Routine physical function assessment through a Branching Logic Electronic Symptom Survey (BLESS) vs. the 32-combined item HAQ-DI + WHODAS (HW) survey: A quality improvement controlled trial.

Abstract

136 Background: Routine outpatient physical function assessment can improve quality of care by prioritizing supports for specific patients. However, conventional research surveys including the 32-combined item HAQ-DI + WHODAS (HW) may be burdensome to patients. To streamline this process, we have developed BLESS, an electronic patient reported outcomes software program that utilizes PRO-ECOG and EQ-5D-3L items to screen for physical dysfunction symptoms, with follow-up questions from HW; BLESS has been demonstrated to have high sensitivity and specificity for the complete HW survey. We compared completion times and patient acceptability of BLESS vs. HW. Methods: Adult oncology outpatients of all stages at Princess Margaret Cancer Centre were allocated prospectively and alternately to receive either BLESS or HW on touchscreen tablets. Completion times were recorded and a patient acceptability survey was administered. Results: Of 225 patients analyzed from breast (19%), GI (22%), GU (12%), gynecology (16%), head/neck (12%), skin (6%) and thoracic (13%) cancer clinics, 118 (52%) patients completed BLESS and 107 (47%) completed HW. Median age was 61 (range: 18-97) years; 60% were female, 68% were Caucasian, 44% were stage IV, and 57% were treated with a curative intent. There were no statistically significant differences in demographic and clinical characteristics between the arms analyzed. Median EQ-5D-3L utility was 0.83 (0.28-1.00), median HAQ-DI was 0.13 (0-3.00) and median WHODAS was 8.3% (0-83.3%). Compared to HW, BLESS resulted in a median completion time reduction of 3.9 minutes (32% decrease; p < 0.001). Although most patients in both arms did not find the survey time-consuming nor caused the clinic visit to be more difficult, a greater proportion of BLESS patients held a stronger conviction in their answers (p = 0.02 for both comparisons). Conclusions: In comparison to traditional research tools of HW for assessing physical function,BLESS was associated with shorter administration times and improved patient acceptability, rendering BLESS more suitable for routine clinical use.