scholarly journals Feasibility of an Interactive Patient Portal for Monitoring Physical Activity, Remote Symptom Reporting, and Patient Education in Oncology: Qualitative Study

JMIR Cancer ◽  
10.2196/15539 ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. e15539 ◽  
Author(s):  
Michael Marthick ◽  
Anna Janssen ◽  
Birinder S Cheema ◽  
Jennifer Alison ◽  
Tim Shaw ◽  
...  
Keyword(s):  
Physical Activity ◽  
Digital Health ◽  
Symptom Reporting ◽  
Patient Portal ◽  
Semistructured Interview ◽  
Web Portal ◽  
Patient Portals ◽  
Web Based ◽  
Qualitative Thematic Analysis ◽  
The Web

Background Digital health interventions, such as the use of patient portals, have been shown to offer benefits to a range of patients including those with a diagnosis of cancer. Objective This study aimed to explore the participant experience and perception of using an interactive Web-based portal for monitoring physical activity, remote symptom reporting, and delivering educational components. Methods Participants who were currently under treatment or had recently completed intensive treatment for cancer were recruited to three cohorts and invited to join a Web-based portal to enhance their physical activity. Cohort 1 received Web portal access and an activity monitor; cohort 2 had additional summative messaging; and cohort 3 had additional personalized health coaching messaging. Following the 10-week intervention, participants were invited to participate in a semistructured interview. Interview recordings were transcribed and evaluated using qualitative thematic analysis. Results A total of 17 semistructured interviews were carried out. Participants indicated that using the Web portal was feasible. Personalized messaging improved participant perceptions of the value of the intervention. There was a contrast between cohorts and levels of engagement with increasing health professional contact leading to an increase in engagement. Educational material needs to be tailored to the participants’ cancer treatment status, health literacy, and background. Conclusions Participants reported an overall positive experience using the Web portal and that personalized messaging positively impacted on their health behaviors. Future studies should focus more on design of interventions, ensuring appropriate tailoring of information and personalization of behavioral support messaging. International Registered Report Identifier (IRRID) RR2-10.2196/9586

scholarly journals Feasibility of an Interactive Patient Portal for Monitoring Physical Activity, Remote Symptom Reporting, and Patient Education in Oncology: Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Michael Marthick ◽  
Anna Janssen ◽  
Birinder S Cheema ◽  
Jennifer Alison ◽  
Tim Shaw ◽  
...  
Keyword(s):  
Physical Activity ◽  
Digital Health ◽  
Symptom Reporting ◽  
Patient Portal ◽  
Semistructured Interview ◽  
Web Portal ◽  
Patient Portals ◽  
Web Based ◽  
Qualitative Thematic Analysis ◽  
The Web

BACKGROUND Digital health interventions, such as the use of patient portals, have been shown to offer benefits to a range of patients including those with a diagnosis of cancer. OBJECTIVE This study aimed to explore the participant experience and perception of using an interactive Web-based portal for monitoring physical activity, remote symptom reporting, and delivering educational components. METHODS Participants who were currently under treatment or had recently completed intensive treatment for cancer were recruited to three cohorts and invited to join a Web-based portal to enhance their physical activity. Cohort 1 received Web portal access and an activity monitor; cohort 2 had additional summative messaging; and cohort 3 had additional personalized health coaching messaging. Following the 10-week intervention, participants were invited to participate in a semistructured interview. Interview recordings were transcribed and evaluated using qualitative thematic analysis. RESULTS A total of 17 semistructured interviews were carried out. Participants indicated that using the Web portal was feasible. Personalized messaging improved participant perceptions of the value of the intervention. There was a contrast between cohorts and levels of engagement with increasing health professional contact leading to an increase in engagement. Educational material needs to be tailored to the participants’ cancer treatment status, health literacy, and background. CONCLUSIONS Participants reported an overall positive experience using the Web portal and that personalized messaging positively impacted on their health behaviors. Future studies should focus more on design of interventions, ensuring appropriate tailoring of information and personalization of behavioral support messaging.

scholarly journals File Not Found: Rarity in an Age of Digital Plenty

2014 ◽  
Vol 15 (1) ◽  
pp. 68-74 ◽  
Author(s):  
Doug Reside
Keyword(s):  
Cultural Heritage ◽  
Good Deal ◽  
The State ◽  
Web Portal ◽  
Web Based ◽  
Rare Books ◽  
The One ◽  
The Web

In the first section of the submission guidelines for this esteemed journal, would-be authors are informed, “RBM: A Journal of Rare Books, Manuscripts, and Cultural Heritage uses a web-based, automated, submission system to track and review manuscripts. Manuscripts should be sent to the editor, […], through the web portal[…]” The multivalent uses of the word “manuscript” in this sentence reveal a good deal about the state of our field. This journal is dedicated to the study of manuscripts, and it is understood by most readers that the manuscripts being studied are of the “one-of-a-kind” variety (even rarer than the “rare . . .

scholarly journals Paper-Based Versus Web-Based Versions of Self-Administered Questionnaires, Including Food-Frequency Questionnaires: Prospective Cohort Study

10.2196/11997 ◽  
2019 ◽  
Vol 5 (4) ◽  
pp. e11997 ◽  
Author(s):  
Itziar Zazpe ◽  
Susana Santiago ◽  
Carmen De la Fuente-Arrillaga ◽  
Jorge M Nuñez-Córdoba ◽  
Maira Bes-Rastrollo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Alcohol Consumption ◽  
Healthy Eating ◽  
Prospective Cohort ◽  
Leisure Time ◽  
Eating Attitudes ◽  
Web Based ◽  
Food Frequency ◽  
The Web

Background Web-based questionnaires allow collecting data quickly, with minimal costs from large sample groups and through Web-based self-administered forms. Until recently, there has been a lack of evidence from large-scale epidemiological studies and nutrition surveys that have evaluated the comparison between traditional and new technologies to measure dietary intake. Objective This study aimed to compare results from the general baseline questionnaire (Q_0) and the 10-year follow-up questionnaire (Q_10) in the Seguimiento Universidad de Navarra (SUN) prospective cohort, obtained from different subjects, some of whom used a paper-based version, and others used a Web-based version. Both baseline and 10-year assessments included a validated 136-item semiquantitative food-frequency questionnaire (FFQ), used to collect dietary intake. Methods The SUN project is a prospective cohort study (with continuous open recruitment and many participants who were recently recruited). All participants were university graduates. Participants who completed the validated FFQ at baseline (FFQ_0, n=22,564) were selected. The variables analyzed were classified into 6 groups of questions: (1) FFQ (136 items), (2) healthy eating attitudes (10 items), (3) alcohol consumption (3 items), (4) physical activity during leisure time (17 items), (5) other activities (24 items), and (6) personality traits (3 items). Multiple linear and logistic regression models were used to assess the adjusted differences between the mean number of missing values and the risk of having apparently incorrect values for FFQ items or mismatches and inconsistencies in dietary variables. Results Only 1.5% (339/22564) and 60.71% (6765/11144) participants reported their information using the Web-based version for Q_0 and Q_10, respectively, and 51.40 % (11598/22564) and 100.00% (11144/11144) of participants who completed the Q_0 and Q_10, respectively, had the option of choosing the Web-based version. Sociodemographic, lifestyle, health characteristics, food consumption, and energy and nutrient intakes were similar among participants, according to the type of questionnaire used in Q_10. Less than 0.5% of values were missing for items related to healthy eating attitudes, alcohol consumption, and personality traits in the Web-based questionnaires. The proportion of missing data in FFQ, leisure time physical activity, and other activities was higher in paper-based questionnaires than Web-based questionnaires. In Web-based questionnaires, a high degree of internal consistency was found when comparing answers that should not be contradictory, such as the frequency of fruit as dessert versus total fruit consumption and the frequency of fried food consumptions versus oil consumption. Conclusions Incorporating a Web-based version for a baseline and 10-year questionnaire has not implicated a loss of data quality in this cohort of highly educated adults. Younger participants showed greater preference for Web-based questionnaires. Web-based questionnaires were filled out to a greater extent and with less missing items than paper-based questionnaires. Further research is needed to optimize data collection and response rate in Web-based questionnaires.

scholarly journals An Interactive Web Portal for Tracking Oncology Patient Physical Activity and Symptoms: Prospective Cohort Study (Preprint)

2018 ◽  
Author(s):  
Michael Marthick ◽  
Haryana M Dhillon ◽  
Jennifer A Alison ◽  
Bobby S Cheema ◽  
Tim Shaw
Keyword(s):  
Physical Activity ◽  
Digital Health ◽  
Activity Levels ◽  
Web Portal ◽  
Oncology Patient ◽  
Supportive Cancer Care ◽  
Physical Activity Levels ◽  
Coaching Methods ◽  
Professional Contact ◽  
History Of

BACKGROUND Physical activity levels typically decline during cancer treatment and often do not return to prediagnosis or minimum recommended levels. Interventions to promote physical activity are needed. Support through the use of digital health tools may be helpful in this situation. OBJECTIVE The goal of the research was to evaluate the feasibility, usability, and acceptability of an interactive Web portal developed to support patients with cancer to increase daily physical activity levels. METHODS A Web portal for supportive cancer care which was developed to act as a patient-clinician information and coaching tool focused on integrating wearable device data and remote symptom reporting. Patients currently receiving or who had completed intensive anticancer therapy were recruited to 3 cohorts. All cohorts were given access to the Web portal and an activity monitor over a 10-week period. Cohort 2 received additional summative messaging, and cohort 3 received personalized coaching messaging. Qualitative semistructured interviews were completed following the intervention. The primary outcome was feasibility of the use of the portal assessed as both the number of log-ins to the portal to record symptoms and the completion of post-program questionnaires. RESULTS Of the 49 people were recruited, 40 completed the intervention. Engagement increased with more health professional contact and was highest in cohort 3. The intervention was found to be acceptable by participants. CONCLUSIONS The portal was feasible for use by people with a history of cancer. Further research is needed to determine optimal coaching methods.

scholarly journals Racial, Ethnic, and Socioeconomic Disparities in Web-Based Patient Portal Usage Among Kidney and Liver Transplant Recipients: Cross-Sectional Study (Preprint)

2018 ◽  
Author(s):  
Joel Wedd ◽  
Mohua Basu ◽  
Laura M Curtis ◽  
Kayla Smith ◽  
Denise J Lo ◽  
...  
Keyword(s):  
Higher Education ◽  
Liver Transplant ◽  
Kidney Transplant ◽  
Socioeconomic Disparities ◽  
Patient Portal ◽  
Transplant Recipients ◽  
Patient Portals ◽  
Web Based ◽  
Liver Transplant Recipients ◽  
Racial Ethnic

BACKGROUND Kidney and liver transplant recipients must manage a complex care regimen after kidney transplant. Although the use of Web-based patient portals is known to improve patient-provider communication and health outcomes in chronic disease populations by helping patients manage posttransplant care, disparities in access to and use of portals have been reported. Little is known about portal usage and disparities among kidney and liver transplant recipients. OBJECTIVE The aim of this study was to examine patient racial/ethnic, socioeconomic, and clinical characteristics associated with portal usage among kidney and liver transplant recipients. METHODS The study included all adult kidney and liver transplant recipients (n=710) at a large academic transplant center in the Southeastern United States between March 2014 and November 2016. Electronic medical record data were linked with Cerner portal usage data. Patient portal use was defined as any portal activity (vs no activity) recorded in the Cerner Web-based portal, including viewing of health records, lab results, medication lists, and the use of secure messaging. Multivariable log-binomial regression was used to determine the patient demographic, clinical, and socioeconomic characteristics associated with portal usage, stratified by organ. RESULTS Among 710 transplant recipients (n=455 kidney, n=255 liver), 55.4% (252/455) of kidney recipients and 48.2% (123/255) of liver recipients used the patient portal. Black patients were less likely to use the portal versus white patients among both kidney (57% black vs 74% white) and liver (28% black vs 55% white) transplant recipients. In adjusted multivariable analyses, kidney transplant recipients were more likely to use the portal if they had higher education; among liver recipients, patients who were white versus black and had higher education were more likely to use the portal. CONCLUSIONS Despite studies showing that patient portals have the potential to benefit transplant recipients as a tool for health management, racial and socioeconomic disparities should be considered before widespread implementation. Transplant centers should include portal training and support to all patients to encourage use, given its potential to improve outcomes.

scholarly journals A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study (Preprint)

2017 ◽  
Author(s):  
Raheem J Paxton ◽  
Richard Hajek ◽  
Patricia Newcomb ◽  
Megha Dobhal ◽  
Sujana Borra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Physical Activity ◽  
Cancer Survivors ◽  
Ethnic Minority ◽  
Lifestyle Intervention ◽  
Breast Cancer Survivors ◽  
Web Based ◽  
Phone Calls ◽  
Racial And Ethnic Minority ◽  
The Web

BACKGROUND Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web, yet few Web-based studies exist in this population. OBJECTIVE The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program, “A Lifestyle Intervention Via Email (ALIVE),” delivered to a sample of racial and ethnic minority breast cancer survivors. METHODS Survivors (mean age: 52 years, 83% [59/71] African American) were recruited and randomized to receive either the ALIVE program’s 3-month physical activity track or its 3-month dietary track. The fully automated system provided tools for self-monitoring and goal setting, tailored content, and automated phone calls. Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study. RESULTS Upon completion, 44 of 71 survivors completed the study. Our “intention-to-treat” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track (+97 vs. +49 min/week, P<.001). Similarly, reductions in total sedentary time among those in the physical activity track (−304 vs. −59 min/week, P<.001) was nearly 5 times greater than that for participants in the dietary track. Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber (+4.4 g/day), fruits and vegetables (+1.0 cup equivalents/day), and reductions in saturated fat (−2.3 g/day) and trans fat (−0.3 g/day) (all P<.05). However, these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track (all P>.05). Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors (97%), were satisfied with ALIVE (82%), and felt that ALIVE was effective (73%). However, survivors expressed concerns about the functionality of the interactive emails. CONCLUSIONS ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation. Although survivors favored the educational content, a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform. CLINICALTRIAL ClinicalTrials.gov NCT02722850; https://clinicaltrials.gov/ct2/show/NCT02722850 (Archived by WebCite at http://www.webcitation.org/6tHN9VsPh)

scholarly journals Digital Health Technologies Respond to the COVID-19 Pandemic In a Tertiary Hospital in China: Development and Usability Study

10.2196/24505 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e24505 ◽  
Author(s):  
Wanmin Lian ◽  
Li Wen ◽  
Qiru Zhou ◽  
Weijie Zhu ◽  
Wenzhou Duan ◽  
...  
Keyword(s):  
Health Care ◽  
Digital Health ◽  
Tertiary Hospital ◽  
Service Platform ◽  
Web Based ◽  
Symptom Monitoring ◽  
Health Technologies ◽  
Epidemic Period ◽  
Control And Prevention ◽  
The Web

Background The outbreak of COVID-19 has caused a continuing global pandemic. Hospitals are integral to the control and prevention of COVID-19; however, they are facing numerous challenges during the epidemic. Objective Our study aimed to introduce the practical experience of the design and implementation of a web-based COVID-19 service platform at a tertiary hospital in China as well as the preliminary results of the implementation. Methods The web-based COVID-19 service platform was deployed within the health care system of the Guangdong Second Provincial General Hospital and Internet Hospital; the function of the platform was to provide web-based medical services for both members of the public and lay health care workers. The focal functions of this system included automated COVID-19 screening, related symptom monitoring, web-based consultation, and psychological support; it also served as a COVID-19 knowledge hub. The design and process of each function are introduced. The usage data for the platform service were collected and are represented by three periods: the pre-epidemic period (December 22, 2019, to January 22, 2020, 32 days), the controlled period (January 23 to March 31, 2020, 69 days), and the postepidemic period (April 1 to June 30, 2020, 91 days). Results By the end of June 2020, 96,642 people had used the automated COVID-19 screening and symptom monitoring systems 161,884 and 7,795,194 times, respectively. The number of general web-based consultation services per day increased from 30 visits in the pre-epidemic period to 122 visits during the controlled period, then dropped to 73 visits in the postepidemic period. The psychological counseling program served 636 clients during the epidemic period. For people who used the automated COVID-19 screening service, 160,916 (99.40%) of the total users were classified in the no risk category. 464 (0.29%) of the people were categorized as medium to high risk, and 12 people (0.01%) were recommended for further COVID-19 testing and treatment. Among the 96,642 individuals who used the COVID-19 related symptoms monitoring service, 6696 (6.93%) were symptomatic at some point during the monitoring period. Fever was the most frequently reported symptom, with 2684/6696 symptomatic people (40.1%) having had this symptom. Cough and sore throat were also relatively frequently reported by the 6696 symptomatic users (1657 people, 24.7%, and 1622 people, 24.2%, respectively). Conclusions The web-based COVID-19 service platform implemented at a tertiary hospital in China is exhibited to be a role model for using digital health technologies to respond to the COVID-19 pandemic. The digital solutions of automated COVID-19 screening, daily symptom monitoring, web-based care, and knowledge propagation have plausible acceptability and feasibility for complementing offline hospital services and facilitating disease control and prevention.

scholarly journals The State of Evidence in Patient Portals: Umbrella Review (Preprint)

2020 ◽  
Author(s):  
Marcy G Antonio ◽  
Olga Petrovskaya ◽  
Francis Lau
Keyword(s):  
Knowledge Translation ◽  
Systematic Reviews ◽  
Business Models ◽  
Digital Health ◽  
Patient Portal ◽  
Umbrella Review ◽  
Patient Portals ◽  
Meta Level ◽  
Patient Reported ◽  
Over Time

BACKGROUND Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. OBJECTIVE This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. METHODS For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. RESULTS Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. CONCLUSIONS Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.

scholarly journals Development of a Web Portal for Physical Activity and Symptom Tracking in Oncology Patients: Protocol for a Prospective Cohort Study (Preprint)

2017 ◽  
Author(s):  
Michael Marthick ◽  
Haryana M Dhillon ◽  
Jennifer A Alison ◽  
Birinder S Cheema ◽  
Tim Shaw
Keyword(s):  
Physical Activity ◽  
Goal Attainment ◽  
Activity Levels ◽  
Web Portal ◽  
Web Based ◽  
Activity Monitors ◽  
Physical Activity Levels ◽  
Related Quality ◽  
Health Related ◽  
History Of

BACKGROUND Significant benefits accrue from increasing physical activity levels in people with a history of cancer. Physical activity levels can be increased using behavioral change interventions in this population. Access to Web portals and provision of activity monitors to provide feedback may support behavior change by encouraging patient engagement in physical therapy. The Web portal evaluated in this study will provide a system to monitor physical activity and sleep, for use by both clinician and patient, along with symptom and health-related quality of life tracking capabilities. OBJECTIVE The aim of this study was to outline a protocol for a feasibility study focused on a Web-based portal that provides activity monitoring and personalized messaging to increase physical activity in people with cancer. METHODS Using a longitudinal cohort design, people with cancer will be serially allocated to 3 intervention cohorts of 20 participants each and followed for 10 weeks. Cohort 1 will be provided a wearable activity monitor and access to a Web-based portal. Cohort 2 will receive the same content as Cohort 1 and in addition will receive a weekly activity summary message. Cohort 3 will receive the same content as Cohorts 1 and 2 and in addition will receive a personalized weekly coaching message. Feasibility of the use of the portal is the primary outcome. RESULTS Results are expected in early 2018. Outcome measures will include goal attainment and completion rate. CONCLUSIONS This study will provide information about the feasibility of investigating eHealth initiatives to promote physical activity in people with cancer. REGISTERED REPORT IDENTIFIER RR1-10.2196/9586

scholarly journals Using the Computer-based Health Evaluation System (CHES) to support self-management of symptoms and functional health: Evaluation of hematological patients’ usage of a web-based patient portal (Preprint)

2020 ◽  
Author(s):  
Jens Lehmann ◽  
Petra Buhl ◽  
Johannes M Giesinger ◽  
Lisa M Wintner ◽  
Monika Sztankay ◽  
...  
Keyword(s):  
Evaluation System ◽  
Functional Health ◽  
Self Management ◽  
Health Evaluation ◽  
Patient Portal ◽  
Structured Interviews ◽  
Patient Portals ◽  
Web Based ◽  
Patient Reported ◽  
Hospital Visits

BACKGROUND Patient portals offer the possibility to assess patient-reported outcome measures (PROMs) remotely and first evidence has demonstrated their potential benefits. OBJECTIVE In this study, we evaluated patients’ use of a web-based patient portal where patients can complete PROMs. The portal was developed to supplement routine monitoring at the Department of Internal Medicine V in Innsbruck. METHODS We included patients with cancer who were already participating in the monitoring at the hospital for usage of the patient portal. Patients were introduced to the portal and asked to complete questionnaires prior to their next hospital visits. We used system access logs and three consecutive semi-structured interviews to analyze patients’ usage and evaluation of the portal. RESULTS Between July 2017 and August 2020, we approached N=122 patients for participation in the study, of whom n=102 (83.6%) consented to use the patient portal. Patients were on average 60 (SD 10.4) years old. Of n=71 patients providing data at all study time points, n=26 (36.6%) patients consistently used the portal prior to their hospital visits. During an average session, patients viewed 5.3 different pages and spent 9.4 minutes logged on to the portal. Feedback from interviews was largely positive with no patients reporting difficulties navigating the survey and 50% of patients valuing the self-management tools provided in the portal. CONCLUSIONS Our study demonstrates how a patient portal can complement a routine PROM implementation at the hospital by reducing the burden of administration for the clinical team and offering an additional way for patients to engage with PROMs.

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