Standardized symptom screening: Cancer Care Ontario's expanded prostate cancer index composite for clinical practice (EPIC-CP) provincial implementation approach.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 100-100 ◽  
Author(s):  
Farzana Haji ◽  
Lisa Catherine Barbera ◽  
Colleen Bedford ◽  
Brett Nichols ◽  
Michael Donald Brundage
Keyword(s):  
Prostate Cancer ◽  
Cancer Care ◽  
Symptom Management ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Provider Education ◽  
Symptom Screening ◽  
Communication Processes ◽  
Implementation Approach ◽  
Patient Reported

100 Background: Cancer Care Ontario endorses patient reported outcome measures to improve outcomes and experience for nearly 14 million Ontarians. The EPIC-CP tool, validated to screen/monitor symptoms and side-effects in men with localized prostate cancer, was selected to improve patient and provider experience, and facilitate symptom management. Two pilots tested EPIC-CPs feasibility and acceptability. Subsequent recommendations include: province-wide implementation, improving technological privacy, patient and provider education and communication processes. This abstract will describe the provincial strategy for implementation of EPIC-CP. Methods: The implementation approach involved stakeholder-driven practices based on Kotter’s organizational process framework. Clinical, technical, administrative and patient stakeholder representatives from 14 cancer centres formed working groups to create a climate for change, to engage centres to strategize locally, to implement and sustain change and to address the challenges identified by the EPIC-CP pilot. Results: The final pilot ended in June 2015, and executive endorsement for EPIC-CP provincial implementation in March 2016. A schedule for multi-site phased implementation was informed by stakeholder consultations and began in Oct 2016. Technological privacy improvements were informed by 95 representatives creating a multidisciplinary team tasked with provincial oversight, development of EMR guidelines and IT solutions. Five patient and five clinical educational guides were designed to assist in symptom management, each focusing on one domain of EPIC-CP. Creation of the guides drew on the clinical and scientific expertise among 12 clinicians of varying disciplines in collaboration with four patients. This team assisted in enhancing communication processes by designing 21 training materials, including FAQs and narrated guides, accessible on a central communications hub. Conclusions: Results indicate that this framework-based, stakeholder-driven approach was successful and could be applied to other wide-scale implementations of symptom management tools.

scholarly journals Benefits and Disadvantages of Electronic Patient-reported Outcome Measures: Systematic Review

10.2196/15588 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e15588 ◽  
Author(s):  
Jill Meirte ◽  
Nick Hellemans ◽  
Mieke Anthonissen ◽  
Lenie Denteneer ◽  
Koen Maertens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Quality ◽  
Outcome Measures ◽  
Symptom Management ◽  
Completion Time ◽  
Clinical Decision Making ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Health Technologies ◽  
Patient Reported

Background Patient-reported outcome measures (PROMs) are important in clinical practice and research. The growth of electronic health technologies provides unprecedented opportunities to systematically collect information via PROMs. Objective The aim of this study was to provide an objective and comprehensive overview of the benefits, barriers, and disadvantages of the digital collection of qualitative electronic patient-reported outcome measures (ePROMs). Methods We performed a systematic review of articles retrieved from PubMED and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed during all stages. The search strategy yielded a total of 2333 records, from which 32 met the predefined inclusion and exclusion criteria. The relevant ePROM-related information was extracted from each study. Results Results were clustered as benefits and disadvantages. Reported benefits of ePROMs were greater patient preference and acceptability, lower costs, similar or faster completion time, higher data quality and response rates, and facilitated symptom management and patient-clinician communication. Tablets were the most used ePROM modality (14/32, 44%), and, as a platform, Web-based systems were used the most (26/32, 81%). Potential disadvantages of ePROMs include privacy protection, a possible large initial financial investment, and exclusion of certain populations or the “digital divide.” Conclusions In conclusion, ePROMs offer many advantages over paper-based collection of patient-reported outcomes. Overall, ePROMs are preferred over paper-based methods, improve data quality, result in similar or faster completion time, decrease costs, and facilitate clinical decision making and symptom management. Disadvantages regarding ePROMs have been outlined, and suggestions are provided to overcome the barriers. We provide a path forward for researchers and clinicians interested in implementing ePROMs. Trial Registration PROSPERO CRD42018094795; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=94795

scholarly journals Capturing PROMs in Oncology Through Consistent Nutrition Risk Identification: An Opportunity to Optimize Care by Embedding Patient Participation Facilitated by eHealth Tools

2021 ◽  
pp. 1-2
Author(s):  
Susana  Couto Irving 
Keyword(s):  
Outcome Measures ◽  
Patient Participation ◽  
Cancer Care ◽  
Clinical Care ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Risk Identification ◽  
Nutrition Status ◽  
Pancreatic Tumors ◽  
Patient Reported

Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study). <b>Background:</b> E-health based patient-reported outcome measures (PROMs) have the potential to automate early identification of both nutrition status and distress status in cancer patients while facilitating treatment and encouraging patient participation. This cross-sectional study assessed the acceptability, accuracy, and clinical utility of PROMs collected via E-Health tools among patients undergoing treatment for stomach, colorectal, and pancreatic tumors. <b>Results:</b> Eight-nine percent mostly, or completely, agreed that PROMs via tablets should be integrated in routine clinical care. Men were significantly more likely to require help completing the questionnaires than women (inv.OR = 0.51, 95% CI = (0.27, 0.95), p = 0.035). The level of help needed increased by 3% with each 1-year increase in age (inv. OR = 1.03, 95% CI = (1.01, 1.06), p = 0.013). On average, a patient tended to declare weight which was 0.84 kg inferior to their true weight (Bland and Altman 95 % CI = (–3.9, 5.6); SD: 2.41) and a height which was 0.95 cm superior to their true height (Bland and Altman 95 % CI = (−5, 3.1); SD 2.08). Patient-reported nutrition status was significantly associated with the professionally generated assessment (95% CI = (2.27, 4.15), p &#x3c; 0.001). As nutrition status declined, the distress score increased (95%CI = (0.88, 1.68), p &#x3c; 0.001). Of the patients, 48.8% who were both distressed and malnourished requested supportive care to address their problems. <b>Conclusion:</b> Patient-reported assessments utilizing E-health tools are an accurate and efficient method to encourage patient participation in cancer care while simultaneously ensuring that regular assessment of psycho-social and nutritional aspects of care are efficiently integrated in the daily clinical routine.

A tale of 2,000 charts: Measuring provider response to patient-reported outcome measures.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 157-157
Author(s):  
Gillian Hurwitz ◽  
Zahra Ismail ◽  
Lesley Moody ◽  
Lisa Catherine Barbera
Keyword(s):  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Physical Symptoms ◽  
Patient Reported Outcome ◽  
Assessment System ◽  
Screening Methods ◽  
Depression And Anxiety ◽  
Chart Audit ◽  
Symptom Screening ◽  
Patient Reported

157 Background: Patients undergoing cancer treatment often experience physical and psychosocial symptoms that go undetected by clinicians, which highlights the need to incorporate patient-reported outcome measures (PROMs) in routine care. Systematic symptom screening for cancer patients using the Edmonton Symptom Assessment System (ESAS) is standard practice in Ontario. However, provider response to PROMs is essential to addressing symptom burden. To measure provider response, Regional Cancer Centre (RCC) Leads and Cancer Care Ontario developed a chart audit process. The objective was to determine whether the clinical team acknowledged, assessed and/or addressed symptoms identified by ESAS screening. Methods: RCCs received a chart audit tool with preset options and a data dictionary. Sites audited at least 140 charts for seven of the ESAS symptoms. Sites used a business intelligence tool to access patient charts based on sampling parameters. RCCs were required to audit charts of patients whose ESAS symptom scores were moderate to severe (4-10), with at least five charts in the moderate range (4-6). Results: 2,380 charts from 13 RCCs were audited based on ESAS scores from September to December 2016. Symptoms were most often acknowledged when the intensity was severe (69.9%), regardless of symptom type. Acknowledgement (71.5%), assessment (67.7%) and intervention (55.8%) were most often offered to patients reporting pain. Patients reporting depression and anxiety were the least likely to have the symptom acknowledged (44.5%, 45.0%, respectively) and be offered assessments (45.8%, 50.1%, respectively) and interventions (35.7%, 36.6%, respectively). Patients reporting moderate to severe depression and anxiety most commonly declined interventions (7.8%, 7.7%, respectively). Conclusions: These data show that providers disproportionately respond to physical symptoms, which may be easiest to treat due to clear management plans and referral pathways. To truly offer person-centred care, the emotional burden related to cancer must also be addressed, and providers must be trained to properly respond to psychosocial symptoms. Chart audits identify gaps in symptom management and areas for quality improvement.

scholarly journals Utilizing Patient Reported Outcome Measures (PROMs) in ambulatory oncology in Alberta: Digital reporting at the micro, meso and macro level

2021 ◽  
Vol 5 (S2) ◽  
Author(s):  
Linda Watson ◽  
Andrea Delure ◽  
Siwei Qi ◽  
Claire Link ◽  
Lindsi Chmielewski ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Symptom Management ◽  
Capacity Planning ◽  
Care Delivery ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cancer Type ◽  
Patient Portal ◽  
Ambulatory Oncology ◽  
Patient Reported

AbstractCancer patients experience numerous distressing symptoms and concerns across the course of their illness, which negatively influence their quality of life. Regardless of cancer type, unmanaged symptoms can lead to adverse downstream consequences. Patient Reported Outcome Measures (PROMs) can be used to inform patient care and lead to targeted symptom management but simply gathering this information does not improve outcomes for the patient. Patient generated information must be easy for the clinicians to access and interpret if it is to be used to inform care delivery in ambulatory oncology facilities. This pragmatic work responded to this need. One Canadian provincial ambulatory oncology jurisdiction implemented digital tracking of PROMs over time in the provincial Electronic Medical Record (EMR) to support full integration of PROMs into standard care workflows and processes. Due to an inability within the EMR for direct patient entry, a hybrid data-entry was designed where the patient completes a paper-based PROM in the waiting room, and after clinical review, a clinician documents this along with their clinical assessment in the EMR. Several digital dashboards were developed which report PROMs data at the micro (individual), meso (clinic) and macro (program) levels. Using PROMs routinely in these provincial practice settings has numerous benefits including enhanced patient-clinician communication, assisting with problem detection, management of symptoms, and improving outcomes for patients. There are over 60,000 unique patients represented in our PROMs database, and over 300,000 unique screening events captured. The PROMs data is now used at all levels of the provincial cancer jurisdiction to provide targeted person centred care (micro), to staff appropriately at a clinic or program level (meso), and for capacity planning for provincial programs (macro). A new provincial EMR is currently being implemented which has an associated patient portal. Based on the success of this work, integration of direct entry of PROMs by the patient prior to the appointment and an associated workflow for symptom management is underway in this jurisdiction.

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