Adaptation of Remote Symptom Monitoring Using Electronic Patient-Reported Outcomes for Implementation in Real-World Settings

Abstract

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.

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.

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.

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.

© 2022 by American Society of Clinical OncologySUPPORT

This work was supported by the National Institute of Nursing Research (R01NR019058).

Conception and design: All authors

Financial support: Gabrielle B. Rocque

Administrative support: Gabrielle B. Rocque, D’Ambra N. Dent, Stacey A. Ingram, Jennifer Young Pierce, Chelsea L. McGowen

Provision of study materials or patients: Gabrielle B. Rocque, Stacey A. Ingram, Omer Jamy, Smith Giri, Jennifer Young Pierce

Collection and assembly of data: Gabrielle B. Rocque, Stacey A. Ingram, Nicole E. Caston, Haley B. Thigpen, Fallon R. Lalor, Jennifer Young Pierce, Chelsea L. McGowen, Chao-Hui Sylvia Huang

Data analysis and interpretation: All authors

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Adaptation of Remote Symptom Monitoring Using Electronic Patient-Reported Outcomes for Implementation in Real-World Settings

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Gabrielle B. Rocque

This author is an Associate Editor for JCO Oncology Practice. Journal policy recused the author from having any role in the peer review of this manuscript.

Consulting or Advisory Role: Pfizer, Flatiron Health, Gilead Sciences

Research Funding: Carevive Systems, Genentech, Pfizer

Travel, Accommodations, Expenses: Gilead Sciences

Smith Giri

Honoraria: CareVive, OncLive, Sanofi

Research Funding: Carevive Systems, Pack Health, Sanofi (Inst)

Doris Howell

Leadership: Carevive Systems

Consulting or Advisory Role: Carevive

Research Funding: AstraZeneca (Inst)

Ethan M. Basch

Consulting or Advisory Role: SIVAN Innovation, Carevive Systems, Navigating Cancer, AstraZeneca, N-Power Medicine, Resilience Care

Other Relationship: Centers for Medicare and Medicaid Services, National Cancer Institute, American Society of Clinical Oncology, JAMA-Journal of the American Medical Association, Patient-Centered Outcomes Research Institute (PCORI)

Open Payments Link: https://openpaymentsdata.cms.gov/physician/427875/summary

Angela M. Stover

Honoraria: Pfizer, Association of Community Cancer Centers (ACCC), Henry Ford Health System, Purchaser Business Group on Health

Consulting or Advisory Role: Navigating Cancer

Research Funding: Urogen pharma (Inst), SIVAN Innovation (Inst)

No other potential conflicts of interest were reported.

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