Distress Screening Through Patient-Reported Outcomes Measurement Information System (PROMIS) at an Academic Cancer Center and Network Site: Implementation of a Hybrid Model

Abstract

PURPOSE: Cancer care guidelines recommend regular distress screening of patients, with approximately one in three patients with cancer experiencing significant distress. However, the implementation of such programs is variable and inconsistent. We sought to assess the feasibility of implementing a hybrid electronic and paper screening tool for distress in all patients coming to a large academic cancer center and an associated integrated network site. METHODS: Patients at an academic cancer center (Stanford Cancer Center) and its associated integrated network site received either an electronic or on-paper modified Patient-Reported Outcomes Measurement Information System-Global Health questionnaire, to assess overall health and distress. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance implementation framework to test and report on the feasibility of using this questionnaire. Iterative workflow changes were made to implement the questionnaire throughout the healthcare system, including processes to integrate with existing electronic health records. RESULTS: From June 2015 to December 2017, 53,954 questionnaires representing 26,242 patients were collected. Approximately 30% of the questionnaires were completed before the visit on an electronic patient portal. The number of patients meeting the positive screen threshold remained around 40% throughout the study period. Following assessment, there were 3,763 referrals to cancer supportive services. Of note, those with a positive screen were more likely to have a referral to supportive care (odds ratio, 6.4; 95% CI, 5.8 to 6.9; P < .0001). CONCLUSION: The hybrid electronic and on-paper use of a commonly available patient-reported outcome tool, Patient-Reported Outcomes Measurement Information System-Global Health, as a large-scale distress screening method, is feasible at a large integrated cancer center.

Patient Reported Outcomes in Metastatic Spine Disease: Concurrent Validity of PROMIS with the Spine Oncology Study Group Outcome Questionnaire

“…If shown to be concurrently valid, PROMIS may adequately replace PROMs and reduce both patient and physician burden. Previous studies have found that PROMIS sufficiently captures information obtained through disease-specific PROMs 4,5,14–16 . PROMIS is unique in that it utilizes an iterative CAT system, based on item response theory that improves flexibility, sensitivity, and efficiency 13 .…”

“…Disease specific PROMs and the more generic PROMIS instrument are increasingly used in spine and oncological patients. [15][16][17] PROMIS provides insight into a patient's health across a variety of health conditions and may therefore capture information provided by various disease specific PROMs. 18,19 If shown to be concurrently valid, PROMIS may adequately replace PROMs and reduce both patient and physician burden.…”

Impact of Real-World Outpatient Cancer Rehabilitation Services on Health-Related Quality of Life of Cancer Survivors across 12 Diagnosis Types in the United States

“…Patient-reported improvements in mental health (GMH) in this study were especially noteworthy. Mental health support is critical considering that up to 65% of individuals with cancer report high levels of distress and depressive or anxious symptoms [17,[58][59][60]. In some cases, high levels of distress are related to unplanned healthcare use [61] and decreased adherence to cancer treatments [62].…”

Evaluation of PROMIS Preference Scoring System (PROPr) in Patients Undergoing Hemodialysis or Kidney Transplant

“…Further, PROMIS domains demonstrated greater reliability over a broader range of symptom severity or functional impairment compared with SF-12 or SF-36 (31,32). The precise, versatile PROMIS item banks (administered either as four-or eight-item short forms, or computer adaptive test) have also already been used as outcome measures studies (33,34) and in clinical practice for symptom monitoring (35)(36)(37). In addition, PROPr, and the overall mental and physical health summary scores (38), provide reliable measures of health utility and overall HRQOL.…”

“…We calculated PROPr using scores generated from seven domains that may be assessed by PROMIS short forms and computer adaptive tests. These seven domains, as well as the total number of items included in the respective item banks, are as follows: depression (28), fatigue (95), physical function (165), sleep disturbance (27), ability to participate in social roles and activities (35), pain interference (40), and cognitive function abilities (31). The PROMIS short-form profiles PROMIS-57, PROMIS-43, and PROMIS-29 assess each domain using eight, six, or four items, respectively.…”