Pilot implementation to assess the feasibility and care team impact of an app-based interactive care plan to remotely monitor breast cancer survivors

Daniela L Stan,Kaley N Johnson,Julie K Brown,Tufia C Haddad,Sarah A Phillips,Jennifer K Hazelton,Jennifer L Ridgeway,Summer V Allen,Kathryn J Ruddy,Samantha M Mccolley,Jonathan W Inselman,Laura A Christopherson

doi:10.1007/s11764-021-01136-1

Daniela L Stan, Kaley N Johnson + Show 10 more

Open Access

https://doi.org/10.1007/s11764-021-01136-1

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Abstract

PurposeTo assess the feasibility of an app-based, electronic health record (EHR)-integrated, interactive care plan (ICP) for breast cancer (BC) survivors.MethodsA single-arm pilot study was conducted with female BC survivors. ICP tasks included quarterly quality of life (QOL) questionnaire; monthly assessments of fatigue, insomnia, sexual dysfunction, hot flashes, and recurrence symptoms; and daily activity reminders. Embedded decision trees escalated recurrence symptoms to providers. On-demand education was available for self-management of treatment-related toxicities. The primary objective was to assess patients’ engagement with ICP tasks against feasibility thresholds of 75% completion rate. Secondary objectives were evaluation of the system’s functionality to track and escalate symptoms appropriately, and care team impact measured by volume of escalation messages generated. We report preliminary results 6 months after the last patient enrolled.ResultsTwenty-three patients enrolled August to November 2020. Mean age was 50.1 years. All patients engaged with at least one ICP task. The monthly average task completion rates were 62% for the QOL questionnaire, 59% for symptom assessments, and 37% for activity reminders. Task completion rate decreased over time. Eleven of 253 symptoms and QOL questionnaires (4.3%) generated messages for care escalation.ConclusionImplementation of an app-based, EHR-integrated ICP in BC survivors was feasible and created minimal provider burden; however, patient engagement was below the feasibility threshold suggesting that changes may enhance broad implementation and adoption.Implications for Cancer SurvivorsAn ICP may facilitate remote monitoring, symptom control, and recurrence surveillance for cancer survivors as strategies to enhance patient engagement are applied.

Highlights

Breast cancer (BC) has recently surpassed lung cancer to become the most diagnosed malignancy in women worldwide, with an estimated 2.3 million new cases diagnosed in 2020 [1]
For the primary outcome of questionnaire task completion rate, we assessed the total response rate of all questionnaires administered over the course of the study
In this pilot feasibility study, we demonstrated that the interactive care plan (ICP) may be ready for larger scale implementation in the oncology practice, but we found the need for strategies to increase adoption and use, given the high engagement rate, but lower than predicted overall task completion rate over time

Summary

Introduction

Breast cancer (BC) has recently surpassed lung cancer to become the most diagnosed malignancy in women worldwide, with an estimated 2.3 million new cases diagnosed in 2020 [1]. BC survivors feel “lost in transition” after they complete the intensive multi-modality treatment as follow-up care can be duplicative and fragmented when multiple teams, rehabilitation specialists, and primary care providers are all co-managing with suboptimal communication and coordination [8]. This creates a mismatch between the intense needs of these patients in the immediate post-primary treatment period, when they are at risk for recurrence and at risk for persistent treatment-related toxicities, and the availability of oncological care

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