Patient and clinician perceptions of a digital patient monitoring program in the community oncology setting: Findings from the Texas Two-Step Study.

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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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 Clinical Cancer Informatics ◽

10.1200/cci.20.00081 ◽

2020 ◽

pp. 947-957

Author(s):

Ethan Basch ◽

Angela M. Stover ◽

Deborah Schrag ◽

Arlene Chung ◽

Jennifer Jansen ◽

...

Keyword(s):

Cancer Care ◽

Patient Reported Outcomes ◽

Clinical Utility ◽

Multicenter Trial ◽

Digital Systems ◽

User Perceptions ◽

Patient Feedback ◽

Community Oncology ◽

Patient Reported ◽

Oncology Practice

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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Patient and Provider Perspectives Regarding Criteria for Patient Prioritization in Rehabilitation Programs (Preprint)

10.2196/preprints.14495 ◽

2019 ◽

Author(s):

Julien Déry ◽

Angel Ruiz ◽

François Routhier ◽

Marie-Pierre Gagnon ◽

André Côté ◽

...

Keyword(s):

Service Providers ◽

Quebec City ◽

Web Based ◽

Rehabilitation Programs ◽

Provider Perspectives ◽

Patient Prioritization ◽

Services Sociaux ◽

Multiple Case ◽

Patient And Provider Perspectives

BACKGROUND Queueing patients on waiting lists is a common practice to manage access to rehabilitation services. To increase fairness and equity in access, a strategy emerging from the literature is patient prioritization. The goal is for patients with the greatest needs to be treated first and for patient wait times to be determined objectively on the basis of explicit criteria. Selecting criteria, however, is a complex task because it is important to simultaneously consider the objectives of all stakeholders. OBJECTIVE The aim of this study was to compare service users’ and service providers’ perspectives regarding patient prioritization criteria in two rehabilitation programs. METHODS We conducted a multiple case study in two rehabilitation programs at the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale in Quebec City (Canada), i.e. a driving evaluation program (DEP) and a compression garment manufacturing program (CGMP). We sent a web-based survey asking two groups (patients and providers) of informed stakeholders to individually produce a set of criteria. We then conducted an inductive thematic analysis where each group’s individual answers were coded and combined in a single set of criteria. RESULTS Stakeholders from the DEP identified a total of 22 criteria to prioritize patients while those from the CGMP listed 27 criteria. Providers shared 76% of the criteria mentioned by patients. Some criteria, such as age, occupation, functional level, pain, absence of caregiver, and time since referral, were considered important by both stakeholders in both programs. CONCLUSIONS Patients and providers tended to have similar opinions about a majority of the criteria to prioritize patients in waitlists. Nonetheless, our study confirms that patients and providers base their choices on different types of knowledge and values, which explains some of the differences observed. Taking into consideration the opinions of all stakeholders concerning prioritization criteria is an important part of the decision-making process, based on a multiple constituency approach.

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Collecting patient reported outcomes to facilitate prescription opioid management: Development and testing of the Opioid Management App (OM-App) (Preprint)

10.2196/preprints.23633 ◽

2020 ◽

Author(s):

Jessica Robinson-Papp ◽

Gabriela Cedillo ◽

Richa Deshpande ◽

Mary Catherine George ◽

Qiuchen Yang ◽

...

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Risk Behaviors ◽

Digital Health ◽

Monitoring Program ◽

Prescription Opioid ◽

Research Database ◽

Cross Sectional ◽

Study Duration ◽

Patient Reported

BACKGROUND Collecting patient-reported data needed by clinicians to adhere to opioid prescribing guidelines represents a significant time burden. OBJECTIVE We developed and tested an opioid management app (OM-App) to collect these data directly from patients. METHODS OM-App used a pre-existing digital health platform to deliver daily questions to patients via text-message and organize responses into a dashboard. We pilot tested OM-App over 9 months in 40 diverse participants with HIV who were prescribed opioids for chronic pain. Feasibility outcomes included: ability to export/integrate OM-App data with other research data; patient-reported barriers and adherence to OM-App use; capture of opioid-related harms, risk behaviors and pain intensity/interference; comparison of OM-App data to urine drug testing, prescription drug monitoring program data, and validated questionnaires. RESULTS OM-App data was exported/integrated into the research database after minor modifications. Thirty-nine of 40 participants were able to use OM-App, and over the study duration 70% of all OM-App questions were answered. Although the cross-sectional prevalence of opioid-related harms and risk behaviors reported via OM-App was low, some of these were not obtained via the other measures, and over the study duration all queried harms/risks were reported at least once via OM-App. Clinically meaningful changes in pain intensity/interference were captured. CONCLUSIONS OM-App was used by our diverse patient population to produce clinically relevant opioid- and pain-related data, which was successfully exported and integrated into a research database. These findings suggest that OM-App may be a useful tool for remote monitoring of patients prescribed opioids for chronic pain. CLINICALTRIAL NCT03669939 INTERNATIONAL REGISTERED REPORT RR2-doi:10.1016/j.conctc.2019.100468

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Healthcare Provider Perspectives on Bipolar I Disorder Screening and the Rapid Mood Screener (RMS), a Pragmatic, New Tool

CNS Spectrums ◽

10.1017/s1092852921000201 ◽

2021 ◽

Vol 26 (2) ◽

pp. 181-183

Author(s):

Michael E. Thase ◽

Stephen M. Stahl ◽

Roger S. McIntyre ◽

Tina Matthews-Hayes ◽

Mehul Patel ◽

...

Keyword(s):

Depressive Symptoms ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

Screening Tool ◽

Positive Impact ◽

Screening Tools ◽

Predictive Values ◽

Bipolar I Disorder ◽

Provider Perspectives ◽

Patient Reported

AbstractIntroductionAlthough mania is the hallmark symptom of bipolar I disorder (BD-I), most patients initially present for treatment with depressive symptoms. Misdiagnosis of BD-I as major depressive disorder (MDD) is common, potentially resulting in poor outcomes and inappropriate antidepressant monotherapy treatment. Screening patients with depressive symptoms is a practical strategy to help healthcare providers (HCPs) identify when additional assessment for BD-I is warranted. The new 6-item Rapid Mood Screener (RMS) is a pragmatic patient-reported BD-I screening tool that relies on easily understood terminology to screen for manic symptoms and other BD-I features in <2 minutes. The RMS was validated in an observational study in patients with clinically confirmed BD-I (n=67) or MDD (n=72). When 4 or more items were endorsed (“yes”), the sensitivity of the RMS for identifying patients with BP-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. To more thoroughly understand screening tool use among HCPs, a 10-minute survey was conducted.MethodsA nationwide sample of HCPs (N=200) was selected using multiple HCP panels; HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the widely recognized Mood Disorder Questionnaire (MDQ). Results were reported by grouped specialties (primary care physicians, general nurse practitioners [NPs]/physician assistants [PAs], psychiatrists, and psychiatric NPs/PAs). Included HCPs were in practice <30 years, spent at least 75% of their time in clinical practice, saw at least 10 patients with depression per month, and diagnosed MDD or BD in at least 1 patient per month. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence interval.ResultsAmong HCPs, 82% used a tool to screen for MDD, while 32% used a tool for BD. Screening tool attributes considered to be of the greatest value included sensitivity (68%), easy to answer questions (66%), specificity (65%), confidence in results (64%), and practicality (62%). Of HCPs familiar with screening tools, 70% thought the RMS was at least somewhat better than other screening tools. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. Most HCPs (81%) preferred the RMS to the MDQ, and the RMS significantly outperformed the MDQ across valued attributes; 76% reported that they were likely to use the RMS to screen new patients with depressive symptoms. A total of 84% said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder.DiscussionThe RMS was viewed positively by HCPs who participated in a brief survey. A large percentage of respondents preferred the RMS over the MDQ and indicated that they would use it in their practice. Collectively, responses indicated that the RMS is likely to have a positive impact on screening behavior.FundingAbbVie Inc.

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