Implementation of Electronic Patient-Reported Outcomes (PRO) in Outpatient Oncology Palliative Medicine (PM) Consults (QI831)

Abstract

•List at least 3 symptoms screened in an electronic PRO tool.•Describe usability of an electronic PRO tool including the average completion rate and duration for completion of each screen. PROs are an important component of oncology care that allows patients to measure their perceptions of their symptoms, functional status, and well-being. Evidence has demonstrated benefits in survival, quality of life, and symptom control. Systematic collection of PROs in the oncology PM setting, where distress and symptom burden is typically high, benefits both the individual patient care plan and monitoring of population level outcomes. To assess utilization and effectiveness of an electronic PRO screening tool for new outpatient oncology PM patients. The oncology PM clinic implemented a tablet-based PRO screening tool available in English or Spanish with a total of 39 questions including 11 symptom scales (0-10) and four validated screens for anxiety/depression, nutrition, spirituality, and function. Patients were provided the tablet at check-in, and completed results were integrated into the electronic medical record. Average completion time was 8 minutes. The PRO results were reviewed by the PM team during the consult to assist with clinical decision-making and referrals. During the first six months of 2017, 85% (n=151) of new oncology PM patients completed the PRO tool. The average fatigue score (0-10) was 6.6, pain 6.1, and nausea 2.5. Patients ranked depression 1.2 and anxiety 0.9 on a 0-3 scale. Anorexia was reported in 52% (n=78) with 32% reporting weight loss of greater than 13 lbs. Functional deficits were reported in 11% (n=16). Electronic PROs provide an effective way to screen new patients to oncology PM for distress and uncontrolled symptoms during the initial consultation. Results of the screening tool allowed the PM team to address issues that may not have been spontaneously offered by the patient, and triggered referrals to cancer support services (i.e. nutrition, psychotherapy) and other medical specialties.