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

Abstract

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.

Conflict of interest statement

Ethan Basch

Consulting or Advisory Role: Sivan, Carevive Systems, Navigating Cancer, AstraZeneca

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

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

Angela M. Stover

Honoraria: Genentech

Deborah Schrag

Stock and Other Ownership Interests: Merck (I)

Honoraria: Pfizer

Consulting or Advisory Role: Journal of the American Medical Association

Research Funding: American Association for Cancer Research (Inst), GRAIL (Inst)

Patents, Royalties, Other Intellectual Property: PRISSMM model is trademarked and curation tools are available to academic medical centers and government under creative commons license.

Travel, Accommodations, Expenses: IMEDEX, Precision Medicine World Conference, Journal of the American Medical Association

Other Relationship: Journal of the American Medical Association

Arlene Chung

Honoraria: United Health Group R&D

Patricia A. Spears

Consulting or Advisory Role: Pfizer

Mattias Jonsson

Consulting or Advisory Role: GlaxoSmithKline (I), Epividian (I)

Other Relationship: GlaxoSmithKline, Takeda, Boehringer Ingelheim, AbbVie, UCB Bioscience and Merck (I)

Gita Mody

Consulting or Advisory Role: iRenix (I)

Bryce B. Reeve

Consulting or Advisory Role: Higgs Boson, The Learning Corporation, United Therapeutics, Takeda

Claire Snyder

Research Funding: Genentech (Inst)

Patents, Royalties, Other Intellectual Property: Royalties as a section author for UptoDate

Lisa A. Kottschade

Consulting or Advisory Role: Array BioPharma, Bristol Myers Squibb (Inst)

Research Funding: Bristol Myers Squibb (Inst), Novartis (Inst)

Anna Weiss

Research Funding: Myriad Laboratories

Amylou C. Dueck

Patents, Royalties, Other Intellectual Property: Royalties from licensing fees for a patient symptom questionnaire (MPN-SAF)

No other potential conflicts of interest were reported.

Figures

FIG 1.

Patient feedback survey responses at 3 months.

FIG 2.

Nurse feedback survey responses.

FIG A1.

Patient feedback survey responses at off-study time point.