Implementing a web-based system of screening for symptoms and needs using patient-reported outcomes in people with cancer

Abstract

Purpose To evaluate the implementation of a web-based system of screening for symptoms and needs in people with diverse cancers in a general hospital in Australia. Methods This was a prospective, single-arm, pragmatic intervention study. After local adaptation of an online portal and training, cancer nurses were asked to register patients to screen via the portal in clinic or at home. Symptoms were scored according to severity, and scores above cut-off were reported to nurses for assessment and management, according to best practice. Results Fifteen nurses working across diverse tumour types agreed to approach patients for screening. Of these, 7 nurses approached 68 patients, with 5 approaching more than 1 during the 7-month study period. Forty-seven (69%) patients completed screening, and 22 rescreened at least once. At first screening, 33 (70%) patients reported at least one symptom, most commonly tiredness ( n = 27; 57%), reduced wellbeing ( n = 24; 51%) and drowsiness ( n = 17; 36%). Of the total 75 screens undertaken during the study, 56 (75%) identified at least one symptom, and 22 (29%) identified at least one severe symptom. All patients with a positive first screen were followed up by a nurse assessment and intervention—mostly reassurance ( n = 19, 59%) or referral to another health professional ( n = 11, 34%). Conclusion Screening for symptoms and needs using a web-based portal identified many unmet needs, but the uptake of this intervention by nurses and patients was lower than expected.

Implementing a nurse‐led screening clinic for symptom distress with community‐based referral for cancer survivors: A feasibility study

“…Sixty‐nine percent of the remaining distress‐symptomatic patients accepted onward referral to community‐based psychosocial support services, one fifth of all screened patients, all of whom received some form of intervention, mostly low‐cost psycho‐educational advice. The 80% acceptance of SDS was higher than other reported studies using ESAS; a 70% screening rate reported in an Ontario province‐wide study, 23,24 77% reported in another Canadian study focusing on advanced cancer 25 and 69% reported in an Australia general hospital 20 . Evidence suggests that implementation strategies could improve the screening rate to >90% 26 …”

“…The 80% acceptance of SDS was higher than other reported studies using ESAS; a 70% screening rate reported in an Ontario province-wide study, 23,24 77% reported in another Canadian study focusing on advanced cancer 25 and 69% reported in an Australia general hospital. 20 Evidence suggests that implementation strategies could improve the screening rate to >90%. 26 One in three patients screened reported moderate-to-severe symptom distress, at the lower end of the 30%-50% range reported in previous cancer SDS studies.…”

“…ESAS-r assesses presence and intensity of 11 symptoms commonly encountered in routine cancer care 19,20 : pain, fatigue/tiredness, nausea, depression, anxiety, drowsiness, lack of appetite, well-being, shortness of breath, numbness, sleep difficulty, and "other (specify)". A numerical rating scale from 0 (no symptom) to 10 (the worst possible) measures each symptom's intensity, taking around 2 min to complete.…”

“…First, patients completed the modified Edmonton Symptom Assessment System (ESAS‐r) to screen for symptoms and any related distress 19,20 . ESAS‐r symptoms scores 0–3 are considered mild; 4‐6 mild‐to‐moderate, while ≥7 indicate moderate‐to‐severe symptom distress 21 .…”

“…Assessment System (ESAS-r) to screen for symptoms and any related distress. 19,20 ESAS-r symptoms scores 0-3 are considered mild; 4-6 mild-to-moderate, while ≥7 indicate moderate-to-severe symptom distress. 21 Second, for patients with ESAS-r symptom scores ≥7, the nurse administered a further symptom-specific assessment (Supplementary Material S1).…”