Comparison of patient-reported symptoms and health behaviors to clinician documentation among patients with breast cancer in follow-up care.

Abstract

9133 Background: Breast cancer (BC) patients (pts) experience symptoms from disease and treatment. While detection of recurrence is fundamental to follow up care, symptom management is equally important. UCSF has implemented a secure online health questionnaire enabling BC pts to update their health history and symptoms. A report summarizing this information is placed in the chart for clinician review prior to visits. Methods: We randomly selected a sample of stage I-III BC pts (n=41) who completed the questionnaire prior to a medical oncology visit and who consented to have data used for research. We conducted a chart review calculating the number of symptoms reported in the questionnaire, the clinic note only, and both questionnaire and clinic note, excluding chronic symptoms addressed previously. We used a paired t-test to compare the number of symptoms reported in the questionnaire compared to those documented by the clinician. We used a regression plot to determine whether the fraction of symptoms agreed upon by the pt questionnaire and provider clinic note affected symptom management. We also compared self-reported data on exercise and alcohol consumption to documentation of these lifestyle factors in clinic notes. Results: Pts reported significantly more symptoms using the online questionnaire (mean=4, range 0-13) than were documented by the provider in clinic notes (mean=2.8, range 0-9; p=0.028 for the difference). A regression plot comparing the percentage of symptoms agreed upon by the pt and provider and the percentage of symptoms addressed yields a slope of 0.50 (95% CI 0.22 to 0.78, p=0.001). Information on exercise behavior and alcohol consumption was completed in 100% of the online questionnaires, but was documented in only 12/41 (29%) and 27/41 (66%) of charts reviewed. In 6/27 (22%) charts where alcohol consumption was documented, there was discordance between pt and clinician reporting. Conclusions: The integration of the online health questionnaire into clinical practice facilitates symptom and lifestyle factor reporting, may increase the percentage of symptoms addressed, and may identify research targets for improved symptom management.