IntroductionRemote patient monitoring (RPM) has emerged as a potential avenue for optimising the management of symptoms in patients undergoing chemotherapy. However, RPM is a complex, multilevel intervention with technology, workflow, contextual and patient experience components. The purpose of this pilot study is to determine the feasibility of RPM protocol implementation with respect to decentralised recruitment, patient retention, adherence to reporting recommendations, RPM platform usability and patient experience in ambulatory cancer patients at high risk for chemotherapy-related symptoms.Methods and analysisThis protocol describes a single-arm decentralised feasibility pilot study of technology-enhanced outpatient symptom management system in patients with gastrointestinal and thoracic cancer receiving chemotherapy and cancer care at a single site (MD Anderson Cancer Center, Houston Texas). An anticipated total of 25 patients will be recruited prior to the initiation of chemotherapy and provided with a set of validated questionnaires at enrollment and after our 1-month feasibility pilot trial period. Our intervention entails the self-reporting of symptoms and vital signs via a HIPAA-compliant, secure tablet interface that also enables (1) the provision of self-care materials to patients, (2) generation of threshold alerts to a dedicated call-centre and (3) videoconferencing. Vital sign information (heart rate, blood pressure, pulse, oxygen saturation, weight and temperature) will be captured via Bluetooth-enabled biometric monitoring devices which are integrated with the tablet interface. Protocolised triage and management of symptoms will occur in response to the alerts. Feasibility and acceptability metrics will characterise our recruitment process, protocol adherence, patient retention and usability of the RPM platform. We will also document the perceived effectiveness of our intervention by patients.Ethics and disseminationThis study has been granted approval by the institutional review board of MD Anderson Cancer Center. We anticipate dissemination of our pilot and subsequent effectiveness trial results via presentations at national conferences and peer-reviewed publications in the relevant medical journals. Our results will also be made available to cancer survivors, their caregivers and hospital administration.Trial registration numberNCI202107464.

This study fills a void in the literature by both validating images of nature for use in future research experiments and examining which characteristics of these visual stimuli are found to be most representative of nature. We utilized a convenience sample of university students to assess 129 different nature images on which best represented nature. Participants (n = 40) viewed one image per question (n = 129) and were asked to rate images using a 5-point Likert scale, with the anchors “best represents nature” (5) and “least represents nature” (1). Average ratings across participants were calculated for each image. Canopies, mountains, bodies of water, and unnatural elements were identified as semantic categories of interest, as well as atmospheric perspectives and close-range views. We conducted the ordinary least squares (OLS) regression and the ordered logistic regression analyses to identify semantic categories highly representative of nature, controlling for the presence/absence of other semantic categories. The results showed that canopies, bodies of water, and mountains were found to be highly representative of nature, whereas unnatural elements and close-range views were inversely related. Understanding semantic categories most representative of nature is useful in developing nature-centered interventions in behavioral performance research and other neuroimaging modalities. All images are housed in an online repository and we welcome the use of the final 10 highly representative nature images by other researchers, which will hopefully prompt and expedite future examinations of nature across multiple research formats.

PURPOSE Although electronic patient-reported outcomes (ePROs) are efficacious in symptom management, much is unknown about the utility of vital signs surveillance. We examined the feasibility of a remote patient monitoring platform that integrates ePROs and biometrics into the ambulatory management of symptom burden. METHODS Using a decentralized workflow, patients with gastrointestinal or thoracic cancer were approached for a 1-month study. Patients reported symptom burden via ePROs and biometrics (blood pressure, oxygen saturation, pulse, weight, and temperature) using bluetooth-enabled devices daily. Alerts on the basis of prespecified thresholds were managed via nurse-led triage. Adherence was defined as the completion of > 70% of daily symptom and biometric reporting requirements. Pilot acceptability, appropriateness, and feasibility were measured using validated instruments. Net promoter score, system usability scale, and emergency department (ED) admission rates were collected. RESULTS Over 8 months, 36 patients were enrolled and 25 (60% gastrointestinal) completed the study. Participants had a mean age of 58.0 years, mean Eastern Cooperative Oncology Group score of 0.88, were 52% female, and predominantly had stage IV or recurrent disease (72%). Program adherence was 73% and associated with high acceptability (4.63), feasibility (4.56), and appropriateness (4.46). System usability scale and net promoter score scores were 88 and 55, respectively. Seventy percent of alerts were generated by biometrics, 28% for symptoms, and 2% were patient-initiated communication. Finally, the ED visitation rate over the pilot period was 8%. CONCLUSION Our remote patient monitoring pilot program was highly acceptable, feasible, and appropriate. It had high rates of patient adherence and satisfaction and was associated with low ED visitation rates.

425 Background: Monitoring patient-reported outcomes (PROs) in the ambulatory setting is an effective modality for chemotherapy-related symptom management. However, much is unknown about the utility of active surveillance of vital signs (i.e. biometrics) in this context. Such an undertaking is also highly complex with technology, workflow, and patient experience components. This decentralized pilot study aimed to investigate the implementation and feasibility of nurse-led active surveillance of chemotherapy-related symptom burden via the electronic collection of PROs and biometrics. Methods: Consecutive adult patients with gastrointestinal (GI) or thoracic cancer, at high risk for emergency room (ER) visits based on published criteria, were approached. Consenting patients performed daily reporting of symptom burden via the Patient reported Outcomes version of the Common Terminology Criteria for Adverse Events and biometrics over a one-month period. Biometric data (pulse, blood pressure, oxygen saturation, weight, and temperature) was captured via Bluetooth-enabled sensors which were integrated with a HIPAA-compliant, secure tablet interface that also enabled the provision of self-care materials and video conferencing. Data, including pre-specified threshold alerts, were sent to a web-based dashboard monitored by a registered nursing team, who triaged patient alerts based on standard operating procedures. Acceptability, appropriateness, and feasibility were measured via validated instruments. Program adherence was defined as the completion of > 70% of PRO survey and biometric reporting requirements ≥ 4 days per week. Patient satisfaction, technology ease of use, and ER admission rates were also collected. Results: Over an eight-month period, thirty-six patients consented to participate, and twenty-five (60% GI) completed the study. Participants had a mean age of 58.0 (range 36-74), mean ECOG score of 0.88, were 52% female, and were predominantly stage IV or recurrent disease (72%). Program adherence rate was 73% and mean scores for acceptability, feasibility, and appropriateness were 4.63, 4.56, and 4.46 respectively. Alert distribution were 28% PROs, 70% biometrics and 2% patient-initiated communication. System usability scale and Net Promoter Score were 88 and 55 respectively. Scores for patient satisfaction score and technology ease of use were 94% and 100% respectively. The rate of ER visits over the pilot period was 8%. Conclusions: Implementation of active surveillance of chemotherapy-related symptom burden via self-reporting of PROs and biometrics is highly acceptable, feasible, and appropriate to patients. It is also associated with low ER visitation rates relative to historical values and high rates of patient satisfaction and ease of use. Clinical trial information: NCI202107464.