2020) Satisfaction with care and adherence to treatment when using patient reported outcomes to individualize follow-up care for women with early breast cancer -a pilot randomized controlled trial,
Purpose:The increasing population of breast cancer survivors highlights the need to (re)consider how we utilize available services for survivorship care in oncology clinics.Electronic Patient Reported Outcomes (ePROs) can be used to identify patients' individual care needs and triage them to the right services. We examined the impact on service use, workflow and workload following the introduction of an ePRO based individual follow-up (PIFU) for women treated for early breast cancer.Methods: A multi-method approach was used. In a pilot randomized controlled trial the use of consultations, telephone calls and specialist referrals were systematically recorded. Comparison was done between PIFU and standard follow-up care (SFU).Focus group interviews with nurse navigators evaluated the impact on workflow and workload qualitatively.
Results:The 64 women randomized to attend SFU used a mean of 3.8 (95% CI: 3.5 -4.1) planned consultations during the two-year study period compared to a mean of 1.9 consultations (95% CI: 1.4 -2.4) for the 60 women randomized to PIFU (P < 0.001).Urgent appointments were more frequent in SFU (mean of 0.47 vs 0.22 per patient, P = 0.03). No statistically significant differences were observed in the use of telephone calls and specialist referrals. The nurse navigators did not experience an increase in their workload, but implementation of PIFU may require a re-structured workflow.
Conclusions: The ePRO based individual follow-up could change organization of care and re-allocate services for those in need of it. Implications for Cancer Survivors: ePRO based individual follow-up could potentially ensure more time for those most in need of face-to-face care.
Background: Patient-reported outcomes (PROs) are frequently used to evaluate treatment effects and quality of life in clinical trials. The application of PROs in breast cancer clinics is evolving but their use to generate real-time information for use in follow-up care is uncommon. This proactive use might help to shift healthcare delivery toward a more patient-centered approach by acting as a screening tool for unmet needs or a dialogue tool to discuss issues proposed by the patient. Aims: This review aims to determine the effects and feasibility of using PROs proactively during follow-up care in early breast cancer. Materials and methods: A systematic search was conducted in January 2019 in PubMed, Cochrane Library, Embase, and CINAHL. Studies that exclusively concerned women treated for early breast cancer where PROs were used as a proactive tool during follow-up were included. Results: The search revealed a total of 653 records and four eligible studies were identified; three of which concerned the use of PROs both as a screening tool and as a dialogue tool, and one study in which PROs were used solely as a screening tool. The studies explored the feasibility of collecting and integrating PROs in the clinic and their ability to detect otherwise unrecognized problems. All of the included studies were prone to bias, but they point to potential benefits in respect of better symptom management in follow-up care. Conclusion: Our search identified a small number of low to moderate quality studies of the proactive use of PROs during follow-up after treatment for early stage breast cancer. The limited evidence available suggests that PROs may be useful for providing a more complete picture of the patient's symptoms and problems, possibly leading to improvements in symptom management.
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