Evaluating Nurses' Time to Response by Severity and Cancer Stage in a Remote Symptom Monitoring Program for Patients With Breast Cancer

Abstract

PURPOSE Remote symptom monitoring (RSM) using electronic patient-reported outcomes enables patients with cancer to communicate symptoms between in-person visits. A better understanding of key RSM implementation outcomes is crucial to optimize efficiency and guide implementation efforts. This analysis evaluated the association between the severity of patient-reported symptom alerts and time to response by the health care team. METHODS This secondary analysis included women with stage I-IV breast cancer who received care at a large academic medical center in the Southeastern United States (October 2020-September 2022). Symptom surveys with at least one severe symptom alert were categorized as severe. Response time was categorized as optimal if the alert was closed by a health care team member within 48 hours. Odds ratios (ORs), predicted probabilities, and 95% CIs were estimated using a patient-nested logistic regression model. RESULTS Of 178 patients with breast cancer included in this analysis, 63% of patients identified as White and 85% of patients had a stage I-III or early-stage cancer. The median age at diagnosis was 55 years (IQR, 42-65). Of 1,087 surveys included, 36% reported at least one severe symptom alert and 77% had an optimal response time by the health care team. When compared with surveys that had no severe symptom alerts, surveys with at least one severe symptom alert had similar odds of having an optimal response time (OR, 0.97; 95% CI, 0.68 to 1.38). The results were similar when stratified by cancer stage. CONCLUSION Response times to symptom alerts were similar for alerts with at least one severe symptom compared with alerts with no severe symptoms. This suggests that alert management is being incorporated into routine workflows and not prioritized based on disease or symptom alert severity.

Learning to Overcome Barriers to Electronic Patient-Reported Outcome Implementation: Lessons From the Field

“…Resistance to change, although nearly universal, can be addressed by the presence of physician, nurse, and leadership champions, as highlighted by both Eng et al and our institutional experiences. 2,4,5 These individuals leverage their social and political influences to highlight the benefits of the intervention and work with other team members to assuage fear and overcome preimplementation resistance. Furthermore, in surveys and interviews with nurses across the United States who used an ePRO system in the PRO-TECT national ePRO implementation study, perceptions of the system and approach markedly improved after using the system.…”

Implementation of electronic patient-reported outcomes for symptom monitoring during cancer treatment: the importance of getting it right

“…Although symptoms reported solely on the day of office visits have been shown to improve patient outcomes [ 6 ], PROs collected frequently in-between visits (e.g., weekly) allow the medical team to be proactive in responding to symptoms, giving the greatest chance to intervene to prevent a hospitalization or ER visit. Symptoms can be trended and truly monitored over time [ 9 ].…”