Cancer follow-up supported by patient-reported outcomes in patients undergoing intended curative complex surgery for advanced cancer

Abstract

Background and aim Patient activation (PA) and Patient Involvement (PI) are considered elements in good survivorship. We aimed to evaluate the effect of a follow-up supported by electronic patient-reported outcomes (ePRO) on PA and PI. Method From February 2017 to January 2019, we conducted an explorative interventional study. We included 187 patients followed after intended curative complex surgery for advanced cancer at two different Departments at a University Hospital. Prior to each follow-up consultation, patients used the ePRO to screen themselves for clinical important symptoms, function and needs. The ePRO was graphically presented to the clinician during the follow-up, aiming to facilitate patient activation and involvement in each follow-up. PA was measured by the Patient Activation Measurement (PAM), while PI was measured by five indicator questions. PAM and PI data compared between (− ePRO) and interventional (+ ePRO) consultations. PAM data were analysed using a linear mixed effect regression model with intervention (yes/no) and time along with the interaction between them as categorical fixed effects. The analyses were further adjusted for time (days) since surgery. Results According to our data, ePRO supported consultations did not improve PA. The average mean difference in PAM score between + ePRO and − ePRO consultations were − 0.2 (95% confidence interval − 2.6; 2.2, p = 0.9). There was no statistically significant improvement in PAM scores over time in neither + ePRO nor − ePRO group (p = 0.5). Based on the five PI-indicator questions, the majority of all consultations were evaluated as “some, much or very much” involved in consultation; providing a wider scope of dialogue, encouraged patients to ask questions and share their experiences and concerns. Nevertheless, another few patients reported not to be involved at all in the consultations. Conclusion We did not demonstrate evidence for ePRO supported consultations to improve patient activation, and patient activation did not improve over time. Our results generate the hypotheses that factors related to ePRO supported consultation had the potential to support PI by offering a wider scope of dialogue, and encourage patients to ask questions and share their experiences and concerns during follow-up.

The advantages, disadvantages, threats, and opportunities of electronic patient-reported outcome systems in cancer: A systematic review

“…According to our findings, we found several significant advantages of ePRO systems in cancer care: “Improved Quality of Life and Care,” “Real-time and Remote Monitoring,” and “Effective Communication Between Clinicians and Patients.” The most prominent advantage identified was the “Improved Quality of Life and Care”. 14 – 16 , 18 , 31 – 71 This finding is consistent with the study by Gressel et al, which emphasized the prevalence of web-based ePRO systems for long-term monitoring and patient empowerment. 101 Similarly, Moradian et al’s exploration of an eHealth tool for capturing and analyzing immune-related adverse events in cancer treatment 31 and Helissey et al’s assessment of the effectiveness of electronic patient reporting outcomes in prostate cancer care further contributed to understanding the benefits of ePRO systems in cancer care.…”

“…According to Table 1 , The advantages of ePRO were found to be diverse, with “Improved Quality of Life and Care” being the most prominent, cited in 45 studies (28.48%). 14 – 16 , 18 , 31 – 71 This was followed by “Real-time and Remote Monitoring” with 39 references (24.68%), highlighting its significance in real-time health monitoring, which can significantly impact patient outcomes 1 , 16 – 18 , 31 , 33 , 34 , 36 – 39 , 43 , 44 , 47 , 49 …”

Monitoring health as an opportunity to categorize preventative and early-treatment actions in a self-care journey: our experience with a Healthcare Magenta Scorecard

“…Most studies and implementations of e-PRO systems have focused on specific diseases or conditions such as oncology. These systems have the potential to improve the identification and monitoring of essential aspects of care, such as treatment-related adverse effects (4)(5)(6)(7). These tools are growing in use and applicability and we believe that applying them to primary care and prevention could have myriad potential benefits (2,3,8).…”