Background: While patient-reported outcome measures (PROMs) have benefit in cancer clinical trials, real-world applications are lacking. This study describes the method of implementation of a cancer enterprise-wide PROMs platform.Methods: After establishing a multispecialty stakeholder group within a large integrated health system, domain-specific instruments were selected from the National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (pain interference, fatigue, physical function, and depression) and were administered at varying frequencies throughout each patient's cancer journey. All cancer patients with an oncologic visit were eligible to complete the PROMs prior to the visit using a patient portal, or at the time of the visit using a tablet. PROMs were integrated into clinical workflow.Clinical partnerships were essential for successful implementation. Descriptive preliminary data were compared using multivariable logistic regression to determine the factors associated with method of PROMs completion.
e24035 Background: Patient reported outcome measures (PROMs) are derived entirely from patients’ perspectives and complementary to traditional clinical assessment. Use of PROMs as a symptom communication tool has been demonstrated to improve quality of life, decrease health care utilization, and improve overall survival in clinical trial settings. However, clinical trial enrollment is known to be biased, often excluding those with the most difficulty accessing care. Henry Ford Cancer Institute has implemented a PROMs platform integrated with routine clinical care throughout the vertically integrated health system for all cancer disease sites. The purpose of this study is to compare patient characteristics in those responding to and those without response to PROMs to understand potential disparities. Methods: All patients with a diagnosis of cancer and a visit with an oncologic provider were offered an opportunity to complete PROMs between September 16, 2020 to July 19, 2021. Domain-specific National Institute of Health’s computer adaptive technology Patients-Reported Outcomes Measurement Information System (PROMIS) instruments in pain interference, physical function, fatigue, and depression were offered prior to a visit using a patient-facing electronic portal or via iPAD at the time of visit. Patient level demographic, insurance, ZIP code level socioeconomic status and clinical data were compared across PROMs responders and non-responders using multivariable logistic regression. Results: A total of 3,226 patients were included in the study, of whom 1,652 (51.2%) responded to PROMs. The mean age of the patients was 60 years (SD = 13) and 60.5% were females. Most were of white race (68.8%) and were married (56.1%). There was similar distribution of patients with private (43.7%) and Medicare (41.6%) insurance. After adjusting for age, sex, race, marital status, education, income, insurance and stage, patients who were single (aOR = 0.78; 95% CI: 0.65—0.94) or had Medicare insurance (aOR = 0.68; 95% CI: 0.55—0.83) were less likely to respond to the PROMs. Patients diagnosed with early-stage (stages 0,1,2) disease (aOR = 0.79; 95% CI: 0.67—0.93) were less likely to respond to PROMs, but those with unknown stage (aOR = 1.27; 95% CI: 1.04—1.56) were more likely to respond to PROMs compared to those diagnosed with late-stage (stages 3,4) disease. There was no significant association between race and PROMs response. Conclusions: Patients who are single, have Medicare insurance, and early-stage disease are less likely to respond to PROMs. Future implementation efforts need to focus on these populations to ensure equitable availability of PROMs as a tool for symptom communications in patients with cancer.
6612 Background: Patient reported outcomes (PRO) can be valuable clinical tools to embed the voice of patients into the clinical assessment. PROs provide important metrics to guide treatment decision making, improve quality of life, reduce acute care, and extend survival in cancer patients. Different modalities for collecting patient reported outcome measures (PROMs) exist (e.g., electronic, paper, telephone); yet little is known about factors associated with PROMs completion modality. More information on PROMs completion modality may determine addressable barriers. We sought to determine whether patients’ sociodemographic and clinical factors differed by completion modality. Methods: Beginning in 2021 all patients diagnosed with cancer who had a visit with an oncologic provider at a tertiary cancer center were assigned the National Institute of Health’s computer adaptive tests Patient-Reported Outcomes Measurement Information System (PROMIS) instruments in pain interference, physical function, fatigue, and depression through the MyChart patient portal 7 days prior to the visit. If this was not completed at the time of the visit, it was available for completion on a tablet during check-in. The outcome variable was completion modality defined as the method a patient used to complete their PROMs (MyChart vs. In-Person). Multivariable logistic regression model was used to estimate the association between patients’ sociodemographic and clinical factors (age, sex, race/ethnicity, marital status, insurance type, stage, provider specialty) and completion modality. Results: A total of 2915 patients completed PROMs, of which 54% completed using MyChart and 46% completed in-person. The average age of patients was 59.6 (SD=12.4) years, most were females (63.1%), White (69.4%) and married (59.2%). Compared to male patients, females were less likely to complete PROMs in-person (aOR=0.80, 0.67–0.95). However, patients were more likely to complete PROMs in-person if they were of Black race (aOR=1.85, 1.52–2.24) or Other race (aOR=1.48, 1.12–1.96) vs. White; single (aOR=1.30, 1.05–1.62) vs. married; or have Medicaid/other insurance (aOR=1.52, 1.15–2.01) vs. private insurance. Patients who had visits with a radiation oncology provider (aOR=1.50, 1.20–1.86) or surgical oncology provider (aOR=1.32, 1.07–1.62) were more likely to complete PROMs in-person compared to those who had visits with a medical oncology provider. Conclusions: Almost half of the patients completed PROMs in-person during check-in, which was unexpected in the context of trends toward mobile-based patient engagement. Patients in underserved populations were the most likely to complete PROMs in-person. Although offering PROMs remotely may be more efficient and allow monitoring between visits, offering an in-person option helps to capture PROs from underserved populations.
1585 Background: Provider assessments consistently fall short in determining when cancer patients enter into the terminal phase of their disease. Despite prior desires to spend their last days outside an institution, patients often seek emergency room care and most report never having a palliative consultation at the time of their terminal admission. Patient reported outcome measures (PROMs) are derived directly from the patient and may provide insight into the experience near the end of life to facilitate earlier involvement of supportive oncology. This study aims to compare PROMs in the 6 months prior to death to those not dying among patients with cancer. Methods: This study uses a routine PROMs program implemented since September 2020 for all patients with a cancer diagnosis at a tertiary care hospital. This study focused on PROMs using 3 domains of the Patient Reported Outcomes Measurement Information System (PROMIS): physical function, pain interference, and fatigue; PROMs frequency mirrored patients’ oncologic visits. Using a retrospective case-control study, patients who had died within 6 months of a PROMs response (cases) were compared to controls who were alive at the time of the case’s death. Cases were matched 1:2 to controls by age at PROMs completion, gender, cancer disease site, and stage. Generalized estimating equation (GEE) models adjusted for age at PROMs completion, gender, cancer disease site, stage, and correlations between individual patient encounters were used to compare mean PROMs scores between cases and controls in each domain. Results: In total, 274 cases were compared to 270 unique controls. Univariate comparisons between cases and controls demonstrated significant differences only in Charlson Comorbidity Index (CCI), with cases demonstrating worse CCI (3.3 ± 2.5) compared to controls (2.3 ±2.2; p < 0.001). Time from diagnosis to PROMs completion was not different between groups (4.08 versus 4.10 years, p = 0.798). Over the 6 months prior to death, 10.5%/15.0%/32.0% cases had severe pain/fatigue/physical function scores compared to 3.3%/3.7%.8.7% in controls (p < 0.001). GEE models demonstrated that cases had a higher mean fatigue score of 5.34 points (95% CI = 3.81 to 6.88), higher mean pain interference score of 4.92 points (95% CI = 3.42 to 6.43), and lower mean physical function score of 7.39 points (95% CI = -8.84 to -5.93) indicating more severe symptom scores for cases in all three domains. Conclusions: On average, patients experiencing death within 6 months of PROMs completion demonstrated worse physical functioning, pain interference, and fatigue scores compared to their age, gender, cancer disease site, and stage matched controls. The differences in PROMs scores represent a first step to improving understanding of PROMs during the terminal stage of disease and may guide indicators for earlier need of supportive oncology support.
6609 Background: Use of Patient Reported Outcomes (PROs) in clinical practice plays a major role in improving care, quality of life, hospitalization, emergency room visits and consequently improving overall survival. However, robust information on real-time assessment of PROs in cancer patients is insufficient, as most available data are limited to specific populations enrolled in clinical trials. This thereby increases disparities among minorities of race, age, and socioeconomic status, creating a barrier between the benefits of PROs and these underserved populations. This study examines the response rates, patterns and characteristics of patients completing PROs in a tertiary cancer center. Methods: Patients with a cancer diagnosis and an oncologic provider visit at a tertiary cancer center were offered an opportunity to complete Patient Reported Outcome Measures (PROMs) between August 2020 and July 2022.We used the National Institute of Health’s computer adaptive tests Patient-Reported Outcomes Measurement Information System (PROMIS) instruments in pain interference, physical function, fatigue, and depression. Seven days prior to their clinical appointment, patients were assigned the PROMIS instruments in MyChart, then offered in-clinic completion with a tablet at check-in, if not completed online. A decision tree model was employed to assess the factors that may influence patients' PROMs completion (age, gender, race, marital status, insurance, stage, comorbidity score, and provider specialty and location). Results: A total of 8,535 patients were offered the PROMIS CAT version 2.0 instrument during the study period. The two most important factors that determine whether a patient completed PROMs in order of importance were provider specialty and patient race. Patients were more likely to complete PROMs if they had a visit with a provider in Radiation Oncology (RC) or Surgery specialty compared with Medicine or Supportive Oncology specialty (40.86% versus 29.68%). Among patients who had a visit with a provider in RC or Surgery specialty, there was a better chance of PROMs completion with White race compared to Black or Other races (45.83% versus 33.69%). Of those who had a visit with a provider in Medicine or Supportive Oncology specialty, there was a better chance of PROMs completion with Other or White races compared to Black race (32.40% versus 22.19%). Conclusions: We found that provider specialty and patient race were the most important factors influencing patients’ PROMs completion. In order to realize the full benefit of PROs in patient care, multilevel interventions can be employed to increase patient-provider utilization of PROs. Moreover, efforts should focus on a patient-centered design to address patient and provider barriers impeding PROs accessibility and completion.
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