Effective routine electronic symptom screening and use of evidence to improve cancer symptom management in Ontario, Canada.

Abstract

e20507 Background: Improving symptom management is a critical component of high quality care. Cancer Care Ontario (CCO) is working to improve through a standardized approach to symptom screening and assessment that leverages electronic tools along the cancer journey. Methods: CCO has developed a web-based application that allows patients to report their symptoms using the Edmonton Symptom Assessment System (ESAS). ESAS is a validated screening tool that asks patients to rate the severity of nine common cancer symptoms. The use of ESAS promotes a common language among patients and providers and across care settings. To support clinicians in determining follow-up to scores, CCO has developed symptom management guides. The guides represent current evidence and best practices and are available in various formats to help the care team assess and manage a patient’s cancer-related symptoms. Results: Since the program’s introduction in 2007, over 1.6 million ESAS screens have been performed across the province. In November 2012, over 53% of all Regional Cancer Centre patients were screened representing over 23,000 patients and nearly 35,000 ESAS screens. Symptom assessments collected from 45,000 cancer patients revealed that 75% of patients reported fatigue as a concern, 57% reported anxiety and 53% reported pain. Patients have indicated that they value this approach. Results from a 2012 survey of 3,320 patients show that 93% thought that indicating their symptom severity is important as it helps their health care providers know how they are feeling. Evidence from chart audit reviews demonstrates that symptom screening is linked to higher rates of documented clinical interventions but further research is needed to analyze its impact on outcomes. Conclusions: Lessons learned include the importance of leadership at all levels, clinician engagement in change, point of care decision support tools and the importance of engaging patients in the management of their symptoms. Patients are overwhelmingly in support of this approach to cancer symptom screening and their involvement is critical to its expansion across all settings of care.