The Benefits and Challenges of Using Computer-Assisted Symptom Assessments in Oncology Clinics: Results of a Qualitative Assessment

Abstract

Developed for clinical use in oncology settings, the Patient Assessment, Care & Education (PACE) System is a computer technology tool designed to address the under-identification and treatment of chemotherapy-related symptoms. This system includes general core questions together with the Patient Care Monitor (PCM), a validated questionnaire that assesses patient-reported problems, six symptom burden indices, and one global quality of life index. The system automatically scores the PCM and generates a written report. The objective of this study was to assess the manner in which clinicians use this system and identify the benefits and challenges that oncology clinics may face when adopting this system. The study was part of a larger evaluation of the system that included standardized surveys and chart review. Sixteen providers (physicians, nurses, and physician assistants) at 13 community oncology clinics participated in a 30-minute interview. Responses were coded according to common phrases or concepts. Clinicians indicated that they use the system mainly for symptom assessment or review of systems. The most common benefits identified included the improved ability to identify under-reported symptoms, enhanced communication with patients; increased efficiency; and its ability to highlight patients' most bothersome symptoms. Challenges included patient burden from the frequent need to answer the questionnaires, issues with the wording and formatting of the screening questionnaire, and technical difficulties. In sum, these interviews suggest that electronic symptom assessments offer potential advantages in terms improving the integration of routine assessment of patients' symptoms and health-related quality of life into the daily flow of an oncology clinic. The approach should receive additional research and development attention.

Response Burden and Questionnaire Length: Is Shorter Better? A Review and Meta-analysis

“…A strong focus has been on questionnaire length, and, consequently, potential response burden is frequently a rationale for reducing the number of items in existing questionnaires (e.g., the short version of the Short-Form Health Survey , SF-12 [5]) and is also driving development of questionnaires with a minimum of items. Lengthy questionnaires have been mentioned as a general obstacle in clinical practice [6] and used as an argument for limiting the overall number of administrations of an instrument. Some studies have even proposed that a single item is preferable to reduce response burden [7].…”

Information and communication technology for managing pain in palliative care: a review of the literature

“…Of the 24 included studies, the target population or intended users of systems were oncology patients,18 22 26 28–30 36 palliative home care patients,33–35 oncology outpatients,27 37 hospice and palliative care patients,24 31 patients undergoing palliative radiotherapy,17 25 a mix of palliative care patients, carers and health professionals,23 brain tumour outpatients,20 patients requiring surgery for cancer,16 patients with cancer with incurable metastatic or locally advanced disease,5 patients receiving chemotherapy for cancer,32 breast cancer survivors,21 patients with cancer with depression and/or pain,19 and a mix of members of the public with pain and people with cancer pain 38…”

“…The remaining articles recruited mixed groups of health professionals and patients,22 31 32 health professionals only,33 36 patients with cancer and the general public,16 and clinicians 25. In the two studies that provided overviews of new and emerging systems, no research participants were involved 23 24…”

“…Of the 24 included studies, no papers discussed the planning stages of systems, 11 studies detail systems in the analysis stage,23 25–27 29 31 33–35 37 38 4 studies described the design stage16 21 24 28 and 9 studies described the evaluation stage 5 17–20 22 30 32 36. Only two systems, from across five articles,22 26 30 36 38 are represented at more than one stage of development, classified in both analysis and evaluation stages. There are a number of systems (n=4) in the evaluation category that do not have representation in earlier categories.…”

“…Six studies documented systems that focused on the capture of pain information only,21 30 33–35 38 while three systems considered the management of pain and depression together as part of a collaborative care approach 17–19. The remaining 15 studies outlined systems that considered pain amid a wider range of symptoms in the context of quality-of-life measurement 5 16 20 22–29 31 32 36 37…”