7 dyads). After a 60-day intervention period, participants completed a follow-up survey and post-exit interview. We used descriptive statistics and t-tests to analyze the data. RESULTS We achieved an 86.21% recruitment rate and a 73.91% retention rate. Among the PRISMS participants who used the system and biometric devices (n = 14, 87.50%), 46.43% used the devices for ≥ 50 days during the study period. Participants reported PRISMS as useful and acceptable. Compared to their UC counterparts, PRISMS patient social well-being scores decreased over time and had an increased trend of physical and emotional well-being; PRISMS caregivers experienced a greater decrease in caregiver burden. CONCLUSIONS PRISMS recruitment and retention rates were comparable to existing family-based intervention studies. PRISMS is a useful and acceptable multilevel intervention with the potential to improve the health outcomes of cancer patients needing ostomy care and their caregivers during post-surgery care transition. A sufficiently powered RCT is needed to test its effects. TRIAL REGISTRATION ClinicalTrial.gov ID: NCT04492007. Registration date: 30/07/2020.
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Affiliation(s)
- Shenmeng Xu
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Xianming Tan
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Chunxuan Ma
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rebecca S McElyea
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karl Shieh
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Angela M Stover
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
| | - Angela Smith
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- School of Medicine, UNC-CH, Chapel Hill, NC, USA
| | - Karyn Stitzenberg
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- School of Medicine, UNC-CH, Chapel Hill, NC, USA
| | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- School of Medicine, UNC-CH, Chapel Hill, NC, USA
| | - Lixin Song
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA.
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
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Caston NE, Franks JA, Balas N, Eltoum N, Thigpen H, Patterson M, Azuero A, Ojesina AI, Dent DN, Hildreth K, Lalor FR, McGowen C, Huang CHS, Dionne-Odom JN, Weiner BJ, Jackson BE, Basch EM, Stover AM, Howell D, Pierce JY, Rocque GB. Evaluating Nurses' Time to Response by Severity and Cancer Stage in a Remote Symptom Monitoring Program for Patients With Breast Cancer. JCO Clin Cancer Inform 2023; 7:e2300015. [PMID: 37279409 PMCID: PMC10530733 DOI: 10.1200/cci.23.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/10/2023] [Accepted: 04/13/2023] [Indexed: 06/08/2023] Open
Abstract
PURPOSE Remote symptom monitoring (RSM) using electronic patient-reported outcomes enables patients with cancer to communicate symptoms between in-person visits. A better understanding of key RSM implementation outcomes is crucial to optimize efficiency and guide implementation efforts. This analysis evaluated the association between the severity of patient-reported symptom alerts and time to response by the health care team. METHODS This secondary analysis included women with stage I-IV breast cancer who received care at a large academic medical center in the Southeastern United States (October 2020-September 2022). Symptom surveys with at least one severe symptom alert were categorized as severe. Response time was categorized as optimal if the alert was closed by a health care team member within 48 hours. Odds ratios (ORs), predicted probabilities, and 95% CIs were estimated using a patient-nested logistic regression model. RESULTS Of 178 patients with breast cancer included in this analysis, 63% of patients identified as White and 85% of patients had a stage I-III or early-stage cancer. The median age at diagnosis was 55 years (IQR, 42-65). Of 1,087 surveys included, 36% reported at least one severe symptom alert and 77% had an optimal response time by the health care team. When compared with surveys that had no severe symptom alerts, surveys with at least one severe symptom alert had similar odds of having an optimal response time (OR, 0.97; 95% CI, 0.68 to 1.38). The results were similar when stratified by cancer stage. CONCLUSION Response times to symptom alerts were similar for alerts with at least one severe symptom compared with alerts with no severe symptoms. This suggests that alert management is being incorporated into routine workflows and not prioritized based on disease or symptom alert severity.
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Affiliation(s)
- Nicole E. Caston
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey A. Franks
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Nora Balas
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Noon Eltoum
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Haley Thigpen
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Megan Patterson
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Andres Azuero
- O'Neal Comprehensive Cancer Center, Birmingham, AL
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Akinyemi I. Ojesina
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - D'Ambra N. Dent
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Keyonsis Hildreth
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Fallon R. Lalor
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Chelsea McGowen
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | - Chao-Hui S. Huang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Bryan J. Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Bradford E. Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ethan M. Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela M. Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, ON, Canada
| | | | - Gabrielle B. Rocque
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
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Rocque GB, Dent DN, Ingram SA, Caston NE, Thigpen HB, Lalor FR, Jamy OH, Giri S, Azuero A, Young Pierce J, McGowen CL, Daniel CL, Andrews CJ, Huang CHS, Dionne-Odom JN, Weiner BJ, Howell D, Jackson BE, Basch EM, Stover AM. Adaptation of Remote Symptom Monitoring Using Electronic Patient-Reported Outcomes for Implementation in Real-World Settings. JCO Oncol Pract 2022; 18:e1943-e1952. [PMID: 36306496 PMCID: PMC9750550 DOI: 10.1200/op.22.00360] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/19/2022] [Accepted: 09/12/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. METHODS This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman's Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (phase I) and workflow (phase II and III) using electronic health data; qualitative evaluation with semistructured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. RESULTS Core components of remote symptom monitoring included electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed > 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. CONCLUSION Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.
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Affiliation(s)
- Gabrielle B. Rocque
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - D’Ambra N. Dent
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Stacey A. Ingram
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Nicole E. Caston
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Haley B. Thigpen
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Fallon R. Lalor
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
| | - Omer H. Jamy
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - Smith Giri
- University of Alabama at Birmingham, Department of Medicine, Division of Hematology and Oncology, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL
| | | | | | - Casey L. Daniel
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | - Courtney J. Andrews
- Institute for Human Rights, University of Alabama at Birmingham, Birmingham, AL
| | - Chao-Hui Sylvia Huang
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
| | - J. Nicholas Dionne-Odom
- University of Alabama at Birmingham, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Birmingham, AL
- University of Alabama at Birmingham School of Nursing, Birmingham, AL
| | - Bryan J. Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Bradford E. Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ethan M. Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela M. Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- University of North Carolina at Chapel Hill Department of Health Policy and Management, Chapel Hill, NC
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Turner K, Stover AM, Tometich DB, Geiss C, Mason A, Nguyen OT, Hume E, McCormick R, Powell S, Hallanger-Johnson J, Patel KB, Kirtane KS, Jammigumpula N, Moore C, Perkins R, Rollison DE, Jim HSL, Oswald LB, Crowder S, Gonzalez BD, Robinson E, Tabriz AA, Islam JY, Gilbert SM. Oncology Providers' and Professionals' Experiences With Suicide Risk Screening Among Patients With Head and Neck Cancer: A Qualitative Study. JCO Oncol Pract 2022:OP2200433. [PMID: 36395441 DOI: 10.1200/op.22.00433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE There has been limited study of the implementation of suicide risk screening for patients with head and neck cancer (HNC) as a part of routine care. To address this gap, this study assessed oncology providers' and professionals' perspectives about barriers and facilitators of implementing a suicide risk screening among patients with HNC. MATERIALS AND METHODS All patients with HNC with an in-person visit completed a suicide risk screening on an electronic tablet. Patients reporting passive death wish were then screened for active suicidal ideation and referred for appropriate intervention. Interviews were conducted with 25 oncology providers and professionals who played a key role in implementation including nurses, medical assistants, patient access representatives, advanced practice providers, physicians, social workers, and informatics staff. The interview guide was based on the Consolidated Framework for Implementation Research. Interviews were transcribed and analyzed for themes. RESULTS Participants identified multilevel implementation barriers, such as intervention level (eg, patient difficulty with using a tablet), process level (eg, limited nursing engagement), organizational level (eg, limited clinic Wi-Fi connectivity), and individual level (eg, low clinician self-efficacy for interpreting and acting upon patient-reported outcome scores). Participants noted facilitators, such as effective care coordination across nursing and social work staff and the opportunity for patients to be screened multiple times. Participants recommended strengthening patient and clinician education and providing patients with other modalities for data entry (eg, desktop computer in the waiting room). CONCLUSION Participants identified important intervention modifications that may be needed to optimize suicide risk screening in cancer care settings.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL.,Department of Oncological Sciences, University of South Florida, Tampa, FL
| | - Angela M Stover
- Department of Health Policy and Management, UNC Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, UNC Chapel Hill, Chapel Hill, NC
| | - Danielle B Tometich
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Carley Geiss
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, Tampa, FL
| | - Arianna Mason
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, Tampa, FL
| | - Oliver T Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Emma Hume
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Rachael McCormick
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Sean Powell
- Department of Social Work, Moffitt Cancer Center, Tampa, FL
| | | | - Krupal B Patel
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL
| | - Kedar S Kirtane
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL
| | - Neelima Jammigumpula
- Department of Clinical Informatics, Center for Digital Health, Moffitt Cancer Center, Tampa, FL
| | - Colin Moore
- Department of Clinical Informatics, Center for Digital Health, Moffitt Cancer Center, Tampa, FL.,Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Randa Perkins
- Department of Clinical Informatics, Center for Digital Health, Moffitt Cancer Center, Tampa, FL.,Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, FL
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Oncological Sciences, University of South Florida, Tampa, FL
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Oncological Sciences, University of South Florida, Tampa, FL
| | - Sylvia Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Oncological Sciences, University of South Florida, Tampa, FL
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Oncological Sciences, University of South Florida, Tampa, FL
| | - Edmondo Robinson
- Department of Clinical Informatics, Center for Digital Health, Moffitt Cancer Center, Tampa, FL.,Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, FL
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Oncological Sciences, University of South Florida, Tampa, FL
| | - Jessica Y Islam
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
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8
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Kaufmann TL, Rocque GB, Kvale EA, Kamal A, Pignone M, Bennett AV, Saxton J, Hernandez RK, Stover AM. Development of a patient-reported outcome measure (PROM) screening strategy for early palliative care needs in outpatients with advanced cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
203 Background: There is a critical need to develop standardized and feasible methods to monitor patients for unmet palliative needs and direct timely referral to specialty palliative care. We developed a patient reported outcome measure (PROM) measurement strategy to screen patients for multidimensional palliative care needs. Methods: Guided by evidence-based frameworks for early palliative care in oncology, we identified 8 key domains for PROM monitoring that are meaningful and actionable in clinical care and appropriate for direct patient report. We conducted a systematic search for PROMs assessing these key domains using the Palliative Care Research Cooperative (PCRC) Measurement Core resources and the Grid-Enabled Measures Database. PROMs for each domain were compared for content coverage, psychometric properties, proprietary availability, Spanish translation, and attributes (response options, length, literacy demand). Results: We selected 13 PRO items for weekly monitoring (Symptom PROs) and 11 PRO items for monthly monitoring (Palliative PROs) (Table). We did not identify any validated PROMs to assess caregiver burden from the patient perspective. Validated PROMs in short formats for spiritual/existential needs are limited. Conclusions: Existing PROMs are limited in capturing the multi-dimensionality of palliative care needs for patients with cancer, particularly for spiritual needs and patient-reported caregiver burden. Future work will focus on piloting identified PROMs to monitor patients for early palliative care needs and determining thresholds to trigger referrals to specialty palliative care.[Table: see text]
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Affiliation(s)
- Tara L. Kaufmann
- Dell Medical School at The University of Texas at Austin, Austin, TX
| | | | | | - Arif Kamal
- Duke University Cancer Institute, Durham, NC
| | - Michael Pignone
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Antonia Vickery Bennett
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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9
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Krishnan J, McGowen CL, McElhany SK, Diaz BE, McNair CC, Caston NE, Dent D, Ingram SA, Hildreth K, Franks J, Azuero A, Andrews CJ, Huang CH, Howell D, Weiner BJ, Jackson BE, Basch E, Stover AM, Rocque GB, Young Pierce J. Identification of target population in the implementation of navigator-delivered home ePRO for patients with cancer receiving treatment. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
351 Background: One key challenge of practice transformation activities, such as remote symptom monitoring (RSM) using electronic patient reported outcomes (ePROs), is identification of patients starting treatment. In real-world settings, reliance on referrals is likely to miss patients. We describe the difficulties encountered in patient identification and the subsequent changes implemented in protocol to remediate this. Methods: We conducted two PDSA cycles focused on identification and engagement of patients for RSM at the Mitchel Cancer Institute (MCI). Target patient capture was > 75%. Modifications to the patient identification process were documented. Schedules of physicians participating in the RSM program were reviewed from 6/2021 – 5/2022 to identify eligible patients. Patients were considered eligible if they were starting chemotherapy, targeted therapy, or immunotherapy. Patients seeking a second opinion were excluded. Patient demographics, cancer type, cancer stage, and PROs were abstracted from electronic health records and the PRO platform (Carevive). Initial clinic roll-out was conducted in gynecologic oncology, with expansion to breast and thoracic oncology in 10/2021 and 3/2022, respectively. The proportion of eligible patients approached per month was reported.Results: In the first PDSA cycle, the eligibility criteria was defined. Although clinical trials included advanced disease, non-clinical staff screening expressed concern about determining advanced vs. early-stage disease. Thus, inclusion criteria was broadened to include all patients starting treatments. From 6/2021 –8/2021, navigators identified patients by screening patients who presented for chemo-education visits. The navigation team approached 23 patients during this period. However, this process didn’t identify all eligible patients as not all patients beginning treatment received chemo-education visits. In PDSA Cycle 2, the process for new patient contact from initial call for appointment through treatment was reviewed. The implementation team screened all patients in a physician’s schedule a week prior to the office visit as well as on the day of visit. This updated process identified all eligible patients starting either intravenous or oral chemotherapy. The recruitment process was modified to screen the physician schedules rather than chemo educator visits. From 9/2022-5/22, the proportion of eligible patients identified and approached remained high at 100%. This methodological screening process helped the navigation team identify all eligible patients in an efficient manner and they reported comfort in expanding to additional disease teams. Conclusions: Systematic screening of physician schedules can be successfully leveraged for patient identification and reduce time spent manually screening for eligible patients by non-clinical navigators. Clinical trial information: NCT04809740.
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Affiliation(s)
| | | | | | - Bryanna E. Diaz
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | - Carrie C. McNair
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | | | | | | | | | | | | | | | | | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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10
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Hildreth K, Caston NE, Dent D, Ingram SA, Lalor F, Franks J, Azuero A, Young Pierce J, McGowen CL, Andrews CJ, Huang CH, Dionne-Odom JN, Weiner BJ, Jackson BE, Basch E, Stover AM, Howell D, Rocque GB. Sociodemographic difference in patients who enroll and decline remote symptom monitoring (RSM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
268 Background: Remote symptom monitoring (RSM) using patient-reported outcomes has been shown to reduce symptom burden and hospitalizations in clinical trials. However, little is known about how willing patients are to participate in remote symptom monitoring in real-world settings, particularly for vulnerable patient populations. This study aims to compare characteristics of cancer patients enrolled vs. patients who declined enrollment into RSM. Methods: This prospective study used data that assessed the characteristics of patients who enrolled vs. patients who declined enrollment into RSM. Inclusion criteria included participants’ age ≥18 with cancer who received chemotherapy, targeted therapy, or immunotherapy at the University of Alabama at Birmingham. Race and ethnicity (Black or African American, White, Asian, other and unknown), sex, cancer type (breast, gastrointestinal [GI], genitourinary [GU], gynecological [GYNX], head and neck, leukemia, lymphoma, melanoma, myeloma and other), urban/rural residence, Area Deprivation Index (ADI), and insurance type (Medicaid, Medicare, none, other and private) were abstracted from electronic medical records (EMR) and PRO platform (Carevive). Descriptive statistics were calculated using frequencies and percentages for categorical variables and medians and interquartile ranges for continuous variables. Differences in enrollment status characteristics were calculated using measures of effect size such as Cramer’s V. Results: Of the 307 patients, two thirds of patients were female (71%); 25% were Black or African American and 66% were White patients; 15% lived in an area of higher disadvantage. For insurance, 46%, 26%, 10%, 8%, and 9% of patients had Private, Medicare, Medicaid, other insurance, and no insurance, respectively. The proportion of patients who declined enrollment was higher for males than females (22% vs. 10%), Black or African American than White (18% vs 13%); and having Medicare than private insurance (22% vs. 10%). Compared to those who enrolled, patients who declined enrollment were more often to be male (V:0.2), Black or African American (V:0.1); and have Medicare insurance (V:0.2). Patients enrolled vs. declined in RSM had similar ADI scores (V:0.01). Conclusions: This study demonstrates that potentially vulnerable patients, including Black patients and those with public insurance, have lower RSM engagement. Future analysis is needed to understand participation barriers and how to better engage diverse populations to ensure optimal healthcare delivery to all patients.
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Affiliation(s)
| | | | | | | | - Fallon Lalor
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | | | | | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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11
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Franks J, Caston NE, Balas N, Lalor F, Eltoum N, Dent D, Hildreth K, Patterson M, Azuero A, Jackson BE, Dionne-Odom JN, Huang CH, Stover AM, Howell D, Weiner BJ, McGowen CL, Basch E, Young Pierce J, Ojesina AI, Rocque GB. Evaluating nurses' time to response by severity and cancer stage in a remote symptom monitoring program. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
341 Background: Remote symptom monitoring (RSM) using electronic patient reported outcomes (ePROs) allow for patients with cancer to communicate symptoms to their clinical team between clinic visits. Prior randomized control trials of RSM focused on advanced cancer, and less data are available for patient with early stage cancers. The University of Alabama at Birmingham (UAB) implemented RSM for early stage (I-III) and advanced stage (IV) patients on active treatment. This study evaluates nurses’ real-world response time to alerts by varying severity and by patients cancer stages. Methods: This study included women with stage I-IV breast cancer who received care at UAB from October 2020 through May 2022. The program was first implemented in the breast clinic allowing for larger patient numbers with early and advanced stage breast cancer. A composite score for symptom severity is automatically calculated in the Carevive® platform for moderate, severe, or worsening symptoms using patient responses for frequency, severity, and interference. The nurse receives an alert if a symptom is moderate or severe. Surveys with at least one severe alert were categorized as severe and response time was categorized as optimal if the survey was closed within 48 hours (goal time for phone message follow-up). Odds ratios (OR), predicted probabilities, and 95% confidence intervals (CI) were estimated using a patient nested logistic regression evaluating time to response comparing surveys with at least one severe alert notification to those with no severe, adjusting for age at enrollment, race, cancer stage, provider who closed the surveys, and quarter from study start and date. An interaction between severity and cancer stage was evaluated. Results: Of 137 patients included in this study, 64% were White; 86% were diagnosed with early-stage breast cancer. The median age at diagnosis was 54 (27-79). Of 802 surveys included, 38% reported at least one severe symptom and 70% had an optimal response time. Similar results were seen when stratified by early vs. advanced stage with 39% and 38% reporting at least one severe alert and 68% and 71% an optimal response time, respectively. In our adjusted analysis, when compared with surveys that had no severe alerts, surveys with at least one severe alert had similar odds of having an optimal response time (OR, 1.29; 95%CI, 0.88, 1.89). No significant interaction between severity and stage was observed on the odds of optimal response time. Conclusions: Response times to alerts were similar regardless of the severity of the alert and cancer stage, suggesting alert management is incorporated into routine workflows and not prioritized based on disease or alert severity. Additional research is needed to understand factors contributing to non-optimal response times.
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Affiliation(s)
| | | | | | - Fallon Lalor
- University of Alabama at Birmingham, Birmingham, AL
| | - Noon Eltoum
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | | | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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12
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Mody GN, Thompson JC, Williams BM, Shrestha S, Bryant MC, Bright A, Nevison J, Cox C, Perez M, Newsome B, Hill L, Deal AM, Jonsson M, Long JM, Haithcock BE, Stover AM, Bennett AV, Basch E. Postoperative symptom monitoring with ePROs in an academic public hospital. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
264 Background: Postoperative symptom burden is high in surgical oncology patients. Electronic patient-reported outcome (ePRO) remote monitoring systems are rapidly proliferating and have the promise of improving care. However, implementation in diverse practice settings is understudied. More information on ePRO participation may determine addressable barriers. Methods: Patients presenting to the Multidisciplinary Thoracic Oncology Program for surgery were prospectively enrolled. ePROs assessing common postop symptoms and functional impairments were administered via a web-based platform daily for 14 days and then weekly until 3 months post-discharge. Automated reminders were provided by email. Phone calls were made for 2 consecutive missed ePROs. ePRO participation levels were categorized as high (> 80%), medium (50-80%), low (1-49%), and none. Patient characteristics were examined by participation level via Fisher’s exact and Kruskal-Wallis tests. Results: From 2020-2022, 202 patients were recruited to participate, and 113 (56%) agreed. There were no differences in demographics of agreed vs. declined. 99 patients initiated ePROs after discharge. Mean age was 60.5 years (sd 13.4), 37.8% were male, 72.5% were White, and the majority (64%) had lung resection. Patients participated in ePROs for an average of 82 days (sd 24) before discontinuing. Overall, 57.7% (1383/2397) of delivered surveys were completed; response rates were lowest in week 1 (48%) and highest in week 7 (71%). Participation levels are described in Table. Married/partnered patients were significantly more likely to have high levels of participation (p = 0.003), and those who regularly used a computing device almost reached significance (p = 0.057). Age, gender, race, employment, email/internet use, financial status, and quality of life did not vary across ePRO participation levels. Conclusions: Monitoring symptoms with ePROs after discharge from thoracic surgery is feasible in a large academic public hospital. Participation levels in ePROs are lower immediately after discharge, when symptomatic complications drive the highest rates of readmissions. This suggests an opportunity to improve ePRO implementation during the post-acute period when intensive monitoring is desired and in patients who are not partnered or are less frequent device users. As length of stay and readmissions are increasingly targeted for expenditure reduction in academic inpatient settings, it is paramount to design and implement systems to effectively monitor at-risk patients. Clinical trial information: NCT04342260. [Table: see text]
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Affiliation(s)
- Gita N Mody
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Sachita Shrestha
- University of North Carolina, Office of Clinical Trials and Translational Research, Chapel Hill, NC
| | | | - Annie Bright
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Chase Cox
- UNC Department of Surgery, Chapel Hill, NC
| | - Miriam Perez
- Research Coordination and Management Unit, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Mattias Jonsson
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Antonia Vickery Bennett
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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13
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McGowen CL, Caston NE, McElhany SK, Diaz BE, McNair CC, Franks J, Andrews CJ, Huang CH, Dionne-Odom JN, Weiner BJ, Jackson BE, Basch E, Stover AM, Howell D, Rocque GB, Young Pierce J. Trajectory of symptoms reported in remote symptom monitoring over the course of oncology treatment for gynecologic cancers. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
270 Background: Patients now have the ability to utilize electronic patient reported outcomes (ePROs) for remote symptom monitoring (RSM). This analysis seeks to better understand trajectory of reported symptoms during treatment for patients with gynecologic cancer participating in RSM. Methods: We approached patients with gynecological cancer initiating treatment at the Mitchell Cancer Institute (MCI) between 7/1/21-4/30/2022. Patients were eligible if they were starting chemotherapy, targeted therapy, or immunotherapy for a new cancer. Patients seeking a second opinion were excluded. Enrolled patients received symptom survey (PRO-CTCAE questions) via text or email once per week. Initially, only severe alerts were forwarded to the clinical care team; moderate alerts were forwarded to clinical teams once they were comfortable with alert management. Patients completed symptom assessments for 24 weeks or until withdrawal. Patient age at enrollment, race, sex, cancer type, cancer stage, and PROs were abstracted from electronic health records and the PRO platform (Carevive). Descriptive statistics were calculated using frequencies and percentages for categorical variables and median and interquartile ranges (IQR) for continuous variables. Results: A total of 60 female patients with gynecological cancer were enrolled; 33% were Black or African American and 67% were White; median age was 61 years (IQR 53-68). Seventy-eight percent (47/60) of patients reported 379 symptoms with at least one moderate or severe alert during this time period; 32% considered moderate and 68% considered severe. Overall, the most frequently reported symptom was pain (29%). At baseline (week 0), 14% and 41% of 56 patients reported moderate symptoms and severe symptoms, respectively. Symptom burden decreased over time with 4% and 7% of 27 patients who completed a survey at 12 weeks reporting moderate and severe symptoms. Specific symptom trajectories followed similar patterns. Conclusions: In our sample, patients reported the majority of symptoms during the first three months of treatment. Symptom trajectory decreased with time, suggesting symptoms are being effectively monitored and addressed by the clinical teams engaging in RSM. Future research is needed to understand if symptom improvement translates to increased quality of life, decreased hospitalizations, and increased survival for patients, as well as lessen the burden of call volume on the clinical team.
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Affiliation(s)
| | | | | | - Bryanna E. Diaz
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | - Carrie C. McNair
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | | | | | | | | | | | | | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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14
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Dent D, Ingram SA, Caston NE, Thigpen H, Lalor F, Jamy O, Giri S, Azuero A, Young Pierce J, McGowen CL, Daniel CL, Andrews CJ, Huang CH, Dionne-Odom JN, Weiner BJ, Howell D, Jackson BE, Stover AM, Rocque GB. Adaptation of remote symptom monitoring using electronic patient-reported outcomes for implementation in real-world settings. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
272 Background: Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. Methods: This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman’s Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (Phase I) and workflow (Phase II and III) using electronic health data; qualitative evaluation with semi-structured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. Results: Core components of remote symptom monitoring included electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real-time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed > 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. Conclusions: Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.
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Affiliation(s)
| | | | | | | | - Fallon Lalor
- University of Alabama at Birmingham, Birmingham, AL
| | - Omer Jamy
- University of Alabama at Birmingham, Division of Hematology/Oncology, Department of Medicine, Birmingham, AL
| | - Smith Giri
- University of Alabama at Birmingham, Alabama, AL
| | | | | | | | - Casey L. Daniel
- University of South Alabama Mitchell Cancer Institute, Mobile, AL
| | | | | | | | | | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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15
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Patterson M, Caston NE, Franks J, Dent D, Ingram SA, Hildreth K, Lalor F, Azuero A, Young Pierce J, McGowen CL, Andrews CJ, Huang CH, Dionne-Odom JN, Jackson BE, Weiner BJ, Basch E, Stover AM, Howell D, Rocque GB. Nursing strategies to improve alert closure for remote symptom monitoring. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
421 Background: For successful remote symptom monitoring using patient-reported outcomes, nurses should respond to alerts in a timely fashion. Where clinical trials utilized research staff for alert management, the shift to standard-of-care delivery necessitates that this responsibility be added as a task to an already strained nursing workforce. Little is known about strategies to engage nurses to improve timeliness of alert management. Methods: In this quality improvement initiative, we aimed to improve timeliness of alert closures generated by moderate or severe symptoms within a remote symptom monitoring program. Optimal closure was defined as < 48 hours, which was consistent with institutional requirements for response to patient phone calls. A continuous quality improvement approach, with multiple Plan Do Study Act (PDSA) cycles was conducted. Data was captured from the electronic medical record and PRO platform (Carevive). Descriptive statistics included frequencies and percentages. The proportion of alerts closed each month < 48 hours, 48-72 hours, 3-7 days, and > 7 days were reported overall and by disease team (i.e., major cancer types). Surveys not closed were considered > 7 days. The timing of strategies to improve nursing engagement were documented and evaluated for impact on alert closure. Results: From June 1, 2021-May 31, 2022, 1121 moderate or severe alerts were generated from 234 patients. Disease teams had variable remote symptom monitoring start dates: breast, leukemia, and limited gynecologic (prior to 6/2021); myeloma and gastrointestinal (7/2021); genitourinary (10/2021); head and neck (12/2021); melanoma (2/2022); and Lymphoma (4/2022). In 6/2021, the overall alert closure at < 48 hours, 48-72 hours, 3-7 days, and > 7 days was 57%, 4%, 14%, and 25% respectively (n = 28). To improve alert closures, several key strategies were deployed to improve alert closure times including disease-specific reporting and meetings with nursing leadership (10/2021); identification of a nurse champion, creation of “cheat sheets” to remind nurses how to close alerts, and individualized calls with nurses with open alerts (1/2022), and inclusions of requirement to close alerts in nursing newsletters (2/2022). Overall, alert closure less than 48 hours improved to 61% by 12/2021 (n = 97) and to 69% by 5/2022 (n = 167). Disease group alert closure varied, with higher closure more commonly in teams with greater duration of use, such as breast cancer team with an alert closure of 85% < 48 hours in May 2022. Conclusions: Key nursing engagement strategies improve alert closure for remote symptom monitoring programs implemented in real-world settings.
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Affiliation(s)
| | | | | | | | | | | | - Fallon Lalor
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | | | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Doris Howell
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Di Maio M, Basch E, Denis F, Fallowfield LJ, Ganz PA, Howell D, Kowalski C, Perrone F, Stover AM, Sundaresan P, Warrington L, Zhang L, Apostolidis K, Freeman-Daily J, Ripamonti CI, Santini D. The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline. Ann Oncol 2022; 33:878-892. [PMID: 35462007 DOI: 10.1016/j.annonc.2022.04.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/05/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- M Di Maio
- Department of Oncology, University of Turin, at A.O. Ordine Mauriziano Hospital, Turin, Italy
| | - E Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - F Denis
- Institut Inter-régional de Cancérologie Jean Bernard (ELSAN), Le Mans, France; Faculté de Santé, Université de Paris, Paris, France
| | - L J Fallowfield
- Sussex Health Outcomes Research & Education in Cancer, Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - P A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles (UCLA), USA
| | - D Howell
- Department of Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - C Kowalski
- Department of Certification - Health Services Research, German Cancer Society, Berlin, Germany
| | - F Perrone
- Clinical Trial Unit, National Cancer Institute IRCCS G. Pascale Foundation, Naples, Italy
| | - A M Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - P Sundaresan
- Sydney West Radiation Oncology Network, Westmead Hospital, Westmead, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - L Warrington
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - L Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - K Apostolidis
- European Cancer Patient Coalition, Brussels, Belgium
| | | | - C I Ripamonti
- Oncology - Supportive Care in Cancer Unit, Department Oncology-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Milan, Italy
| | - D Santini
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
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Stover AM, Wang M, Shea CM, Richman E, Rees J, Cherrington AL, Cummings DM, Nicholson L, Peaden S, Craft M, Mackey M, Safford MM, Halladay JR. The Key Driver Implementation Scale (KDIS) for practice facilitators: Psychometric testing in the “Southeastern collaboration to improve blood pressure control” trial. PLoS One 2022; 17:e0272816. [PMID: 36001592 PMCID: PMC9401114 DOI: 10.1371/journal.pone.0272816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/17/2022] [Indexed: 11/19/2022] Open
Abstract
Background Practice facilitators (PFs) provide tailored support to primary care practices to improve the quality of care delivery. Often used by PFs, the “Key Driver Implementation Scale” (KDIS) measures the degree to which a practice implements quality improvement activities from the Chronic Care Model, but the scale’s psychometric properties have not been investigated. We examined construct validity, reliability, floor and ceiling effects, and a longitudinal trend test of the KDIS items in the Southeastern Collaboration to Improve Blood Pressure Control trial. Methods The KDIS items assess a practice’s progress toward implementing: a clinical information system (using their own data to drive change); standardized care processes; optimized team care; patient self-management support; and leadership support. We assessed construct validity and estimated reliability with a multilevel confirmatory factor analysis (CFA). A trend test examined whether the KDIS items increased over time and estimated the expected number of months needed to move a practice to the highest response options. Results PFs completed monthly KDIS ratings over 12 months for 32 primary care practices, yielding a total of 384 observations. Data was fitted to a unidimensional CFA model; however, parameter fit was modest and could be improved. Reliability was 0.70. Practices started scoring at the highest levels beginning in month 5, indicating low variability. The KDIS items did show an upward trend over 12 months (all p < .001), indicating that practices were increasingly implementing key activities. The expected time to move a practice to the highest response category was 9.1 months for standardized care processes, 10.2 for clinical information system, 12.6 for self-management support, 13.1 for leadership, and 14.3 months for optimized team care. Conclusions The KDIS items showed acceptable reliability, but work is needed in larger sample sizes to determine if two or more groups of implementation activities are being measured rather than one.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States of America
- * E-mail:
| | - Mian Wang
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States of America
| | - Christopher M. Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Erica Richman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jennifer Rees
- NC Tracs Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Andrea L. Cherrington
- University of Alabama Birmingham, School of Medicine, Birmingham, AL, United States of America
| | | | - Liza Nicholson
- Department of Public Health, Samford University, Birmingham, AL, United States of America
| | - Shannon Peaden
- East Carolina University, Greenville, NC, United States of America
| | - Macie Craft
- University of Alabama Birmingham, School of Medicine, Birmingham, AL, United States of America
| | - Monique Mackey
- Area L Area Health Education Center (AHEC)—Part of the NC AHEC Program, Rocky Mount, NC, United States of America
| | | | - Jacqueline R. Halladay
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Basch E, Schrag D, Henson S, Jansen J, Ginos B, Stover AM, Carr P, Spears PA, Jonsson M, Deal AM, Bennett AV, Thanarajasingam G, Rogak LJ, Reeve BB, Snyder C, Bruner D, Cella D, Kottschade LA, Perlmutter J, Geoghegan C, Samuel-Ryals CA, Given B, Mazza GL, Miller R, Strasser JF, Zylla DM, Weiss A, Blinder VS, Dueck AC. Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer: A Randomized Clinical Trial. JAMA 2022; 327:2413-2422. [PMID: 35661856 DOI: 10.1001/jama.2022.9265.pmid:35661856;pmcid:pmc9168923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
IMPORTANCE Electronic systems that facilitate patient-reported outcome (PRO) surveys for patients with cancer may detect symptoms early and prompt clinicians to intervene. OBJECTIVE To evaluate whether electronic symptom monitoring during cancer treatment confers benefits on quality-of-life outcomes. DESIGN, SETTING, AND PARTICIPANTS Report of secondary outcomes from the PRO-TECT (Alliance AFT-39) cluster randomized trial in 52 US community oncology practices randomized to electronic symptom monitoring with PRO surveys or usual care. Between October 2017 and March 2020, 1191 adults being treated for metastatic cancer were enrolled, with last follow-up on May 17, 2021. INTERVENTIONS In the PRO group, participants (n = 593) were asked to complete weekly surveys via an internet-based or automated telephone system for up to 1 year. Severe or worsening symptoms triggered care team alerts. The control group (n = 598) received usual care. MAIN OUTCOMES AND MEASURES The 3 prespecified secondary outcomes were physical function, symptom control, and health-related quality of life (HRQOL) at 3 months, measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30; range, 0-100 points; minimum clinically important difference [MCID], 2-7 for physical function; no MCID defined for symptom control or HRQOL). Results on the primary outcome, overall survival, are not yet available. RESULTS Among 52 practices, 1191 patients were included (mean age, 62.2 years; 694 [58.3%] women); 1066 (89.5%) completed 3-month follow-up. Compared with usual care, mean changes on the QLQ-C30 from baseline to 3 months were significantly improved in the PRO group for physical function (PRO, from 74.27 to 75.81 points; control, from 73.54 to 72.61 points; mean difference, 2.47 [95% CI, 0.41-4.53]; P = .02), symptom control (PRO, from 77.67 to 80.03 points; control, from 76.75 to 76.55 points; mean difference, 2.56 [95% CI, 0.95-4.17]; P = .002), and HRQOL (PRO, from 78.11 to 80.03 points; control, from 77.00 to 76.50 points; mean difference, 2.43 [95% CI, 0.90-3.96]; P = .002). Patients in the PRO group had significantly greater odds of experiencing clinically meaningful benefits vs usual care for physical function (7.7% more with improvements of ≥5 points and 6.1% fewer with worsening of ≥5 points; odds ratio [OR], 1.35 [95% CI, 1.08-1.70]; P = .009), symptom control (8.6% and 7.5%, respectively; OR, 1.50 [95% CI, 1.15-1.95]; P = .003), and HRQOL (8.5% and 4.9%, respectively; OR, 1.41 [95% CI, 1.10-1.81]; P = .006). CONCLUSIONS AND RELEVANCE In this report of secondary outcomes from a randomized clinical trial of adults receiving cancer treatment, use of weekly electronic PRO surveys to monitor symptoms, compared with usual care, resulted in statistically significant improvements in physical function, symptom control, and HRQOL at 3 months, with mean improvements of approximately 2.5 points on a 0- to 100-point scale. These findings should be interpreted provisionally pending results of the primary outcome of overall survival. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03249090.
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Affiliation(s)
- Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Deborah Schrag
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sydney Henson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | | | - Angela M Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Patricia A Spears
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Mattias Jonsson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Antonia V Bennett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | | | - Lauren J Rogak
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bryce B Reeve
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Claire Snyder
- Johns Hopkins Schools of Medicine and Public Health, Baltimore, Maryland
| | | | - David Cella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | - Cleo A Samuel-Ryals
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Barbara Given
- College of Nursing, Michigan State University, East Lansing
| | | | - Robert Miller
- American Society of Clinical Oncology, Alexandria, Virginia
| | | | - Dylan M Zylla
- The Cancer Research Center, HealthPartners/Park Nicollet, Minneapolis, Minnesota
| | - Anna Weiss
- Brigham and Women's Hospital, Boston, Massachusetts
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Basch E, Schrag D, Henson S, Jansen J, Ginos B, Stover AM, Carr P, Spears PA, Jonsson M, Deal AM, Bennett AV, Thanarajasingam G, Rogak LJ, Reeve BB, Snyder C, Bruner D, Cella D, Kottschade LA, Perlmutter J, Geoghegan C, Samuel-Ryals CA, Given B, Mazza GL, Miller R, Strasser JF, Zylla DM, Weiss A, Blinder VS, Dueck AC. Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer: A Randomized Clinical Trial. JAMA 2022; 327:2413-2422. [PMID: 35661856 PMCID: PMC9168923 DOI: 10.1001/jama.2022.9265] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Electronic systems that facilitate patient-reported outcome (PRO) surveys for patients with cancer may detect symptoms early and prompt clinicians to intervene. OBJECTIVE To evaluate whether electronic symptom monitoring during cancer treatment confers benefits on quality-of-life outcomes. DESIGN, SETTING, AND PARTICIPANTS Report of secondary outcomes from the PRO-TECT (Alliance AFT-39) cluster randomized trial in 52 US community oncology practices randomized to electronic symptom monitoring with PRO surveys or usual care. Between October 2017 and March 2020, 1191 adults being treated for metastatic cancer were enrolled, with last follow-up on May 17, 2021. INTERVENTIONS In the PRO group, participants (n = 593) were asked to complete weekly surveys via an internet-based or automated telephone system for up to 1 year. Severe or worsening symptoms triggered care team alerts. The control group (n = 598) received usual care. MAIN OUTCOMES AND MEASURES The 3 prespecified secondary outcomes were physical function, symptom control, and health-related quality of life (HRQOL) at 3 months, measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30; range, 0-100 points; minimum clinically important difference [MCID], 2-7 for physical function; no MCID defined for symptom control or HRQOL). Results on the primary outcome, overall survival, are not yet available. RESULTS Among 52 practices, 1191 patients were included (mean age, 62.2 years; 694 [58.3%] women); 1066 (89.5%) completed 3-month follow-up. Compared with usual care, mean changes on the QLQ-C30 from baseline to 3 months were significantly improved in the PRO group for physical function (PRO, from 74.27 to 75.81 points; control, from 73.54 to 72.61 points; mean difference, 2.47 [95% CI, 0.41-4.53]; P = .02), symptom control (PRO, from 77.67 to 80.03 points; control, from 76.75 to 76.55 points; mean difference, 2.56 [95% CI, 0.95-4.17]; P = .002), and HRQOL (PRO, from 78.11 to 80.03 points; control, from 77.00 to 76.50 points; mean difference, 2.43 [95% CI, 0.90-3.96]; P = .002). Patients in the PRO group had significantly greater odds of experiencing clinically meaningful benefits vs usual care for physical function (7.7% more with improvements of ≥5 points and 6.1% fewer with worsening of ≥5 points; odds ratio [OR], 1.35 [95% CI, 1.08-1.70]; P = .009), symptom control (8.6% and 7.5%, respectively; OR, 1.50 [95% CI, 1.15-1.95]; P = .003), and HRQOL (8.5% and 4.9%, respectively; OR, 1.41 [95% CI, 1.10-1.81]; P = .006). CONCLUSIONS AND RELEVANCE In this report of secondary outcomes from a randomized clinical trial of adults receiving cancer treatment, use of weekly electronic PRO surveys to monitor symptoms, compared with usual care, resulted in statistically significant improvements in physical function, symptom control, and HRQOL at 3 months, with mean improvements of approximately 2.5 points on a 0- to 100-point scale. These findings should be interpreted provisionally pending results of the primary outcome of overall survival. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03249090.
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Affiliation(s)
- Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Deborah Schrag
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sydney Henson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | | | - Angela M. Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Patricia A. Spears
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Mattias Jonsson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Antonia V. Bennett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | | | | | - Bryce B. Reeve
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Claire Snyder
- Johns Hopkins Schools of Medicine and Public Health, Baltimore, Maryland
| | | | - David Cella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | - Cleo A. Samuel-Ryals
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Barbara Given
- College of Nursing, Michigan State University, East Lansing
| | | | - Robert Miller
- American Society of Clinical Oncology, Alexandria, Virginia
| | | | - Dylan M. Zylla
- The Cancer Research Center, HealthPartners/Park Nicollet, Minneapolis, Minnesota
| | - Anna Weiss
- Brigham and Women’s Hospital, Boston, Massachusetts
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Cruz Rivera S, Aiyegbusi OL, Ives J, Draper H, Mercieca-Bebber R, Ells C, Hunn A, Scott JA, Fernandez CV, Dickens AP, Anderson N, Bhatnagar V, Bottomley A, Campbell L, Collett C, Collis P, Craig K, Davies H, Golub R, Gosden L, Gnanasakthy A, Haf Davies E, von Hildebrand M, Lord JM, Mahendraratnam N, Miyaji T, Morel T, Monteiro J, Zwisler ADO, Peipert JD, Roydhouse J, Stover AM, Wilson R, Yap C, Calvert MJ. Ethical Considerations for the Inclusion of Patient-Reported Outcomes in Clinical Research: The PRO Ethics Guidelines. JAMA 2022; 327:1910-1919. [PMID: 35579638 DOI: 10.1001/jama.2022.6421] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Patient-reported outcomes (PROs) can inform health care decisions, regulatory decisions, and health care policy. They also can be used for audit/benchmarking and monitoring symptoms to provide timely care tailored to individual needs. However, several ethical issues have been raised in relation to PRO use. OBJECTIVE To develop international, consensus-based, PRO-specific ethical guidelines for clinical research. EVIDENCE REVIEW The PRO ethics guidelines were developed following the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network's guideline development framework. This included a systematic review of the ethical implications of PROs in clinical research. The databases MEDLINE (Ovid), Embase, AMED, and CINAHL were searched from inception until March 2020. The keywords patient reported outcome* and ethic* were used to search the databases. Two reviewers independently conducted title and abstract screening before full-text screening to determine eligibility. The review was supplemented by the SPIRIT-PRO Extension recommendations for trial protocol. Subsequently, a 2-round international Delphi process (n = 96 participants; May and August 2021) and a consensus meeting (n = 25 international participants; October 2021) were held. Prior to voting, consensus meeting participants were provided with a summary of the Delphi process results and information on whether the items aligned with existing ethical guidance. FINDINGS Twenty-three items were considered in the first round of the Delphi process: 6 relevant candidate items from the systematic review and 17 additional items drawn from the SPIRIT-PRO Extension. Ninety-six international participants voted on the relevant importance of each item for inclusion in ethical guidelines and 12 additional items were recommended for inclusion in round 2 of the Delphi (35 items in total). Fourteen items were recommended for inclusion at the consensus meeting (n = 25 participants). The final wording of the PRO ethical guidelines was agreed on by consensus meeting participants with input from 6 additional individuals. Included items focused on PRO-specific ethical issues relating to research rationale, objectives, eligibility requirements, PRO concepts and domains, PRO assessment schedules, sample size, PRO data monitoring, barriers to PRO completion, participant acceptability and burden, administration of PRO questionnaires for participants who are unable to self-report PRO data, input on PRO strategy by patient partners or members of the public, avoiding missing data, and dissemination plans. CONCLUSIONS AND RELEVANCE The PRO ethics guidelines provide recommendations for ethical issues that should be addressed in PRO clinical research. Addressing ethical issues of PRO clinical research has the potential to ensure high-quality PRO data while minimizing participant risk, burden, and harm and protecting participant and researcher welfare.
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Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- DEMAND Hub, University of Birmingham, Birmingham, United Kingdom
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Centre West Midlands, Birmingham, United Kingdom
| | - Jonathan Ives
- Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Heather Draper
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Rebecca Mercieca-Bebber
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Carolyn Ells
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | | | - Jane A Scott
- PRO Center of Excellence, Global Commercial Strategy Organization, Janssen Global Services, Warrington, United Kingdom
| | - Conrad V Fernandez
- Division of Pediatric Haematology-Oncology, IWK Health Care Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew P Dickens
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Observational and Pragmatic Research Institute, Midview City, Singapore
| | - Nicola Anderson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Andrew Bottomley
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | | | - Philip Collis
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Patient partner, University of Birmingham, Birmingham, United Kingdom
| | - Kathrine Craig
- Fast Track Research Ethics Committee, Health Research Authority, London, United Kingdom
| | - Hugh Davies
- Fast Track Research Ethics Committee, Health Research Authority, London, United Kingdom
| | | | - Lesley Gosden
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Patient partner, University of Birmingham, Birmingham, United Kingdom
| | | | | | - Maria von Hildebrand
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Patient partner, University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
| | | | - Tempei Miyaji
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Thomas Morel
- Global Patient-Centred Outcomes Research & Policy, UCB, Belgium, Brussels
| | | | - Ann-Dorthe Olsen Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | | | - Roger Wilson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Consumer Forum, National Cancer Research Institute, London, United Kingdom
- Patient Involvement Network, Health Research Authority, London, United Kingdom
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- DEMAND Hub, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Applied Research Centre West Midlands, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
- Health Data Research United Kingdom, London, United Kingdom
- UK SPINE, University of Birmingham, Birmingham, United Kingdom
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Rocque GB, Dionne-Odom JN, Stover AM, Daniel CL, Azuero A, Huang CHS, Ingram SA, Franks JA, Caston NE, Dent DAN, Basch EM, Jackson BE, Howell D, Weiner BJ, Pierce JY. Evaluating the implementation and impact of navigator-supported remote symptom monitoring and management: a protocol for a hybrid type 2 clinical trial. BMC Health Serv Res 2022; 22:538. [PMID: 35459238 PMCID: PMC9027833 DOI: 10.1186/s12913-022-07914-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background Symptoms in patients with advanced cancer are often inadequately captured during encounters with the healthcare team. Emerging evidence demonstrates that weekly electronic home-based patient-reported symptom monitoring with automated alerts to clinicians reduces healthcare utilization, improves health-related quality of life, and lengthens survival. However, oncology practices have lagged in adopting remote symptom monitoring into routine practice, where specific patient populations may have unique barriers. One approach to overcoming barriers is utilizing resources from value-based payment models, such as patient navigators who are ideally positioned to assume a leadership role in remote symptom monitoring implementation. This implementation approach has not been tested in standard of care, and thus optimal implementation strategies are needed for large-scale roll-out. Methods This hybrid type 2 study design evaluates the implementation and effectiveness of remote symptom monitoring for all patients and for diverse populations in two Southern academic medical centers from 2021 to 2026. This study will utilize a pragmatic approach, evaluating real-world data collected during routine care for quantitative implementation and patient outcomes. The Consolidated Framework for Implementation Research (CFIR) will be used to conduct a qualitative evaluation at key time points to assess barriers and facilitators, implementation strategies, fidelity to implementation strategies, and perceived utility of these strategies. We will use a mixed-methods approach for data interpretation to finalize a formal implementation blueprint. Discussion This pragmatic evaluation of real-world implementation of remote symptom monitoring will generate a blueprint for future efforts to scale interventions across health systems with diverse patient populations within value-based healthcare models. Trial registration NCT04809740; date of registration 3/22/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07914-6.
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Affiliation(s)
- Gabrielle B Rocque
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA. .,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA. .,O'Neal Comprehensive Cancer Center, Birmingham, AL, USA.
| | - J Nicholas Dionne-Odom
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Angela M Stover
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Casey L Daniel
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Chao-Hui Sylvia Huang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stacey A Ingram
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Jeffrey A Franks
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Nicole E Caston
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - D' Ambra N Dent
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Bradford E Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Bryan J Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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22
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Basch E, Schrag D, Jansen J, Henson S, Stover AM, Spears P, Jonsson M, Deal AM, Bennett AV, Thanarajasingam G, Reeve B, Snyder CF, Bruner D, Cella D, Kottschade LA, Perlmutter J, Miller RS, Strasser JF, Zylla DM, Dueck AC. Digital symptom monitoring with patient-reported outcomes in community oncology practices: A U.S. national cluster randomized trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.36_suppl.349527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
349527 Background: Symptoms are common during cancer care but often go undetected. Digital systems that elicit patient-reported outcomes (PRO) surveys may detect symptoms early and prompt clinicians to intervene, thereby alleviating suffering and averting complications. Methods: In a cluster-randomized trial, U.S.-based community oncology practices were randomized 1:1 to digital symptom monitoring with PRO surveys, or to usual care control. Patients receiving systemic treatment for metastatic cancer were eligible. At PRO practices, participants were invited to complete a weekly survey via web or automated telephone system for up to one year, including questions about nine common symptoms, performance status, and falls. Severe or worsening symptoms triggered electronic alerts to care team nurses, and reports showing longitudinal symptom data were available to oncologists at visits. Pre-specified secondary outcomes included impact on physical function, symptom control, and health-related quality of life (HRQL). The primary outcome of survival is not yet mature. Results: At 52 practices, 1,191 patients were eligible and enrolled (593 PRO; 598 control). Clinically meaningful benefits were experienced in physical function by 13.8% more patients with PRO versus control (P=0.009); symptom control by 16.1% (P=0.003); and HRQL by 13.4% (P=0.006). Mean changes from baseline were superior with PRO versus control for physical function (mean difference 2.47, 95% CI 0.41-4.53; P=0.02), symptom control (2.56, 0.95-4.17; P=0.002), and HRQL (2.43, 0.90-3.96; P=0.002). Patients completed 20,565/22,486 (91.5%) of expected weekly PRO surveys. Conclusions: Digital symptom monitoring during cancer treatment confers clinical benefits. Clinical trial information: NCT03249090.
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Affiliation(s)
- Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sydney Henson
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Mattias Jonsson
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Allison Mary Deal
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Antonia Vickery Bennett
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Bryce Reeve
- Duke University School of Medicine, Durham, NC
| | | | - Deborah Bruner
- Winship Cancer Institute at Emory University, Atlanta, GA
| | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | | | - Robert S. Miller
- American Society of Clinical Oncology’s CancerLinQ, Alexandria, VA
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23
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Patt DA, Patel A, Wilfong LS, Books H, Ortega L, Franklin M, Croft S, Stover AM, Boren R, Basch EM. Patient and clinician perceptions of a digital patient monitoring program in the community oncology setting: Findings from the Texas Two-Step Study. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
189 Background: Digital monitoring strategies that include electronic patient reported outcomes (ePRO) measures to monitor symptoms among cancer patients have been shown to be effective in improving patient outcomes in a large academic setting and across several smaller multi-center trials. However, demonstration of clinical utility in the real-world setting must incorporate patient and provider perspectives of ePRO programs to ensure successful implementation. We sought to understand perceptions among patients and clinicians in ePRO digital symptom monitoring program. Methods: Texas Two-Step is an ongoing hybrid implementation-effectiveness study of Navigating Cancer’s ePRO digital monitoring program at Texas Oncology. Patients initiating new systemic therapy for their cancer diagnosis were introduced to the program by their oncologist and enrolled in the program by nursing staff for weekly reporting of symptoms based on a modified version of NCI’s PRO-CTCAE instrument. Feedback surveys were administered to both patients and clinic staff after 6 months of implementation of the program to evaluate the overall experience with the program. Results: 1040 (23.5%) patients and 215 (12.4%) clinicians completed the feedback survey. Of the patient responders, 90% found the program very or somewhat easy for reporting symptoms, 85% moderately-extremely beneficial for having symptoms addressed, and 84% moderately-extremely interested in utilizing the program for future treatments. Of the clinician responders, 73% indicated that that they had a good understanding of the benefit of the program; 70.6% felt confident in their ability to interpret patients’ ePRO responses; 80.3% felt confident in their ability to discuss the program with patients; 71.2% confident in their ability to counsel patients based on ePRO responses; and 55.3% felt the program enhanced communication with patients. Additionally, 59% of clinicians felt the program was beneficial for patients. Conclusions: Patients have a more favorable perception of the benefit of the ePRO program than clinicians. Methods to reduce staff burden and reinforcement of program benefits during training and implementation are imperative to improve clinical utility and will be studied further as the program is optimized. As implementation occurred during the COVID-19 pandemic, this may impact perceptions regarding the tool.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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24
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Stover AM, Basak R, Mueller D, Smith AB. Health-related quality of life outcomes in adults with nonmuscle-invasive bladder cancer receiving a mitomycin-containing reverse thermal gel as a primary treatment (Optima II: Phase 2b, single-arm, open-label trial). J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
270 Background: The standard of care for low-grade non‐muscle‐invasive bladder cancer (LG NMIBC) is transurethral resection of the bladder tumor, which can worsen health‐related quality of life (HRQOL). The “OPTimized Instillation of Mitomycin for Bladder Cancer Treatment” (Optima II, clinicaltrials.gov: NCT03558503) is a Phase 2b, open label, single arm, multicenter trial evaluating a nonsurgical alternative as a primary treatment. Patients receive six weekly instillations of UGN-102, a mitomycin-containing reverse thermal gel with a sustained release time of up to 8 hours. We report on HRQOL changes between baseline and the primary endpoint of 3 months. Methods: A total of 63 patients enrolled in the Optima II trial at 20 sites in the U.S. and 2 sites in Israel between October 2018 and October 2020. Of the 63 patients enrolled, 44 were in the HRQOL cohort and completed a quarterly questionnaire. The QLQ-NMIBC24 has six subscales (urinary symptoms, malaise, future health worries, bloating and flatulence, sexual functioning, and male sexual problems) and five single items (intravesical treatment issues, sexual intimacy, worry about contaminating partner, sexual enjoyment, and female sexual problems) assessed with 24 items. Items were rescaled to 0-100 and reverse-coded so that higher scores indicate worse symptom burden. Longitudinal score changes were evaluated using the Sign test. We examined demographic and clinical characteristics associated with HRQOL change scores with regression modeling. A p-value of ≤0.01 was used. Results: The HRQOL cohort was 61% men, 57% age 65+, and 89% non-Hispanic White. Clinically, most LG NMIBC patients had multiple tumors (88%) with prior NMIBC episodes (77%), and two or more prior transurethral resection of bladder procedures (TURBT) (85%). Approximately half (55%) had their most recent TURBT surgery within 12 months of trial enrollment. No patients had missing HRQOL data at baseline or the primary end point of 3 months. The chemoablative reverse thermal gel used as a primary treatment did not cause decrements in patient-reported urinary symptoms, bloating/ flatulence, malaise, fever, general health, or future health worries. Sexual function mildly worsened between baseline and 3 months, and abated by 6 months. Demographic and clinical characteristics were not correlated with HRQOL change scores. By 3 months, 31/44 (70%) LG NMIBC patients achieved a complete response (negative endoscopic examination, cytology, and for-cause biopsy) and 0 experienced a recurrence. By 12 months, 8/44 (18%) patients had a recurrence. Conclusions: Adults with LG NMIBC in a Phase 2b trial who received a mitomycin-containing reverse thermal gel with sustained release maintained their HRQOL through 3 months. A Phase 3 trial is warranted. Clinical trial information: NCT03558503.
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Affiliation(s)
| | - Ramsankar Basak
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dana Mueller
- Department of Urology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela B. Smith
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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25
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Ellis GK, Chapman H, Manda A, Salima A, Itimu S, Banda G, Seguin R, Manda G, Butia M, Huibers M, Ozuah N, Tilly A, Stover AM, Basch E, Gopal S, Reeve BB, Westmoreland KD. Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains. Pediatr Blood Cancer 2021; 68:e29257. [PMID: 34339099 PMCID: PMC8497011 DOI: 10.1002/pbc.29257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patient-reportedoutcomes (PROs) that assess health-related quality of life (HRQoL) are increasingly important components of cancer care and research that are infrequently used in sub-Saharan Africa (SSA). METHODS We administered the Chichewa Pediatric Patient-Reported Outcome Measurement Information System Pediatric (PROMIS)-25 at diagnosis, active treatment, and follow-up among pediatric lymphoma patients in Lilongwe, Malawi. Mean scores were calculated for the six PROMIS-25 HRQoL domains (Mobility, Anxiety, Depressive Symptoms, Fatigue, Peer Relationships, Pain Interference). Differences in HRQoL throughout treatment were compared using the minimally important difference (MID) and an ANOVA analysis. Kaplan-Meier survival estimates and Cox hazard ratios for mortality are reported. RESULTS Seventy-five children completed PROMIS-25 surveys at diagnosis, 35 (47%) during active treatment, and 24 (32%) at follow-up. The majority of patients died (n = 37, 49%) or were lost to follow-up (n = 6, 8%). Most (n = 51, 68%) were male, median age was 10 (interquartile range [IQR] 8-12), 48/73 (66%) presented with advanced stage III/IV, 61 (81%) were diagnosed with Burkitt lymphoma and 14 (19%) Hodgkin lymphoma. At diagnosis, HRQoL was poor across all domains, except for Peer Relationships. Improvements in HRQoL during active treatment and follow-up exceeded the MID. On exploratory analysis, fair-poor PROMIS Mobility <40 and severe Pain Intensity = 10 at diagnosis were associated with increased mortality risk and worse survival, but were not statistically significant. CONCLUSIONS Pediatric lymphoma patients in Malawi present with poor HRQoL that improves throughout treatment and survivorship. Baseline PROMIS scores may provide important prognostic information. PROs offer an opportunity to include patient voices and prioritize holistic patient-centered care in low-resource settings.
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Affiliation(s)
| | | | | | | | - Salama Itimu
- UNC Project-Malawi,Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program
| | | | | | - Geoffrey Manda
- Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program
| | - Mercy Butia
- Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program
| | - Minke Huibers
- Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program,Baylor College of Medicine
| | - Nmazuo Ozuah
- Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program,Baylor College of Medicine
| | | | | | | | - Satish Gopal
- UNC Project-Malawi,University of North Carolina at Chapel Hill
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26
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Basch E, Stover AM, Schrag D, Chung A, Jansen J, Henson S, Carr P, Ginos B, Deal A, Spears PA, Jonsson M, Bennett AV, Mody G, Thanarajasingam G, Rogak LJ, Reeve BB, Snyder C, Kottschade LA, Charlot M, Weiss A, Bruner D, Dueck AC. Clinical Utility and User Perceptions of a Digital System for Electronic Patient-Reported Symptom Monitoring During Routine Cancer Care: Findings From the PRO-TECT Trial. JCO Clin Cancer Inform 2021; 4:947-957. [PMID: 33112661 DOI: 10.1200/cci.20.00081] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is increasing interest in implementing digital systems for remote monitoring of patients' symptoms during routine oncology practice. Information is limited about the clinical utility and user perceptions of these systems. METHODS PRO-TECT is a multicenter trial evaluating implementation of electronic patient-reported outcomes (ePROs) among adults with advanced and metastatic cancers receiving treatment at US community oncology practices (ClinicalTrials.gov identifier: NCT03249090). Questions derived from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) are administered weekly by web or automated telephone system, with alerts to nurses for severe or worsening symptoms. To elicit user feedback, surveys were administered to participating patients and clinicians. RESULTS Among 496 patients across 26 practices, the majority found the system and questions easy to understand (95%), easy to use (93%), and relevant to their care (91%). Most patients reported that PRO information was used by their clinicians for care (70%), improved discussions with clinicians (73%), made them feel more in control of their own care (77%), and would recommend the system to other patients (89%). Scores for most patient feedback questions were significantly positively correlated with weekly PRO completion rates in both univariate and multivariable analyses. Among 57 nurses, most reported that PRO information was helpful for clinical documentation (79%), increased efficiency of patient discussions (84%), and was useful for patient care (75%). Among 39 oncologists, most found PRO information useful (91%), with 65% using PROs to guide patient discussions sometimes or often and 65% using PROs to make treatment decisions sometimes or often. CONCLUSION These findings support the clinical utility and value of implementing digital systems for monitoring PROs, including the PRO-CTCAE, in routine cancer care.
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Affiliation(s)
- Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Angela M Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Arlene Chung
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Sydney Henson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Allison Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Patricia A Spears
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Mattias Jonsson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Antonia V Bennett
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Gita Mody
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | | | - Bryce B Reeve
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC
| | - Claire Snyder
- Johns Hopkins Schools of Medicine and Public Health, Baltimore, MD
| | | | - Marjory Charlot
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Anna Weiss
- Brigham and Women's Hospital, Boston, MA
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27
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Stover AM, Kurtzman R, Walker Bissram J, Jansen J, Carr P, Atkinson T, Ellis CT, Freeman AT, Turner K, Basch EM. Stakeholder Perceptions of Key Aspects of High-Quality Cancer Care to Assess with Patient Reported Outcome Measures: A Systematic Review. Cancers (Basel) 2021; 13:cancers13143628. [PMID: 34298841 PMCID: PMC8306432 DOI: 10.3390/cancers13143628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary We conducted a review to identify important symptoms reported by patients on questionnaires (e.g., pain) that can be used to compare cancer centers on how well they provide care. For example, cancer centers could be compared on the percentage of patients with controlled pain after adjusting for demographic and clinical characteristics. Standard review methods were used to identify studies through August 2020. Searches generated 1813 articles and 1779 were coded as not relevant. The remaining 34 studies showed that patients, caregivers, clinicians, and healthcare administrators identify psychosocial care (e.g., distress) and symptom management as critical parts of high-quality care. Patients and caregivers also perceive that maintaining physical function and daily activities are important. Clinicians and healthcare administrators perceive control of specific symptoms to be important (e.g., pain, poor sleep, diarrhea). Results were used to inform testing of symptom questionnaires to compare the quality of care provided by six cancer centers. Abstract Performance measurement is the process of collecting, analyzing, and reporting standardized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and conflicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Correspondence:
| | - Rachel Kurtzman
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC 27599, USA;
| | | | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Thomas Atkinson
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - C. Tyler Ellis
- Department of Surgery, University of Louisville Health, Louisville, KY 40202, USA;
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Ethan M. Basch
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
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28
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Haines ER, Kirk MA, Lux L, Smitherman AB, Powell BJ, Dopp A, Stover AM, Birken SA. Ethnography and user-centered design to inform context-driven implementation. Transl Behav Med 2021; 12:6315391. [PMID: 34223893 DOI: 10.1093/tbm/ibab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite pervasive findings pointing to its inextricable role in intervention implementation, context remains poorly understood in implementation science. Existing approaches for describing context (e.g., surveys, interviews) may be narrow in scope or superficial in their elicitation of contextual data. Thus, in-depth and multilevel approaches are needed to meaningfully describe the contexts into which interventions will be implemented. Moreover, many studies assess context without subsequently using contextual information to enhance implementation. To be useful for improving implementation, though, methods are needed to apply contextual information during implementation. In the case example presented in this paper, we embedded an ethnographic assessment of context within a user-centered design approach to describe implementation context and apply that information to promote implementation. We developed a patient-reported outcome measure-based clinical intervention to assess and address the pervasive unmet needs of young adults with cancer: the Needs Assessment & Service Bridge (NA-SB). In this paper, we describe the user-centered design process that we used to anticipate context modifications needed to deliver NA-SB and implementation strategies needed to facilitate its implementation. Our ethnographic contextual inquiry yielded a rich understanding of local implementation context and contextual variation across potential scale-up contexts. Other methods from user-centered design (i.e., translation tables and a design team prototyping workshop) allowed us to translate that information into specifications for NA-SB delivery and a plan for implementation. Embedding ethnographic methods within a user-centered design approach can help us to tailor interventions and implementation strategies to their contexts of use to promote implementation.
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Affiliation(s)
- Emily R Haines
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Lauren Lux
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Andrew B Smitherman
- Pediatric Hematology-Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Alex Dopp
- RAND Corporation, Santa Monica, CA, USA
| | - Angela M Stover
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
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29
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Diepstra KL, Barr L, Palm D, Hogg E, Mollan KR, Henley L, Stover AM, Simoni JM, Sugarman J, Brown B, Sauceda JA, Deeks S, Fox L, Gandhi RT, Smith D, Li JZ, Dubé K. Participant Perspectives and Experiences Entering an Intensively Monitored Antiretroviral Pause: Results from the AIDS Clinical Trials Group A5345 Biomarker Study. AIDS Res Hum Retroviruses 2021; 37:489-501. [PMID: 33472545 DOI: 10.1089/aid.2020.0222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The AIDS Clinical Trials Group (ACTG) A5345 study included an intensively monitored antiretroviral pause (IMAP), during which a cohort of participants temporarily stopped antiretroviral treatment during chronic HIV infection. We surveyed participant perceptions and understanding of A5345 using a cross-sectional sociobehavioral questionnaire. Participants completed the baseline questionnaire either before or after initiating the study's IMAP. Questionnaire responses were linked to existing demographic data. Quantitative responses were analyzed overall and stratified by IMAP status. Open-ended responses were analyzed using conventional content analysis. Thirty-two participants completed the baseline sociobehavioral questionnaire. Half (n = 16) completed it before (i.e., pre-IMAP initiation group) and half (n = 16) after IMAP initiation (i.e., post-IMAP initiation group). Eight pre-IMAP initiation respondents (50%) and 11 post-IMAP respondents (69%) responded "yes" when asked if they perceived any direct benefits from participating in A5345. Perceived societal-level benefits included furthering HIV cure-related research and helping the HIV community. Perceived personal-level benefits included the opportunity to learn about the body's response to IMAP and financial compensation. The majority of respondents-13 from each group (81% of each)-reported risks from participation, for example, viral load becoming detectable. A5345 participants perceived both societal- and personal-level benefits of study participation. While the majority of survey respondents perceived participatory risks, nearly one in five did not. Key messages pertaining to study-related risks and benefits may need to be clarified or reiterated periodically throughout follow-up in HIV cure-related studies with IMAPs. Clinical Trail Registration Number: NCT03001128.
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Affiliation(s)
- Karen L. Diepstra
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Liz Barr
- AIDS Clinical Trials Group (ACTG) Community Scientific Sub-Committee, Baltimore, Maryland, USA
| | - David Palm
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Evelyn Hogg
- Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | - Katie R. Mollan
- Center for AIDS Research (CFAR), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laney Henley
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Angela M. Stover
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
- Department of Global Health and Gender, Women, and Sexuality Studies, University of Washington, Seattle, Washington, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, Maryland, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California, USA
| | - Steven Deeks
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Lawrence Fox
- National Institute of Health (NIH) Division of AIDS (DAIDS), Bethesda, Maryland, USA
| | | | - Davey Smith
- Division of Infectious Diseases and Global Health, University of California, San Diego, California, USA
| | - Jonathan Z. Li
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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30
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Haines ER, Lux L, Smitherman AB, Kessler ML, Schonberg J, Dopp A, Stover AM, Powell BJ, Birken SA. An actionable needs assessment for adolescents and young adults with cancer: the AYA Needs Assessment & Service Bridge (NA-SB). Support Care Cancer 2021; 29:4693-4704. [PMID: 33511477 DOI: 10.1007/s00520-021-06024-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In the USA, many of the nearly 90,000 adolescents and young adults (AYAs) diagnosed with cancer each year do not receive services to address the full scope of needs they experience during and after cancer treatment. To facilitate a systematic and patient-centered approach to delivering services to address the unmet needs of AYAs with cancer, we developed the AYA Needs Assessment & Service Bridge (NA-SB). METHODS To develop NA-SB, we leveraged user-centered design, an iterative process for intervention development based on prospective user (i.e., provider and AYA) engagement. Specifically, we conducted usability testing and concept mapping to refine an existing tool-the Cancer Needs Questionnaire-Young People-to promote its usability and usefulness in routine cancer practice. RESULTS Our user-centered design process yielded a need assessment which assesses AYAs' physical, psychosocial, and practical needs. Importantly, needs in the assessment are grouped by services expected to address them, creating an intuitive and actionable link between needs and services. CONCLUSION NA-SB has the potential to improve care coordination at the individual level by allowing cancer care programs to tailor service delivery and resource provision to the individual needs of AYAs they serve.
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Affiliation(s)
- Emily R Haines
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, 525 Vine Street, Winston-Salem, NC, 27101, USA.
| | - Lauren Lux
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, 101 Manning Dr, Chapel Hill, NC, 27514, USA
| | - Andrew B Smitherman
- Pediatric Hematology-Oncology, Lineberger Comprehensive Cancer Center, 101 Manning Dr, Chapel Hill, NC, 27514, USA
| | - Melody L Kessler
- Department of Chemistry, University of North Carolina at Chapel Hill, 125 South Road, Chapel Hill, NC, 27599-3290, USA
| | - Jacob Schonberg
- Center for Excellence in Community Mental Health, Department of Psychiatry, University of North Carolina School of Medicine, 3010 Falstaff Rd, Raleigh, NC, 27610, USA
| | - Alex Dopp
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Angela M Stover
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - Byron J Powell
- Brown School & School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, 525@Vine Room 5219, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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Wood WA, Deal AM, Stover AM, Basch E. Comparing Clinician-Assessed and Patient-Reported Performance Status for Predicting Morbidity and Mortality in Patients With Advanced Cancer Receiving Chemotherapy. JCO Oncol Pract 2021; 17:e111-e118. [PMID: 33417484 DOI: 10.1200/op.20.00515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Performance status (PS) is assessed during cancer treatment to determine clinical trial eligibility, appropriateness for treatment, and need for supportive care. There is rising interest for patients to report this information directly. We determined whether clinician- and patient-reported PS were equally associated with mortality and service utilization in patients with cancer. METHODS A secondary analysis was conducted using data from an radiotherapy plus chemotherapy in which 441 patients with advanced cancer and clinicians reported PS using the Eastern Cooperative Oncology Group scale. Simple kappa statistics measured agreement between clinician-reported performance status (cPS) and patient-reported performance status (pPS). Associations of cPS and pPS with emergency department (ED) and hospital visits and overall survival were evaluated via Cox regression, competing risk regression, and Fisher's exact tests. RESULTS cPS and pPS correlated weakly (kappa = 0.27). Both pPS and cPS were associated with survival, ED visits, and hospitalizations, but only cPS remained associated after adjustment (survival: HR, 1.75; P < .0001). The first available cPS predicted mortality more strongly than the first available pPS (HR for death, comparing PS ≥ 1 v 0: 2.05 for cPS and 1.41 for pPS). When pPS questionnaires were repeated over time and averaged, associations with outcomes were stronger as measured by AIC model fit. Both pPS and cPS were associated with EQ-5D subcomponents (eg, 75%-77% with no usual activity deficits for PS 0, v 42%-51% for PS ≥ 1). CONCLUSION Both clinician-reported PS and patient-reported PS provide useful information and can be considered for clinical trials and routine care.
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Affiliation(s)
- William A Wood
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Allison M Deal
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Angela M Stover
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Ethan Basch
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Check DK, Zullig LL, Davis MM, Davies L, Chambers D, Fleisher L, Kaplan SJ, Proctor E, Ramanadhan S, Schroeck FR, Stover AM, Koczwara B. Improvement Science and Implementation Science in Cancer Care: Identifying Areas of Synergy and Opportunities for Further Integration. J Gen Intern Med 2021; 36:186-195. [PMID: 32869193 PMCID: PMC7859137 DOI: 10.1007/s11606-020-06138-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 08/11/2020] [Indexed: 12/30/2022]
Abstract
Efforts to improve cancer care primarily come from two fields: improvement science and implementation science. The two fields have developed independently, yet they have potential for synergy. Leveraging that synergy to enhance alignment could both reduce duplication and, more importantly, enhance the potential of both fields to improve care. To better understand potential for alignment, we examined 20 highly cited cancer-related improvement science and implementation science studies published in the past 5 years, characterizing and comparing their objectives, methods, and approaches to practice change. We categorized studies as improvement science or implementation science based on authors' descriptions when possible; otherwise, we categorized studies as improvement science if they evaluated efforts to improve the quality, value, or safety of care, or implementation science if they evaluated efforts to promote the implementation of evidence-based interventions into practice. All implementation studies (10/10) and most improvement science studies (6/10) sought to improve uptake of evidence-based interventions. Improvement science and implementation science studies employed similar approaches to change practice. For example, training was employed in 8/10 implementation science studies and 4/10 improvement science studies. However, improvement science and implementation science studies used different terminology to describe similar concepts and emphasized different methodological aspects in reporting. Only 4/20 studies (2 from each category) described using a formal theory or conceptual framework to guide program development. Most studies were multi-site (10/10 implementation science and 6/10 improvement science) and a minority (2 from each category) used a randomized design. Based on our review, cancer-related improvement science and implementation science studies use different terminology and emphasize different methodological aspects in reporting but share similarities in purpose, scope, and methods, and are at similar levels of scientific development. The fields are well-positioned for alignment. We propose that next steps include harmonizing language and cross-fertilizing methods of program development and evaluation.
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Affiliation(s)
- Devon K Check
- Department of Population Health Sciences and Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Leah L Zullig
- Department of Population Health Sciences and Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Melinda M Davis
- Oregon Rural Practice-based Research Network and Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.,School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, USA
| | - Louise Davies
- The VA Outcomes Group, White River Junction VA Medical Center, Hartford, VT, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, NH, USA.,Department of Surgery - Otolaryngology Head & Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - David Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Samantha J Kaplan
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Enola Proctor
- The Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Florian R Schroeck
- The VA Outcomes Group, White River Junction VA Medical Center, Hartford, VT, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, NH, USA.,Section of Urology and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, PA, USA
| | - Angela M Stover
- Department of Health Policy and Management, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Urick B, Stover AM, Deal AM, Jansen J, Chiang AC, Cleeland CS, Zylla DM, Basch EM. Development and evaluation of patient reported outcomes-based performance measures during chemotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19175 Background: As value-based oncology care models become increasingly common, there is need for reliable and valid patient-reported outcome performance measures (PRO-PMs) to assess quality of symptom control at practices. We propose a method for combining PRO items across multiple symptoms into a single reliable and valid summary PRO-PM metric. Methods: Symptom surveys were administered to 607 patients at 6 cancer centers, between 5-15 days after starting a chemotherapy cycle. Twelve symptoms were elicited, each scored from 0-4, with higher scores indicating greater severity. Summary PRO-PM metrics were generated by summing scores for symptoms. A 3-item short form (score range 0-12) included nausea, diarrhea, and pain. A 12-item long form (score range 0-48) included short form items plus neuropathy, dyspnea, vomiting, fatigue, constipation, anxiety, sadness, insomnia, and appetite. PRO-PM summary item scores were dichotomized into high and low symptom burden categories. Cut points for dichotomization were compared based on reliability, validity, and prevalence. Reliability was defined as the average of practice-specific signal-to-noise ratios, with an optimal score ≥0.7. Practice-level validity was defined as the Pearson correlation between the proportion of patients with high symptom burden and low self-reported physical functioning. Patient-level validity was estimated as the relative risk (RR) of low physical functioning for patients with high vs. low symptom burden. For prevalence, measures were required to have > 5% or < 95% of patients with high symptom burden. Optimal cut-points were identified via a scatter plot comparing measure reliability and validity. Results: Optimal cut-points were identified for both summary PRO-PM metrics. For the short form, a cut-point at ≥5 had a reliability of 0.56, correlation of 0.14, RR of 2.56, and prevalence of 24.5%. For the long form, a cut point at ≥22 had reliability of 0.54, correlation of 0.56, RR of 2.61, and prevalence of 8.5%. Conclusions: Summary PRO-PM metrics can be generated from multiple PRO symptom items, with optimal cut-point scores determined by comparing reliability and validity. Reliability scores approached but did not meet the recommended 0.7 threshold due to sample size, therefore additional data are currently being collected to further support these cut points.
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Affiliation(s)
- Benjamin Urick
- Eshelman School of Pharmacy at University of North Carolina-Chapel Hill, Chapel Hill, NC
| | | | - Allison Mary Deal
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Charles S. Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Basch EM, Teal R, Dueck AC, Jansen J, Henson S, Vu M, Carda-Auten J, Carr PM, Wang M, Bennett AV, Stover AM. Nurse, oncologist, and patient impressions of electronic symptom monitoring via patient-reported outcomes in community oncology practices: Qualitative results from the U.S. national PRO-TECT trial (AFT-39, NCT03249090). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7044 Background: There is growing interest to implement electronic patient-reported outcomes in oncology practices for symptom monitoring. It is not well known what nurse, physician, and patient impressions of benefits, acceptability, and challenges are in routine care use. Methods: PRO-TECT is an ongoing U.S. national trial including 26 community oncology practices across 15 states that implemented PRO symptom monitoring [NCT03249090]. Patients complete weekly PROs between visits, nurses receive alerts for severe/worsening symptoms, and oncologists review PROs at office visits. Interviews were conducted with 147 stakeholders including nurses (N = 46), oncologists (N = 27), data managers (N = 15), and patients (N = 59). Each stakeholder group had different interview guides with overlapping topics to explore experiences with the PRO system. Interviews lasted 15-60 minutes, were digitally recorded, transcribed, and entered into a qualitative analysis software program. A codebook was developed from the research questions, interview guides, and discussions with the project team. Standardized coding methods were applied, with transcripts double coded for thematic analysis. Feedback surveys were also completed by nurses (N = 57), oncologists (N = 38), and patients (N = 435). Results: Key benefits perceived across stakeholder groups included increased patient self-awareness of symptoms; improved direct communication of patients with care teams; more open and honest conveying of symptom experiences; ability to track symptoms over time; and increased involvement of patients in their own care. Most stakeholders felt PRO symptom monitoring had a positive impact on quality of care delivery, and believed benefits of PROs outweighed necessary staff efforts. Challenges included additional work by nurses to review and respond to alerts, staff turnover requiring retraining, and limited time of oncologists. In the survey, 39/56 (70%) nurses felt the PRO system improved quality of care; 27/33 (82%) oncologists noted PROs were useful for team discussions and care delivery; and 320/434 (74%) patients agreed that weekly PRO reporting improved discussions with their care team. Conclusions: Clinicians and patients perceived weekly PRO symptom monitoring between visits to be valuable despite added staff effort. Results of additional analyses are forthcoming. Clinical trial information: NCT03249090 .
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Affiliation(s)
- Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Randall Teal
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sydney Henson
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Maihan Vu
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Philip M Carr
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Mian Wang
- Lineberger Comprehensive Cancer Center at University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Antonia Vickery Bennett
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Stover AM, Urick BY, Deal AM, Teal R, Vu MB, Carda-Auten J, Jansen J, Chung AE, Bennett AV, Chiang A, Cleeland C, Deutsch Y, Tai E, Zylla D, Williams LA, Pitzen C, Snyder C, Reeve B, Smith T, McNiff K, Cella D, Neuss MN, Miller R, Atkinson TM, Spears PA, Smith ML, Geoghegan C, Basch EM. Performance Measures Based on How Adults With Cancer Feel and Function: Stakeholder Recommendations and Feasibility Testing in Six Cancer Centers. JCO Oncol Pract 2020; 16:e234-e250. [PMID: 32074014 PMCID: PMC7069703 DOI: 10.1200/jop.19.00784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-reported outcome measures (PROMs) that assess how patients feel and function have potential for evaluating quality of care. Stakeholder recommendations for PRO-based performance measures (PMs) were elicited, and feasibility testing was conducted at six cancer centers. METHODS Interviews were conducted with 124 stakeholders to determine priority symptoms and risk adjustment variables for PRO-PMs and perceived acceptability. Stakeholders included patients and advocates, caregivers, clinicians, administrators, and thought leaders. Feasibility testing was conducted in six cancer centers. Patients completed PROMs at home 5-15 days into a chemotherapy cycle. Feasibility was operationalized as ≥ 75% completed PROMs and ≥ 75% patient acceptability. RESULTS Stakeholder priority PRO-PMs for systemic therapy were GI symptoms (diarrhea, constipation, nausea, vomiting), depression/anxiety, pain, insomnia, fatigue, dyspnea, physical function, and neuropathy. Recommended risk adjusters included demographics, insurance type, cancer type, comorbidities, emetic risk, and difficulty paying bills. In feasibility testing, 653 patients enrolled (approximately 110 per site), and 607 (93%) completed PROMs, which indicated high feasibility for home collection. The majority of patients (470 of 607; 77%) completed PROMs without a reminder call, and 137 (23%) of 607 completed them after a reminder call. Most patients (72%) completed PROMs through web, 17% paper, or 2% interactive voice response (automated call that verbally asked patient questions). For acceptability, > 95% of patients found PROM items to be easy to understand and complete. CONCLUSION Clinicians, patients, and other stakeholders agree that PMs that are based on how patients feel and function would be an important addition to quality measurement. This study also shows that PRO-PMs can be feasibly captured at home during systemic therapy and are acceptable to patients. PRO-PMs may add value to the portfolio of PMs as oncology transitions from fee-for-service payment models to performance-based care that emphasizes outcome measures.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Benjamin Y. Urick
- Department of Pharmacy, Center for Medication Optimization in the Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Randall Teal
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Connected Health Applications and Interventions (CHAI-Core), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Maihan B. Vu
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Connected Health Applications and Interventions (CHAI-Core), University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jessica Carda-Auten
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Connected Health Applications and Interventions (CHAI-Core), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Arlene E. Chung
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Departments of Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Antonia V. Bennett
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Anne Chiang
- Yale University and Smilow Cancer Center, Hartford, CT
| | | | | | - Edmund Tai
- Palo Alto Medical Foundation, Palo Alto, CA
| | - Dylan Zylla
- Park Nicollet Oncology Research, Frauenshuh Cancer Center, HealthPartners Institute, Minneapolis, MN
| | | | | | | | | | | | | | | | | | - Robert Miller
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Mary Lou Smith
- Patient Advocate
- Research Advocacy Network, Naperville, IL
| | | | - Ethan M. Basch
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Check D, Zullig LL, Davis M, Stover AM, Davies L, Schroeck FR, Fleisher L, Chambers D, Proctor E, Koczwara B. Quality improvement and implementation science in cancer care: Identifying areas of synergy and opportunities for further integration. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
29 Background: Efforts to improve cancer care delivery have been driven by two approaches: quality improvement (QI) and implementation science (IS). QI and IS have developed independently but have potential for synergy. To inform efforts to better align these fields, we examined 20 cancer-related QI and IS articles to identify differences and areas of commonality. Methods: We searched PubMed for cancer care studies that used IS or QI methods and were published in the past 5 years in one of 17 leading journals. Through consensus-based discussions, we categorized studies as QI if they evaluated efforts to improve the quality, value, or safety of care, or IS if they evaluated efforts to promote the adoption of evidence-based interventions into practice. We identified the 10 most frequently cited studies from each category (20 total studies), characterizing and comparing their objectives, methods – including use of theoretical frameworks involvement of stakeholders – and terminology. Results: All IS studies (10/10) and half (5/10) of QI studies addressed barriers to uptake of evidence-based practices. The remaining five QI studies sought to improve clinical outcomes, reduce costs, and/or address logistical issues. QI and IS studies employed common approaches to change provider and/or organizational practice (e.g., training, performance monitoring/feedback, decision support). However, the terminology used to describe these approaches was inconsistent within and between IS and QI studies. Fewer than half (8/20) of studies (4 from each category) used a theoretical or conceptual framework and only 4/20 (2 from each category) consulted key stakeholders in developing their approach. Most studies (10/10 IS and 6/10 QI) were multi-site, and most were observational, with only 4/20 studies (2 from each category) using a randomized design to evaluate their approach. Conclusions: Cancer-related QI and IS studies had overlapping objectives and used similar approaches but used inconsistent terminology. The impact of IS and QI on cancer care delivery could be enhanced by greater harmonization of language and by promoting rigor through the use of conceptual frameworks and stakeholder input.
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Affiliation(s)
| | - Leah L. Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | | | | | - Louise Davies
- Dartmouth College Department of Surgery, White River Junction, VT
| | | | | | | | - Enola Proctor
- Washington University in Saint Louis, Saint Louis, MO
| | - Bogda Koczwara
- Flinders Medical Centre, Flinders University, Adelaide, Australia
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Charlot M, Henson S, Spears P, Schrag D, Stover AM, Basch EM. Barriers to minority recruitment in a multicenter clinical trial (PRO-TECT [AFT-39]): Research staff insights. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
145 Background: Rates of minority enrollment in U.S. cancer clinical trials, including supportive care trials, are disproportionately low. Clinical research associates (CRAs) are the linchpin for successful accrual and often help screen and approach patients to discuss research studies. We sought to understand clinic-level factors that influence recruitment of African American patients (AA) in an ongoing U.S. multicenter, cluster- randomized controlled trial (PRO-TECT: Patient-Reported Outcomes to Enhance Cancer Treatment; NCT03249090 AFT-39]). Notably, partway through this trial, a purposeful enrollment strategy was initiated where sites were asked to focus on minority recruitment. Methods: A subset of community oncology practices participating in PRO-TECT was identified with: 1) overall patient populations ≥20% AA; or 2) <20% AA but trial enrollment ≥20% AA. Semi-structured phone interviews were conducted with CRAs at each site to elicit perceived barriers and facilitators in identifying and approaching AA patients for this trial. Results: Among 13 identified community practices out of a potential 50 randomized sites, 3 had populations <20% AA but enrollment >20% AA; 3 had populations ≥20% AA but enrollment <20% AA; and 7 had populations ≥20% AA and enrollment >20% AA. All sites identified participants through review of clinic visit lists with clinicians. Eleven out of 13 sites felt they experienced no barriers to identifying, approaching, or enrolling minority patients. One site CRA felt minority patients are often “too sick to participate”. One CRA felt awkward about the request to purposefully approach minority patients. Conclusions: Site CRAs generally did not perceive barriers to minority recruitment, even when their population demographics were underrepresented in accrual. Results of efforts in this trial to increase minority participation through a purposeful enrollment strategy will be reported elsewhere.
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Affiliation(s)
| | - Sydney Henson
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Patty Spears
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Stover AM, Urick B, Deal AM, Jansen J, Henson S, Miller RS, Smith T, Scholle SH, Chiang AC, Cleeland CS, Deutsch YE, Zylla DM, Pitzen C, Snyder CF, McNiff KK, Krzyzanowska MK, Spears P, Smith ML, Geoghegan C, Basch EM. Development and testing of patient-reported outcome performance measures (PRO-PMs) for oncology practice. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
173 Background: Symptom management is a cornerstone of quality oncology practice. ASCO established a Working Group to develop patient-reported outcome performance measures (PRO-PMs) for assessing symptom management. We describe multi-center testing funded by PCORI. Methods: Multi-stakeholder consensus and literature review identified 11 symptoms for testing as potential PRO-PMs. For these symptoms, questions from the NCI’s PRO-CTCAE tool were administered at 6 US academic and community oncology practices. Patients across cancer types completed questions electronically on days 5-15 of chemotherapy cycles. PRO-CTCAE mapped scores were dichotomized to delineate clinically meaningful thresholds (0-1 vs ≥2), and rates were tabulated between practices. Symptoms were selected to become PRO-PMs if clinically actionable and with prevalence ≥20%; between-practice variation was evaluated using χ2. Twelve candidate sociodemographic and clinical risk adjustment (RA) variables were evaluated via Akaike information criterion testing. Risk-adjusted PRO-PM rates were calculated using observed:expected ratios via generalized linear mixed modeling. Results: Among 653 enrolled patients, 607 (93%) completed questionnaires. Four of 11 symptoms met criteria for PRO-PM development: nausea, constipation, insomnia, pain. Four RA variables met inclusion criteria: age, gender, cancer type, insurance type. The Table shows raw and risk-adjusted rates of symptom burden (scores ≥2) for each PRO-PM across practices. Risk-adjustment yielded a modest impact on scores. Conclusions: Oncology PRO-PMs have been developed to quantify the burden of actionable symptoms at the practice level. Collection from patients is feasible. Further refinement is underway prior to submission for endorsement by the National Quality Forum. [Table: see text]
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Affiliation(s)
| | - Ben Urick
- Eshelman School of Pharmacy at University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Allison Mary Deal
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sydney Henson
- Lineberger Comprehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert S. Miller
- American Society of Clinical Oncology’s (ASCO) CancerLinQ, Alexandria, VA
| | | | | | | | | | | | | | | | | | | | | | - Patricia Spears
- Lineberger Compehensive Cancer Center at University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Stover AM, McLeod LD, Langer MM, Chen WH, Reeve BB. State of the psychometric methods: patient-reported outcome measure development and refinement using item response theory. J Patient Rep Outcomes 2019; 3:50. [PMID: 31359210 PMCID: PMC6663947 DOI: 10.1186/s41687-019-0130-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/19/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This paper is part of a series comparing different psychometric approaches to evaluate patient-reported outcome (PRO) measures using the same items and dataset. We provide an overview and example application to demonstrate 1) using item response theory (IRT) to identify poor and well performing items; 2) testing if items perform differently based on demographic characteristics (differential item functioning, DIF); and 3) balancing IRT and content validity considerations to select items for short forms. METHODS Model fit, local dependence, and DIF were examined for 51 items initially considered for the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Depression item bank. Samejima's graded response model was used to examine how well each item measured severity levels of depression and how well it distinguished between individuals with high and low levels of depression. Two short forms were constructed based on psychometric properties and consensus discussions with instrument developers, including psychometricians and content experts. Calibrations presented here are for didactic purposes and are not intended to replace official PROMIS parameters or to be used for research. RESULTS Of the 51 depression items, 14 exhibited local dependence, 3 exhibited DIF for gender, and 9 exhibited misfit, and these items were removed from consideration for short forms. Short form 1 prioritized content, and thus items were chosen to meet DSM-V criteria rather than being discarded for lower discrimination parameters. Short form 2 prioritized well performing items, and thus fewer DSM-V criteria were satisfied. Short forms 1-2 performed similarly for model fit statistics, but short form 2 provided greater item precision. CONCLUSIONS IRT is a family of flexible models providing item- and scale-level information, making it a powerful tool for scale construction and refinement. Strengths of IRT models include placing respondents and items on the same metric, testing DIF across demographic or clinical subgroups, and facilitating creation of targeted short forms. Limitations include large sample sizes to obtain stable item parameters, and necessary familiarity with measurement methods to interpret results. Combining psychometric data with stakeholder input (including people with lived experiences of the health condition and clinicians) is highly recommended for scale development and evaluation.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1101-G McGavran-Greenberg Hall (CB# 7411), Chapel Hill, NC 27599 USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, Chapel Hill, NC 27599 USA
| | - Lori D. McLeod
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Michelle M. Langer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, Chapel Hill, NC 27599 USA
- Current affiliation: Medical Social Sciences; Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL 60611 USA
| | - Wen-Hung Chen
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Bryce B. Reeve
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1101-G McGavran-Greenberg Hall (CB# 7411), Chapel Hill, NC 27599 USA
- Current affiliation: Center for Health Measurement Department of Population Health Sciences and Pediatrics, Duke University School of Medicine, 2200 West Main St, Suite 720A, Durham, NC 27707 USA
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Bryant AL, Coffman E, Phillips B, Tan X, Bullard E, Hirschey R, Bradley J, Bennett AV, Stover AM, Song L, Shea TC, Wood WA. Pilot randomized trial of an electronic symptom monitoring and reporting intervention for hospitalized adults undergoing hematopoietic stem cell transplantation. Support Care Cancer 2019; 28:1223-1231. [PMID: 31222392 DOI: 10.1007/s00520-019-04932-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/07/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Patients undergoing a hematopoietic stem cell transplantation (HCT) have varied symptoms during their hospitalization. This study examined whether daily symptom reporting (with electronic patient-reported outcomes [PROs]) in an inpatient bone marrow transplant clinic reduced symptom burden on post-transplant days +7, +10, and +14. METHODS A prospective, single-institution 1:1 pilot randomized, two-arm study recruited HCT patients. HCT inpatients (N = 76) reported daily on 16 common symptoms using the PRO version of the Common Terminology for Adverse Events (PRO-CTCAE). Fisher's exact test was used to examine differences in the proportion of patients reporting individual symptoms. Multivariable linear regression modeling was used to examine group differences in peak symptom burden, while controlling for symptom burden at baseline, age, comorbidity, and transplantation type (autologous or allogeneic). RESULTS HCT patients receiving the PRO intervention also experienced lower peak symptom burden (average of 16 symptoms) at days +7, +10, and +14 (10.4 vs 14.5, p = 0.03). CONCLUSIONS Daily use of electronic symptom reporting to nurses in an inpatient bone marrow transplant clinic reduced peak symptom burden and improved individual symptoms during the 2 weeks post-transplant. A multi-site trial is warranted to demonstrate the generalizability, efficacy, and value of this intervention. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02574897.
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Affiliation(s)
- Ashley Leak Bryant
- The University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599-7460, USA.
| | - Erin Coffman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Brett Phillips
- Hemophilia and Thrombosis Center, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Xianming Tan
- UNC Lineberger Biostatistics Core, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7460, USA
| | | | - Rachel Hirschey
- The University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599-7460, USA
| | - Joshua Bradley
- North Carolina Cancer Hospital, UNC Hospitals, Chapel Hill, USA
| | - Antonia V Bennett
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Angela M Stover
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Lixin Song
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Thomas C Shea
- Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - William A Wood
- Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, USA
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Affiliation(s)
- Angela M Stover
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ethan M Basch
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Stover AM, Henson S, Deal AM, Stricker CT, Hammelef KJ, Bennett AV, Carr PM, Jansen J, Kottschade LA, Dueck AC, Basch EM. Methods for alerting clinicians to concerning symptom questionnaire responses during cancer care: Approaches from two randomized trials (STAR, AFT-39 PRO-TECT). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
158 Background: There is limited research on methods for alerting clinicians to concerning patient-reported outcome (PRO) responses and how often PROs trigger alerts to nurses during cancer care. Methods: In two randomized trials, adults with advanced cancer receiving chemotherapy were enrolled. Participants were randomized to usual care vs. weekly PROs completed between visits (with automated feedback to nurses). PRO responses in the intervention arm triggered automated email alerts to nurses for frequent, severe, or worsening symptoms in the last 7 days. Alert thresholds for PROs were chosen a priori but were unique to each study. The “Symptom Tracking and Reporting” (STAR) trial was conducted at one academic medical center. The “PROs to Enhance Cancer Treatment” (PRO-TECT [AFT-39]) cluster-randomized trial is being conducted in > 30 community practices. Results: In STAR, 766 patients participated (58% female, 38% ages ≥65, 17% minority, 28% ≤high school). 441 participants were randomized to the intervention arm, where 1,431/84,212 items (2%) triggered a concerning symptom alert, during 1,070/8,498 weeks (13%). Frequent alerts were for fatigue (62%), pain (32%), and appetite (16%). In PRO-TECT (AFT-39), 300 patients have been enrolled (58% female, 49% ages ≥65, 8% minority, 47% ≤high school) out of 1,000. 146 participants have been randomized to the intervention arm, where 1,422/24,739 items (6%) triggered an alert, during 824/2249 weeks (37%). Common alerts were for pain (48%), physical function (35%), and diarrhea (15%). PRO-TECT provided clinical decision support with alerts. Conclusions: In two randomized trials in advanced cancer, PROs collected during care delivery enabled tailored treatment based on issues identified on PROs. Pain, physical function, appetite, and diarrhea commonly triggered alerts for concerning symptoms. Early PRO-TECT results are showing a trend for higher weekly alert rates for concerning symptoms (37% vs. 13% in STAR), which may indicate that the PRO intervention will be even more effective in community practices. Results assist in addressing logistical considerations for implementing PROs into routine care. Clinical trial information: NCT03249090.
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Affiliation(s)
- Angela M. Stover
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Sydney Henson
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Allison Mary Deal
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | - Antonia Vickery Bennett
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Philip M Carr
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jennifer Jansen
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Wood WA, Tan X, Grover NS, Stover AM, Kannappan A, Carr PM, Burkes R, Shea TC, Artz AS, Devine SM, Ligibel JA, Bennett AV, Basch EM. Objective measures of performance status in cancer: A pilot Alliance study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
284 Background: Clinician-assessed performance status (cPS) is prognostic in oncology. However, cPS may be limited by subconscious bias, and is confined to clinic visits. A more objective PS measure derived from cardiorespiratory fitness (VO2peak) and/or sensor-derived biometrics (activity (A), heart rate (HR), and activity/HR combinations (A/HR)) could better inform treatment selection, trial design, safety monitoring, and outcomes assessment. A multi-site study was conducted to examine the feasibility and utility of VO2peak and sensor-derived biometrics as complements to cPS and patient-reported PS (pPS). Methods: We enrolled 45 patients receiving chemotherapy at 4 institutions in 3 cohorts (solid tumor, hematologic malignancy, bone marrow transplant) to assess the feasibility and usefulness of VO2peak and sensor-derived biometrics. Patients underwent VO2peak prior to a cycle of treatment, wore a sensor for 4 weeks, and self-reported PS, physical function (PF), mental health (MH), and instrumental activities of daily living (IADLs). Sensor-derived variables included A, HR, and A/HR. Spearman’s rank correlations described bivariate relationships. Results: 70% of participants underwent VO2peak testing. 81% provided ≥ 2 weeks of sensor data. At baseline, VO2peak was moderately to strongly correlated with pPS and A/HR (r = 0.44-0.66, p < 0.05). pPS, but not cPS, was correlated with MH, PF, and IADLs (r = 0.58-0.69, p < 0.05). During treatment, pPS, PF, and IADLs were moderately to strongly correlated with A/HR (r > 0.4, p < 0.05). Conclusions: VO2peak testing and biometric sensor deployment were feasible within a multi-institutional setting of cancer patients receiving chemotherapy. Sensor-derived A/HR variables were correlated with underlying fitness, as well as patient-reported functioning throughout treatment. A/HR variables are candidates for further development and validation as digital biomarkers of performance status in cancer patients. Support: UG1CA189823; Clinicaltrials.gov Id: NCT02786628
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Affiliation(s)
- William Allen Wood
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Xianming Tan
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Natalie Sophia Grover
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Angela M. Stover
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Arun Kannappan
- University of North Carolina, Chapel Hill, Chapel Hill, NC
| | - Philip M Carr
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Robert Burkes
- University of North Carolina, Chapel Hill, Chapel Hill, NC
| | - Thomas C. Shea
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | - Antonia Vickery Bennett
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Turner K, Trogdon JG, Weinberger M, Stover AM, Ferreri S, Farley JF, Ray N, Patti M, Renfro C, Shea CM. Testing the organizational theory of innovation implementation effectiveness in a community pharmacy medication management program: a hurdle regression analysis. Implement Sci 2018; 13:105. [PMID: 30064454 PMCID: PMC6069858 DOI: 10.1186/s13012-018-0799-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/23/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Many state Medicaid programs are implementing pharmacist-led medication management programs to improve outcomes for high-risk beneficiaries. There are a limited number of studies examining implementation of these programs, making it difficult to assess why program outcomes might vary across organizations. To address this, we tested the applicability of the organizational theory of innovation implementation effectiveness to examine implementation of a community pharmacy Medicaid medication management program. METHODS We used a hurdle regression model to examine whether organizational determinants, such as implementation climate and innovation-values fit, were associated with effective implementation. We defined effective implementation in two ways: implementation versus non-implementation and program reach (i.e., the proportion of the target population that received the intervention). Data sources included an implementation survey administered to participating community pharmacies and administrative data. RESULTS The findings suggest that implementation climate is positively and significantly associated with implementation versus non-implementation (AME = 2.65, p < 0.001) and with program reach (AME = 5.05, p = 0.001). Similarly, the results suggest that innovation-values fit is positively and significantly associated with implementation (AME = 2.17, p = 0.037) and program reach (AME = 11.79, p < 0.001). Some structural characteristics, such as having a clinical pharmacist on staff, were significant predictors of implementation and program reach whereas other characteristics, such as pharmacy type or prescription volume, were not. CONCLUSIONS Our study supported the use of the organizational theory of innovation implementation effectiveness to identify organizational determinants that are associated with effective implementation (e.g., implementation climate and innovation-values fit). Unlike broader environmental factors or structural characteristics (e.g., pharmacy type), implementation climate and innovation-values fit are modifiable factors and can be targeted through intervention-a finding that is important for community pharmacy practice. Additional research is needed to determine what implementation strategies can be used by community pharmacy leaders and practitioners to develop a positive implementation climate and innovation-values fit for medication management programs.
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Affiliation(s)
- Kea Turner
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
| | - Justin G. Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
| | - Angela M. Stover
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
| | - Stefanie Ferreri
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, 115B Beard Hall, Chapel Hill, NC 27599-7411 USA
| | - Joel F. Farley
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455 USA
| | - Neepa Ray
- Center for Medication Optimization through Practice and Policy, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, 2400 Kerr Hall, Chapel Hill, NC 27599-7411 USA
| | - Michael Patti
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, 115B Beard Hall, Chapel Hill, NC 27599-7411 USA
| | - Chelsea Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN 38163 USA
| | - Christopher M. Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Chapel Hill, NC 27599-7411 USA
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Koczwara B, Stover AM, Davies L, Davis MM, Fleisher L, Ramanadhan S, Schroeck FR, Zullig LL, Chambers DA, Proctor E. Harnessing the Synergy Between Improvement Science and Implementation Science in Cancer: A Call to Action. J Oncol Pract 2018; 14:335-340. [PMID: 29750579 PMCID: PMC6075851 DOI: 10.1200/jop.17.00083] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bogda Koczwara
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Angela M. Stover
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Louise Davies
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Melinda M. Davis
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Linda Fleisher
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Shoba Ramanadhan
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Florian R. Schroeck
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Leah L. Zullig
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - David A. Chambers
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
| | - Enola Proctor
- Flinders University, Adelaide, South Australia, Australia; University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill; Durham Veterans Affairs Health Care System; Duke University Medical Center, Durham, NC; Department of Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine, Hanover; Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Hitchcock Medical Center, Lebanon, NH; Oregon Health & Science University, Portland, OR; Children’s Hospital of Philadelphia, Philadelphia; Fox Chase Cancer Center, Cheltenham, PA; Dana-Farber Cancer Institute; Harvard T.H. Chan School of Public Health, Boston, MA; National Cancer Institute, Bethesda, MD; and Washington University in St Louis, St Louis, MO
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Kwan SW, Charalel RA, Stover AM, Baumhauer JF, Cella D, Darien G, Durack JC, Gerson J, Opelka F, Patrick DL, Salem R, Spies JB, Wu AW, White SB. Development of National Research and Clinical Agendas for Patient-Reported Outcomes in IR: Proceedings from a Multidisciplinary Consensus Panel. J Vasc Interv Radiol 2018; 29:1-8. [DOI: 10.1016/j.jvir.2017.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 11/27/2022] Open
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Chung A, Stover AM, Wagner LI, LeBlanc TW, Topalaglu U, Zafar Y, Zullig LL, Smeltzer P, Basch EM. Harmonization of patient-reported outcomes into EHRs at four cancer hospital outpatient clinics for patient care and quality assessment. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
129 Background: Patient-reported outcome (PRO) measures are well established in oncology trials but are not collected systematically during clinical care, to guide symptom management, or to assess quality. A growing body of evidence shows that collecting PROs during cancer care yields better clinical outcomes. Yet, little is known about best practices for PRO integration into electronic health record (EHR) workflows. We report on the first cross-institutional effort for PRO data harmonization across four CTSA-funded institutions (University of North Carolina at Chapel Hill, Wake Forest University, Duke University, Medical University of South Carolina). Methods: Through surveys, systematic stakeholder qualitative focus groups, a landscape analysis, and technical/workflow assessment, our cross-institutional team sought to: 1) determine a set of common PRO measures to be collected via patient portals tethered to EHRs across the 4 sites; 2) develop an implementation strategy for the collection of PROs via patient portal within clinical workflows; and 3) collect a common set of PROs in cancer clinical care. We also sought to develop the methodological steps to harmonize extracted PRO data across each site to each other and then to the PCORnet Common Data Model Common Measures for PROs across each site. Results: Across the four sites, each institution uses Epic Systems (EHR and patient portal) and had available a library of PRO questionnaires which included the PROMIS profile (29 items) and short forms, SF-20, RAND, PHQ-2, and PHQ-9. The study team developed a list of domains and the tools available within each domain for stakeholders to prioritize at each site. The proposed workflows take into consideration the use of these data within the clinical encounter. Pilots at each site to collect PROs are underway along with the methodological work for data extraction and harmonization and will be reported at the meeting. Conclusions: The collection of a common set of PROs across EHRs has important implications for improving individual patient’s symptoms and for enhancing the quality of cancer care. Complex workflows and technical barriers must be considered successful implementation.
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Affiliation(s)
- Arlene Chung
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | - Lynne I. Wagner
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Umit Topalaglu
- Comprehensive Cancer Center of Wake Forest Baptist, Winston Salem, NC
| | | | - Leah L. Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | - Phil Smeltzer
- Medical University of South Carolina, Charleston, SC
| | - Ethan M. Basch
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Stover AM, Chung A, Jansen J, Basch EM. Bringing the patient voice into quality assessment: National stakeholder perceptions of facilitators and barriers for the use of PROs as performance measures. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
61 Background: An emerging trend in quality improvement is to incorporate the patient voice into performance metrics for routine care delivery using patient-reported outcomes (PRO). For instance, patients may complete a questionnaire about how well their symptoms are controlled (e.g., nausea). High-quality care is then determined by adjusting scores and comparing similar practices on symptom control. However, stakeholder (clinicians, administrators, and researchers) perspectives of facilitators and barriers are not well characterized because PRO performance measures are an emerging concept. Methods: Key informant interviews were conducted with 35 stakeholders (9 medical oncology clinicians, 13 administrators, and 13 health services researchers) from 5 healthcare systems across the U.S. Interview guides were used to elicit perceptions of barriers, facilitators, and acceptability for using PROs as performance measures. Transcripts were content analyzed by stakeholder group using standard methodology. Results: Clinicians reported barriers that were structural (e.g., complexity of programming electronic health record [EHR] changes) and process-oriented (e.g., changing clinic workflow to accommodate PRO review and alerts). Clinicians noted concerns about appropriate adjustments to ensure fair quality comparisons across practices. Clinicians and administrators reported structural barriers such as reimbursement and staff training, and outcome barriers such as choosing symptoms that have clear treatment guidelines. Facilitators included dashboards to visually display results that are intuitive and easily accessible in the EHR. Researchers focused on standardization and selecting thresholds for symptom alerts. Conclusions: Clinicians, administrators, and researchers reported barriers to the integration of PROs as quality measures. These barriers are mainly structural- and process-oriented but generally did not focus on acceptability. Facilitators focused on presenting PRO scores in an easily interpretable and accessible way within the EHR. Results will inform multi-site feasibility testing of PROs as quality metrics.
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Affiliation(s)
| | - Arlene Chung
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Jennifer Jansen
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ethan M. Basch
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Atkinson TM, Stover AM, Storfer DF, Saracino RM, D'Agostino TA, Pergolizzi D, Matsoukas K, Li Y, Basch E. Patient-Reported Physical Function Measures in Cancer Clinical Trials. Epidemiol Rev 2017; 39:59-70. [PMID: 28453627 PMCID: PMC5858035 DOI: 10.1093/epirev/mxx008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/22/2022] Open
Abstract
Patient-reported outcomes (PROs) are increasingly used to monitor treatment-related symptoms and physical function decrements in cancer clinical trials. As more patients enter survivorship, it is important to capture PRO physical function throughout trials to help restore pretreatment levels of function. We completed a systematic review of PRO physical function measures used in cancer clinical trials and evaluated their psychometric properties on the basis of guidelines from the US Food and Drug Administration. Five databases were searched through October 2015: PubMed/MEDLINE, EMBASE, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Health and Psychosocial Instruments, and Cochrane. From an initial total of 10,233 articles, we identified 108 trials that captured PRO physical function. Within these trials, approximately 67% used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and 25% used the Medical Outcomes Study Short Form 36. Both the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and Medical Outcomes Study Short Form 36 instruments generically satisfy most Food and Drug Administration requirements, although neither sought direct patient input as part of item development. The newer Patient-Reported Outcomes Measurement Information System physical function short form may be a brief, viable alternative. Clinicians should carefully consider the psychometric properties of these measures when incorporating PRO instrumentation into clinical trial design to provide a more comprehensive understanding of patient function.
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Affiliation(s)
- Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Angela M Stover
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel F Storfer
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas A D'Agostino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Denise Pergolizzi
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantina Matsoukas
- Information Systems, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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Atkinson TM, Ryan SJ, Bennett AV, Stover AM, Saracino RM, Rogak LJ, Jewell ST, Matsoukas K, Li Y, Basch E. The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review. Support Care Cancer 2016; 24:3669-76. [PMID: 27260018 PMCID: PMC4919215 DOI: 10.1007/s00520-016-3297-9] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/30/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Symptomatic adverse events (AEs) are monitored by clinicians as part of all US-based clinical trials in cancer via the U.S. National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) for the purposes of ensuring patient safety. Recently, there has been a charge toward capturing the patient perspective for those AEs amenable to patient self-reporting via patient-reported outcomes (PRO). The aim of this review was to summarize the empirically reported association between analogous CTCAE and PRO ratings. METHODS A systematic literature search was conducted using PubMed, EMBASE, Web of Science, and Cochrane databases through July 2015. From a total of 5658 articles retrieved, 28 studies met the inclusion criteria. RESULTS Across studies, patients were of mixed cancer types, including anal, breast, cervical, chronic myeloid leukemia, endometrial, hematological, lung, ovarian, pelvic, pharyngeal, prostate, and rectal. Given this mixture, the AEs captured were variable, with many common across studies (e.g., dyspnea, fatigue, nausea, neuropathy, pain, vomiting), as well as several that were disease-specific (e.g., erectile dysfunction, hemoptysis). Overall, the quantified association between CTCAE and PRO ratings fell in the fair to moderate range and had a large variation across the majority of studies (n = 21). CONCLUSIONS The range of measures used and symptoms captured varied greatly across the reviewed studies. Regardless of concordance metric employed, reported agreement between CTCAE and PRO ratings was moderate at best. To assist with reconciliation and interpretation of these differences toward ultimately improving patient care, an important next step is to explore approaches to integrate PROs with clinician reporting of AEs.
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Affiliation(s)
- Thomas M Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Sean J Ryan
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
- City University of New York, New York, NY, USA
| | | | - Angela M Stover
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca M Saracino
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Lauren J Rogak
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Sarah T Jewell
- Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Konstantina Matsoukas
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Yuelin Li
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Ethan Basch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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