PRO-SHOUT: Patient reported outcome supportive health in oncology utilizing technology.

Abstract

578 Background: High levels of symptoms and distress in cancer patients are linked to negative outcomes related to treatment adherence, healthcare utilization, quality of life, and survival. As such, psychosocial distress screening is now mandated in the American College of Surgeons Commission on Cancer accreditation standards. A growing body of evidence supports usage of electronic patient-reported outcomes (ePROs) for screening, with ePRO added as a quality metric in CMS’s Oncology Care First Model. However, some concerns related to uptake, accessibility, and clinician buy-in remain. In 2020, our palliative oncology (PO) team’s provider-driven (PD) screening workflow transitioned from a qualitative to quantitative approach, using four research-validated tools to assess mental distress (PHQ-9, GAD-7), symptoms (ESAS), and spirituality (FICA). In 2021, we initiated an ePRO workflow in which patients were prompted to complete all tools via the EHR patient portal before each visit, defaulting to PD workflow when not utilized. The aim of this project was to uncover the team’s perception of this workflow evolution and assess ePRO utilization. Methods: We collected EHR data from July 2020 to January 2023 for encounters in our PO clinic within a community-based cancer institute in the Midwest United States. We included in-office and virtual encounters with 13 providers where at least one tool was used (ePRO or PD). We conducted 45-minute semi-structured interviews and 2 usability surveys with 7 of these providers to assess their perspectives of ePRO tools. The IRB determined this to be a quality improvement project. Results: A total of 16,923 encounters with 3,101 patients (54.4% male, 89.3% white, average age 64.8) were analyzed. Post-ePRO initiation, 30.4% of encounters (primarily virtual) utilized ePRO; as expected, most of these included all four questionnaires (96.1%). In contrast, providers often completed only the ESAS in the PD workflow, particularly for established patients. Clinicians rated the workflow positively on surveys and described advantages such as improved visit preparation, flow, and efficiency. Validated tools overall were credited with greater standardization and improved data tracking and usage. Disadvantages of our ePRO workflow included excessive repetition of tools compared to PD and concerns with accuracy and patient misinterpretation. Suggested solutions included reduced frequency of questionnaires and improved instructional aids. Conclusions: Identifying and treating symptoms and distress remains an important aspect of palliative oncology care. EHRs offer real-time engagement for patients through ePROs, although some challenges with uptake and utilization remain. Our providers viewed ePROs as favorable updates to their workflow and felt that challenges could be mitigated with further changes.