Implementing a web-based patient reported outcomes (PRO) assessment: Uptake, usability, and lessons learned.

Abstract

e23062 Background: PRO assessment has the potential to improve patient-provider communication, yet has been difficult to implement in practice. We developed and pilot-tested a web-based PRO assessment (Assessing Concerns at End of Treatment, ACE) within an existing cancer survivorship clinic to ascertain practicality, usability, and uptake by both patients and providers. Methods: ACE is a brief PRO assessment that interfaces with the patient-portal and delivers results into the electronic medical record (EMR). Prior to visit eligible patients were asked to complete a series of measures including a 19-item instrument assessing severity of physical and emotional difficulties and desire for assistance. These results were then made available to providers during the visit through the EMR. Patients were provided up to 3 reminder calls/emails to prompt completion. Eligibility included a breast cancer (BC) diagnosis up to 5 years prior to a scheduled survivorship visit, no current cancer treatment aside from hormonal therapies, and access to the internet. Results: Over 27-months 779 eligible BC survivors were approached and asked to participate, and 566 (73%) agreed. The ACE survey was completed by 332 (59%) of these patients prior to their visit. The most common difficulties reported were Fatigue (86.6%), Worry (75.4%), Difficulty Sleeping (74.8%), and Pain (72.2%). Patients most commonly requested assistance for Aching Joints (31.2%), Fatigue (29%), Difficulty Sleeping (28.6%), and Weight Gain (25.7%). Providers reported being burdened by the information provided and few referrals were made in response to ACE. Technical difficulties were encountered frequently and required more maintenance than initially anticipated. Conclusions: Most eligible patients agreed to complete ACE, however a minority actually did so despite repeated contacts. Lack of buy-in from providers was an obstacle, as were technical difficulties. Difficulties with physical and emotional issues were common, but desire for assistance was less so, and resulted in few referrals. Although practicable, questions remain about the cost vs. benefit of a web-based PRO assessment with survivors.