Journal
CANCER
Volume 125, Issue 22, Pages 4059-4068Publisher
WILEY
DOI: 10.1002/cncr.32172
Keywords
ehealth; electronic health records; outcomes measurement; patient-reported outcomes; psychosocial care; symptom management
Categories
Funding
- Robert H. Lurie Comprehensive Cancer Center
- Coleman Foundation
- Northwestern University Clinical and Translational Sciences Institute [UL1TR001422]
- National Institutes of Health [U54AR057951]
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Background Oncology practice can be enhanced by the integration of the assessment of patient-reported symptoms and concerns into the electronic health record (EHR) and clinical workflows. Methods Adult oncology outpatients (n = 6825) received 38,422 invitations to complete assessments through the EHR patient portal. Patient-Reported Outcomes Measurement Information System computer adaptive tests were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial, nutritional, and informational needs. In real time, assessment results were populated in the EHR, and clinicians were notified of elevated symptoms and needs. Results In all, 3521 patients (51.6%) completed 8162 assessments; approximately 55% of the responding patients completed 2 or more within 32 months. Fatigue, pain, anxiety, and depression scores were comparable to those of the general population (approximately 5% of assessments triggered clinical alerts across those domains); mean scores indicated a lower level of physical function (with severe scores prompting alerts in nearly 5% of assessments). More than half of assessments triggered an alert based on patient endorsement of supportive care needs, with the majority of those being nutritional (41.82% of assessments). Patient endorsement of supportive care needs was associated with significantly higher anxiety, depression, fatigue, and pain interference scores and lower physical function scores. Patients who triggered clinical alerts tended to be younger and more recently diagnosed, to have greater comorbidities, and to be a racial/ethnic minority. Patients who triggered clinical alerts had more health care service encounters in the ensuing month. Conclusions EHR integration facilitated the assessment and reporting of patient-reported symptoms and needs within routine oncology outpatient care.
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