Symptom and needs assessment screening in oncology patients: Alternate outreach methods during COVID-19

Abstract

Patients with cancer are ideally screened for symptoms, including distress, using patient-reported outcome measures (PROMs). This initiative was developed to ensure patients without access to an electronic portal were screened for distress and related symptoms during the COVID-19 pandemic. Prior to the pandemic, these patients could complete screening in clinic. However, many visits transitioned to telehealth. We implemented a standardized telephone outreach process targeting patients without active electronic portal accounts to improve remote symptom monitoring. Outreach resulted in 172 completed screens, identifying 110 needs for 63 individuals. Twentyeight patients completed patient portal enrollment. Outreach calls captured a higher percentage of Black patients (34%) and a higher percentage of 61-80 year olds (69%) compared to portal users. Telephone outreach during the pandemic captured data that otherwise would have been missed in elderly and minority patients without electronic patient portal access. Patient engagement is vital to the distress screening process.

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

“…[47][48][49][50][51][52][53]55 • The patient-facing initiatives reported in the literature are limited to technological training and support, with an emphasis on mitigating the risk of digital health disparities. [47][48][49][50]52,[55][56][57][58][59][60][61][62] Developing and deploying portal tools to respond to COVID-19…”

“…48,52,53,58,[66][67][68][69][70] However, studies also documented disparities in patient portal enrollment and virtual visits through the portal during the pandemic, 56,58,69,[71][72][73] with one potential factor being that remote portal enrollment appears less effective than in-person workflows for underserved populations. 56,59 Deploying Tools for COVID-19 Response Three studies investigated how the portal, as important virtual care infrastructure, could be used in the COVID-19 response, particularly for triage and remote monitoring of those diagnosed with COVID-19. [63][64][65] For instance, Judson et al developed and deployed a COVID-19 self-triage and selfscheduling tool through their portal and early evidence showed significant use by patients, high sensitivity for patients with severe disease requiring emergency care, and reduced triage time for patients with less severe disease.…”

“…Numerous telehealth studies suggest the importance of offering multimodal opportunities for remote patient engagement, including telephone calls and text messages, to mitigate the risk of disparities. [58][59][60][61][62] For example, Davis et al reported on their telephone outreach efforts to augment their patient portal process for remote symptom monitoring among cancer patients, finding that they were able to increase the number of completed screens, identify additional needs, and capture a higher percentage of black and older adult (61-80 years) patients through telephone outreach. 59 Outside of the telehealth context, few studies published within our timeframe evaluated strategies for addressing disparities in portal engagement, with two exceptions.…”

“…[58][59][60][61][62] For example, Davis et al reported on their telephone outreach efforts to augment their patient portal process for remote symptom monitoring among cancer patients, finding that they were able to increase the number of completed screens, identify additional needs, and capture a higher percentage of black and older adult (61-80 years) patients through telephone outreach. 59 Outside of the telehealth context, few studies published within our timeframe evaluated strategies for addressing disparities in portal engagement, with two exceptions. 89,96 Table 5 Digital health disparity topic thematic analysis results summary table…”

“…• Clinicians play an important role in encouraging or discouraging portal engagement. 89 • Addressing the digital divide 96 and offering multimodal mechanisms [58][59][60][61][62] to engage in one's care can mitigate the risk of digital health disparities.…”