Automated assessment of illness and treatment understanding (ITU) via the Memorial Sloan Kettering Patient Portal.

Abstract

e24146 Background: Patient-reported outcome (PRO) technology offers opportunities to address research questions and unmet clinical needs of cancer patients’ ITU. We tested the feasibility of PRO assessment of ITU. Methods: With the same 5-item questionnaire (2 open- [about expectations of cancer outcome and treatment intent] and 3 validated [Weeks JC NEJM 2012] closed-ended items) administered by medical oncology nurses in clinic in a previous pilot (Shin P ASCO 2020), we used the electronic patient portal in our cancer center to elicit responses from all gastrointestinal medical oncology patients scheduled for clinic follow-up. Patients registered on the portal received this questionnaire automatically the day before the second follow-up visit and then quarterly, with a brief explanation that it applied to all patients for quality improvement. Responses were available for review in the electronic health record by all oncology team members, who were offered a 20-minute Zoom introduction to this initiative. Workflow and content of communications about prognosis, treatment intent, and goals of care stayed within clinicians’ discretion. Results: From 5/2021 through 12/2021, 5000 questionnaires were sent to 3852 patients (1-3 times per patient, quarterly), of which all but one was returned, including 3863 with open- and closed-ended responses and 1135 with closed answers only. Patients: 55% male, 83% white, median age 64 (range, 15-96). Most common cancers: colorectal (54%) and pancreatic (21%). In patients with stage data (78%), 35% had stage IV disease. In closed-ended responses, patients receiving treatment (n = 2637 questionnaires) reported that based on the most recent discussions with the oncology team, they thought the treatment was at least a little likely to cure the cancer (66%), prolong life (98%), and/or help with cancer-related problems (92%). Open-ended answers ranged in length from 0-1013 words (median, 6; IQR, 10). Conclusions: Almost all patients in this large, heterogeneous cancer center cohort participated in an automatic assessment system via electronic patient portal addressing questions about their understanding of prognosis and treatment goals. PROs, traditionally focused on symptoms, represent a promising mechanism for scaling structured assessment of patients’ understanding of the prognosis and intent of their treatment. Our future research will address: effects in other cancer types/care settings; temporal changes in sequential responses: associations with clinical factors (e.g., stage, symptoms, treatment, oncologist documentation of prognosis/treatment intent, healthcare delivery and outcomes including patient reports of the quality of clinician communication); open vs. closed-ended questions for assessing ITU; administration in-person vs. via portal; and perspectives of patients and clinicians on our assessment process.