The Routine Clinical Implementation of Electronic Patient-reported Outcome Measures (ePROMs) at The Christie NHS Foundation Trust

Crockett, Cathryn; Gomes, Fábio; Faivre-Finn, Corinne; Howell, Sacha J.; Kasipandian, Vidya; Smith, Ed; Thomson, David J; Yorke, Janelle; Price, James

doi:10.1016/j.clon.2021.06.004

Cited by 24 publications

(20 citation statements)

References 9 publications

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“…Furthermore, the study was conducted during the COVID-19 pandemic (with a rapid associated transition to telehealth platforms) and a state-wide roll out of an electronic health record; thus, iSCREEN represented a third simultaneous technology-related service change being implemented adding to nurses’ workload, change-fatigue and perhaps “digital health fatigue”. The study feasibility threshold was set at 75% which may have been set too high and was higher than in evaluations of many other complex interventions in similar patient populations where the acceptable threshold was set at 60% [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

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

Koczwara

Knowles

Beatty

et al. 2022

Support Care Cancer

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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.

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Section: Discussionmentioning

confidence: 99%

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

Koczwara

Knowles

Beatty

et al. 2022

Support Care Cancer

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“…Looking forward, it may be possible in the future to perform causal inference analyses, which would help establish whether the increased proportion of patients treated with curative intent, and their improved survival, is indeed attributable to the introduction on IMRT. The data could also be enhanced by including treatment related toxicity, something that can now be achieved through the use of patient reported outcomes (ePROMS) and proactive, prospective clinician reported toxicity, which we are now documenting at our centre on an eform at each outpatient visit ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer

et al. 2022

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BackgroundLung cancer survival remains poor. The introduction of Intensity-Modulated Radiotherapy (IMRT) allows treatment of more complex tumours as it improves conformity around the tumour and greater normal tissue sparing. However, there is limited evidence assessing the clinical impact of IMRT. In this study, we evaluated whether the introduction of IMRT had an influence on the proportion of patients treated with curative-intent radiotherapy over time, and whether this had an effect on patient survival.Materials and MethodsPatients treated with thoracic radiotherapy at our institute between 2005 and 2020 were retrospectively identified and grouped into three time periods: A) 2005-2008 (pre-IMRT), B) 2009-2012 (selective use of IMRT), and C) 2013-2020 (full access to IMRT). Data on performance status (PS), stage, age, gross tumour volume (GTV), planning target volume (PTV) and survival were collected. The proportion of patients treated with a curative dose between these periods was compared. Multivariable survival models were fitted to evaluate the hazard for patients treated in each time period, adjusting for PS, stage, age and tumour volume.Results12,499 patients were included in the analysis (n=2675 (A), n=3127 (B), and n=6697 (C)). The proportion of patients treated with curative-intent radiotherapy increased between the 3 time periods, from 38.1% to 50.2% to 65.6% (p<0.001). When stage IV patients were excluded, this increased to 40.1% to 58.1% to 82.9% (p<0.001). This trend was seen across all PS and stages. The GTV size increased across the time periods and PTV size decreased. Patients treated with curative-intent during period C had a survival improvement compared to time period A when adjusting for clinical variables (HR=0.725 (0.632-0.831), p<0.001).ConclusionIMRT was associated with to more patients receiving curative-intent radiotherapy. In addition, it facilitated the treatment of larger tumours that historically would have been treated palliatively. Despite treating larger, more complex tumours with curative-intent, a survival benefit was seen for patients treated when full access to IMRT was available (2013-2020). This study highlights the impact of IMRT on thoracic oncology practice, accepting that improved survival may also be attributed to a number of other contributing factors, including improvements in staging, other technological radiotherapy advances and changes to systemic treatment.

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“…In a recent paper about their own version of electronic PROMs, the Christie reported initial limited engagement from clinical teams as the electronic PROMs was a separate online system not integrated into their main computer system used by clinicians. Engagement has improved following integration of the systems 9 . We hope that similar integration will help increase engagement from site specific teams in our own area.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

“…The routine use of PROMs is recognised as a priority in the NHS Cancer Strategy for 'living with and beyond cancer' 8 . Reviewing PROMs prior to clinic appointments can help tailor interactions and aid clinicians in holistic care -for example enquiring about psychological wellbeing which is often overlooked in a busy clinic appointment 9 . Recording PROMs focuses patients on their own symptom burden and can provide a visual representation of this trend over time.…”

Section: Introductionmentioning

confidence: 99%

A Short Report Examining the Introduction of Routine Use of Patient-Reported Outcome Measures in a Mixed Oncology Population

et al. 2022

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The Routine Clinical Implementation of Electronic Patient-reported Outcome Measures (ePROMs) at The Christie NHS Foundation Trust

Abstract: Clinical Oncology j o ur n a l h o m e p a ge : w w w . c l i n i c a l on c o l o gy o n l i ne . n e t

Cited by 24 publications

References 9 publications

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

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

Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer

A Short Report Examining the Introduction of Routine Use of Patient-Reported Outcome Measures in a Mixed Oncology Population

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