Text messaging yields high research response rate to track menstrual cycles and patient-reported outcomes

e18312 Background: Establishing a system to monitor patient reported outcomes (“PRO”) has been demonstrated to be essential for a well-functioning cancer system. Studies have shown that routine collection of PROs allows providers to address medical issues earlier and impacts a patient’s overall survival. Unmet needs for symptom management are prevalent in the cancer population, especially patients with advanced cancer. Approximately 35% of UCLA Hematology-Oncology patients with advanced cancer in 2016 presented to Emergency Rooms for symptom-related complaints such as nausea, pain, constipation, dehydration, and fatigue. We hypothesize that the creation of an electronic PRO platform through EPIC MyChart will ensure patients receive timely evaluation of their symptoms, resulting in improved quality of life, and decreased ER and hospital utilization. Methods: We developed an innovative PRO platform through Epic MyChart along with a Best Practice Advisory alert system to identify patients at risk for worsening symptoms, ER visits, and inpatient admissions. We then built an electronic version of the Edmonson Symptoms Assessment System, which providers can push to patients through Epic MyChart, with results stored within the Flowsheets section of Epic. We also built a passive alert using Epic’s Best Practice Advisory (“BPA”) system, to notify providers when a patient’s MyChart ESAS Assessment Scores have exceeded a defined threshold. Results: Preliminary data from surveys sent to a series of advanced cancer patients seen in an outpatient palliative oncology clinic over 1 month, demonstrated a 100% response rate (6/7) surveys completed when sent one week prior to patient’s being seeing in clinic, and 17% response rate (1/6) when sent two to three weeks prior to clinic visit. The average total ESAS score reported was 40, with average individual score of 4/10 for any given symptom. Conclusions: We will implement this electronic PRO platform in multiple oncology clinics at UCLA, and measure provider and patient satisfaction, completion rates, and monitor outcomes such as ED visits and inpatient admissions. We hope this system will lead to an overall survival benefit. This project demonstrates the potential of developing innovative PRO platforms through Epic MyChart and the importance of clinical workflows in the implementation process.

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Adherence to remote versus clinic-based collection of patient-reported outcomes in patients with advanced lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14109 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14109-e14109

Author(s):

Peter Edward Gabriel ◽

Tara L. Kaufmann ◽

Abigail N. Blauch ◽

Donna A. Pucci ◽

Linda A. Jacobs ◽

...

Keyword(s):

Lung Cancer ◽

Pilot Study ◽

Real Time ◽

Text Messaging ◽

Patient Reported Outcomes ◽

Advanced Nsclc ◽

Text Messages ◽

Advanced Lung Cancer ◽

Small Pilot Study ◽

Patient Reported

e14109 Background: Routine collection of patient-reported outcomes (PROs) is an evidence-based practice to improve communication, symptom management, and health outcomes in cancer care. However, optimal implementation strategies are poorly understood. Previous studies have mostly assessed PROs collected during clinic visits, which may be less actionable and more subject to recall bias than those collected in real time. Behavioral economics-informed digital approaches have shown increasing promise as sustainable and scalable strategies for remote patient monitoring. We compared remote text-messaging versus usual clinic-based PRO collection approaches. Methods: Between September 2018 and May 2019, we conducted a prospective pilot feasibility study of remote PRO monitoring via text-messaging among 20 patients with advanced non-small cell lung cancer (NSCLC). Pilot participants consented to enroll in a HIPAA-compliant, bidirectional text-messaging platform, which allowed for direct reporting of PRO measures at home. Data were integrated into the electronic health record in real time, and clinicians were notified of severe or escalating symptoms. We compared patient-level adherence over 12 weeks among: 1) pilot participants and 2) patients with advanced NSCLC reporting via usual clinic-based collection methods. We identified predictors of adherence using multivariable logistic regression, and surveyed pilot participants on feasibility outcomes. Results: During the study period, 20 patients with advanced NSCLC participated in the remote text-messaging pilot study (mean age, 63y; 60% male; 85% white), and 328 patients with advanced NSCLC participated in usual clinic-based PRO collection (mean age, 66y; 48% male; 69% white). Baseline characteristics were similar between groups. Mean adherence was 88.4% for remote text-messaging vs 71.2% for clinic-based collection (p < 0.001). Pilot participation predicted > 80% adherence after adjusting for age, sex, race, and marital status (OR 3.5, p = 0.029). Pilot participants reported high levels of usability (97%) and satisfaction (96%) with text-messaging, and 90% noted that text messages reminded them to report symptoms to their clinical team. Conclusions: Among patients with advanced NSCLC, remote PRO monitoring via text-messaging was feasible and enabled significantly higher adherence to reporting than usual clinic-based collection. These results are based on a small pilot study, and further research on text messaging as a PRO implementation strategy is warranted. Clinical trial information: NCT03616522.

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Patient-Reported Chronic Pain Outcomes After Lung Transplantation

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253219882432 ◽

2019 ◽

Vol 24 (1) ◽

pp. 96-103 ◽

Cited By ~ 1

Author(s):

Rebecca Y. Klinger ◽

Claire Cunniff ◽

Negmeldeen Mamoun ◽

Mary Cooter ◽

Nazish Hashmi ◽

...

Keyword(s):

Chronic Pain ◽

Lung Transplantation ◽

Patient Reported Outcomes ◽

Lung Transplant ◽

Response Rate ◽

Transplant Recipients ◽

Patient Reported ◽

Pain Outcomes ◽

Lung Transplant Recipients

Chronic pain after lung transplantation is a significant concern, in particular given the heterogeneity of the patient population and the challenges of achieving adequate pain control amid concerns related to complex immunosuppressant regimens and the possibility of respiratory depression. We undertook a patient-reported outcomes (PRO) survey administered via our electronic health care portal to examine the postoperative incisional pain prevalence in a cohort of lung transplant recipients at a single, high-volume center where bilateral thoracosternotomy is the preferred surgical approach. The Patient Reported Outcomes Measurement Information System (PROMIS) Global Health and Pain Intensity short forms were sent to a total of 173 lung transplant recipients who were more than 2 months postsurgery at the time of the study. A total of 64 patients responded to both PROMIS surveys (response rate 38%). In the cohort of survey respondents, we observed a chronic pain incidence of 58% after lung transplantation (median pain score 1/10) and an overall good quality of life score (median score 4/5); however, only 9.4% reported moderate-severe pain (pain score ≥5/10). Survey nonrespondents had higher rates of pretransplant opioid and psychiatric medication use compared with respondents. In this study, we demonstrated the feasibility of using an electronic PRO survey for assessing postoperative pain outcomes after lung transplantation. However, measuring pain outcomes using this type of tool highlights issues of response rate and potential selection bias. Larger studies are needed to adequately assess the risk and predictors of chronic pain after lung transplantation and its impact on quality of life.

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Patient-Reported Outcomes and Long-Term Nonadherence to Aromatase Inhibitors

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab022 ◽

2021 ◽

Cited By ~ 1

Author(s):

Dawn L Hershman ◽

Alfred I Neugut ◽

Anna Moseley ◽

Kathryn B Arnold ◽

Julie R Gralow ◽

...

Keyword(s):

Aromatase Inhibitors ◽

Text Messaging ◽

Patient Reported Outcomes ◽

Risk Level ◽

Targeted Interventions ◽

Patient Reported ◽

Risk Patients ◽

Baseline Characteristics ◽

Composite Risk ◽

Endocrine Symptoms

Abstract Background Nonadherence to aromatase inhibitors (AIs) is common and increases risk of breast cancer (BC) recurrence. We analyzed factors associated with nonadherence among patients enrolled in S1105, a randomized trial of text messaging. Methods At enrollment, patients were required to have been on an adjuvant AI for at least 30 days and were asked about financial, medication, and demographic factors. They completed patient-reported outcomes (PROs) representing pain (Brief Pain Inventory), endocrine symptoms (Functional Assessment of Cancer Therapy–Endocrine Symptoms), and beliefs about medications (Treatment Satisfaction Questionnaire for Medicine; Brief Medication Questionnaire). Our primary endpoint was AI nonadherence at 36 months, defined as urine AI metabolite assay of less than 10 ng/mL or no submitted specimen. We evaluated the association between individual baseline characteristics and nonadherence with logistic regression. A composite risk score reflecting the number of statistically significant baseline characteristics was examined. Results We analyzed data from 702 patients; median age was 60.9 years. Overall, 35.9% patients were nonadherent at 36 months. Younger patients (younger than age 65 years) were more nonadherent (38.8% vs 28.6%, odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.05 to 2.16; P = .02). Fourteen baseline PRO scales were each statistically significantly associated with nonadherence. In a composite risk model categorized into quartile levels, each increase in risk level was associated with a 46.5% increase in the odds of nonadherence (OR = 1.47, 95% CI =1.26 to 1.70; P < .001). The highest-risk patients were more than 3 times more likely to be nonadherent than the lowest-risk patients (OR = 3.14, 95% CI = 1.97 to 5.02; P < .001). Conclusions The presence of multiple baseline PRO-specified risk factors was statistically significantly associated with AI nonadherence. The use of these assessments can help identify patients for targeted interventions to improve adherence.

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Response Rate of Patient Reported Outcomes: the Delivery Method Matters

10.21203/rs.3.rs-141497/v1 ◽

2021 ◽

Author(s):

Olaf Neve ◽

Peter Paul G. Van Benthem ◽

Anne M. Stiggelbout ◽

Erik F. Hensen

Keyword(s):

Outpatient Clinic ◽

Patient Reported Outcomes ◽

Response Rate ◽

Response Rates ◽

Delivery Mode ◽

Delivery Method ◽

Delivery Methods ◽

Substantial Impact ◽

Patient Reported ◽

The Impact

Abstract Background: Patient Reported Outcomes (PROs) are subjective outcomes of disease and/or treatment in clinical research. For effective evaluations of PROs, high response rates are crucial. This study assessed the impact of the delivery method on the patients’ response rate.Methods: A cohort of patients with a unilateral vestibular schwannoma (a condition with substantial impact on quality of life, requiring prolonged follow-up) was assigned to three delivery methods: email, regular mail, and hybrid. Patients were matched for age and time since the last visit to the outpatient clinic. The primary outcome was the response rate, determinants other than delivery mode were age, education and time since the last consultation. In addition, the effect of a second reminder by phone was evaluated. Results: In total 602 patients participated in this study. The response rates for delivery by email, hybrid, and mail were 45%, 58% and 60%, respectively. The response rates increased after a reminder by phone to 62%, 67% and 64%, respectively. A lower response rate was seen in association with a low level of education and longer time interval since last outpatient clinic visit.Conclusion: The response rate for PRO surveys is influenced by the delivery method. PRO surveys by regular mail yield the highest response rate, followed by hybrid and email delivery methods. Hybrid delivery combines good response rates with the ease of digitally returned questionnaires.

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Ensuring a high response rate to patient reported outcomes in surgical trials using incentives - a trial manager perspective

Trials ◽

10.1186/1745-6215-14-s1-o83 ◽

2013 ◽

Vol 14 (S1) ◽

Author(s):

Hanne Bruhn ◽

Alison McDonald ◽

Angus Watson ◽

John Norrie

Keyword(s):

Patient Reported Outcomes ◽

Response Rate ◽

High Response Rate ◽

High Response ◽

Surgical Trials ◽

Patient Reported ◽

Trial Manager

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Response rate and costs for automated patient-reported outcomes collection alone compared to combined automated and manual collection

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-019-0121-6 ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 4

Author(s):

Yvette Pronk ◽

Peter Pilot ◽

Justus M. Brinkman ◽

Ronald J. van Heerwaarden ◽

Walter van der Weegen

Keyword(s):

Patient Reported Outcomes ◽

Response Rate ◽

Patient Reported

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Feasibility of implementing a same-day electronic screening tool for clinical assessment to measure patient-reported outcomes for eliciting actionable information on adherence to HIV medication and related factors in a busy Canadian urban HIV clinic

International Journal of STD & AIDS ◽

10.1177/09564624211032796 ◽

2021 ◽

pp. 095646242110327

Author(s):

Shivali Suri ◽

Deborah Yoong ◽

Duncan Short ◽

Darrell HS Tan ◽

Mark Naccarato ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Screening Tool ◽

Response Rate ◽

Family Doctor ◽

Participation Rate ◽

Art Adherence ◽

Related Factors ◽

Electronic Screening ◽

Patient Reported ◽

Optimal Adherence

Background: An optimal adherence to antiretroviral therapy (ART) is fundamental for suppression of HIV viral load and favourable treatment outcomes. Patient-reported outcomes (PROs) are effective tools for improving patient–provider communication and focusing providers’ awareness on current health problems. The objectives of this analysis were (1) to determine the feasibility of implementing an electronic screening tool to measure PROs in a Canadian HIV clinic to obtain information on ART adherence and related factors and (2) to determine the factors related to sub-optimal adherence. Methods: This implementation research with a convenience sample of 600 people living with HIV (PLWH) was conducted in a busy, academic, urban HIV clinic in Toronto, Canada. PLWH were approached to participate in PRO assessments just prior to their in-clinic appointments, including health-related domains such as mental health, housing, nutrition, financial stress and medication adherence, and responses were summarized on a single sheet available for providers to review. Feasibility of implementing PROs was assessed by quantifying response rate, completion rate, time taken and participation rate. Medication adherence was elicited by self-report of the percentage of prescribed HIV medications taken in the last month. Unadjusted and adjusted odds ratios were estimated from logistic regression models to identify factors associated with adherence of <95%. Results: Of the 748 PLWH invited to participate, 692 (participation rate: 92.5%) completed the PRO assessments as standard of care in clinic. Of these, 600 consented to the use of their PRO results for research and were included in this analysis. The average response rate to the ART-related questions was 96.8% and mean completion rate was 95.5%. The median time taken to complete the assessment was 12.0 (IQR = 8.4–17.3) min, adjusted 8.7 (IQR = 7.2–10.8) min. 445 (74.9%) of participants were male, and 153 (26.2%) reported dissatisfaction with ART. 105 (19.7%) of the PLWH reported ART adherence of <95%. Multivariable logistic regression identified the following risk factors for sub-optimal adherence: dissatisfaction with ART (OR = 2.30, 95% CI 1.38–3.83), not having a family doctor or not visiting a family doctor in last year (OR = 1.69, 95% CI 1.02–2.79). Conclusion: Collecting self-reported health information from PLWH through PROs in a busy urban clinic was feasible and can provide relevant information to healthcare providers on issues related to adherence. This has a potential to help in individualizing ambulatory care.

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Multicenter Phase II Study of Whole-Body and Intracranial Activity With Ceritinib in Patients With ALK-Rearranged Non–Small-Cell Lung Cancer Previously Treated With Chemotherapy and Crizotinib: Results From ASCEND-2

Journal of Clinical Oncology ◽

10.1200/jco.2015.65.5936 ◽

2016 ◽

Vol 34 (24) ◽

pp. 2866-2873 ◽

Cited By ~ 176

Author(s):

Lucio Crinò ◽

Myung-Ju Ahn ◽

Filippo De Marinis ◽

Harry J.M. Groen ◽

Heather Wakelee ◽

...

Keyword(s):

Lung Cancer ◽

Brain Metastases ◽

Patient Reported Outcomes ◽

Overall Response Rate ◽

Response Rate ◽

Whole Body ◽

Prior Therapy ◽

Patient Reported ◽

Previously Treated

Purpose Phase I data (ASCEND-1) showed ceritinib efficacy in patients with ALK-rearranged non–small-cell lung cancer (NSCLC), regardless of brain metastases status and with or without prior therapy with an inhibitor of the ALK protein. Data are presented from a phase II trial (ASCEND-2) in which ceritinib efficacy and safety were evaluated in patients who had ALK-rearranged NSCLC previously treated with at least one platinum-based chemotherapy and who had experienced progression during crizotinib treatment as their last prior therapy. Patients and Methods Patients with advanced ALK-rearranged NSCLC, including those with asymptomatic or neurologically stable baseline brain metastases, received oral ceritinib 750 mg/d. Whole-body and intracranial responses were investigator assessed (according to RECIST version 1.1). Patient-reported outcomes were evaluated with the Lung Cancer Symptom Scale and European Organisation for Research and Treatment of Cancer surveys (the core-30 and the 13-item lung cancer–specific quality-of-life questionnaires). Results All 140 patients enrolled had received two or more previous treatment regimens, and all patients had received crizotinib. The median duration of exposure and the follow-up time with ceritinib were 8.8 months (range, 0.1 to 19.4 months) and 11.3 months (range, 0.1 to 18.9 months), respectively. Investigator-assessed overall response rate was 38.6% (95% CI, 30.5% to 47.2%). Secondary end points, all investigator assessed, included disease control rate (77.1%; 95% CI, 69.3% to 83.8%), time to response (median, 1.8 months; range, 1.6 to 5.6 months), duration of response (median, 9.7 months; 95% CI, 7.1 to 11.1 months), and progression-free survival (median, 5.7 months; 95% CI, 5.4 to 7.6 months). Of 100 patients with baseline brain metastases, 20 had active target lesions at baseline; investigator-assessed intracranial overall response rate was 45.0% (95% CI, 23.1% to 68.5%). The most common adverse events (majority, grade 1 or 2) for all treated patients were nausea (81.4%), diarrhea (80.0%), and vomiting (62.9%). Patient-reported outcomes showed a trend toward improved symptom burden. The global quality-of-life score was maintained during treatment. Conclusion Consistent with its activity in ASCEND-1, ceritinib treatment provided clinically meaningful and durable responses with manageable tolerability in chemotherapy- and crizotinib-pretreated patients, including those with brain metastases.

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