Understanding Electronic Patient-Reported Outcomes, with Lee Schwartzberg, MD, FACP

October 17, 2016
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Patient-reported outcomes, or PROs, are anything reported directly by the patient, such as symptoms or emotions. In today’s podcast, Dr. Lee Schwartzberg discusses his article, “Electronic Patient-Reported Outcomes: The Time Is Ripe for Integration Into Patient Care and Clinical Research,” and explains how electronic PRO systems can help improve communication between patients and their health care team. 



ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors that care for people with cancer.

This podcast is part of a series featuring articles from the 2016 ASCO Educational Book. Published annually, the Educational Book is a collection of articles written by ASCO annual meeting speakers and oncology experts. Each volume highlights the most compelling research and developments across the multidisciplinary fields of oncology.

Patient-reported outcomes, or PROs, are anything reported directly by the patient, such as symptoms or emotions. In today's podcast, Dr. Lee Schwartzberg discusses his article, “Electronic Patient-Reported Outcomes: The Time is Ripe for Integration into Patient Care and Clinical Research,” and explains how electronic PRO systems can help improve communication between patients and their healthcare team. Dr. Schwartzberg is a medical oncologist and hematologist at West Cancer Center in Memphis, Tennessee. ASCO would like to thank Dr. Schwartzberg for discussing this topic.

Dr. Schwartzberg: Hello. My name is Dr. Lee Schwartzberg from the West Cancer Center, University of Tennessee. I will be sharing some of the key points from my 2016 Educational Book article titled, “Electronic Patient-Reported Outcomes: The Time is Ripe for Integration into Patient Care and Clinical Research.”

 In order to achieve optimal patient-centered cancer care, all members of the care delivery team must participate. It does indeed take a village to treat a patient, not only for the cancer itself, but for the many faceted life dimensions impacted by a cancer diagnosis. No member of the team is more important than the one at the heart of it all, the patient and his or her voice. Everyone involved in care must hear that voice frequently and clearly.

One important way to capture the patient's voice is through patient-reported outcomes, or PROs, which means anything reported directly by the patient without interpretation by any other individual. This could be a symptom, such as pain, or an emotional state, like anxiety. For cancer patients immersed in a complex and sometimes hectic healthcare system, where they may only get a few minutes with their provider, and so many issues to address, toxicities of treatment, functional status, and psychosocial issues can get lost.

To fill this gap, the rise of electronic PRO systems have made patient reporting simple to do at every office visit through mobile technology. Such systems allow patient responses to be standardized, archived, and dashboarded to see trends over time. While a variety of systems are in use, most practices are not yet utilizing these valuable tools.

Our group developed a tablet computer-based system of electronically-captured PROs over a decade ago, with sequential improvements over time. Turning to patient care monitor, it is based on a standardized survey of about 50 questions that the patient answers every time they visit their provider. With touchscreen technology and a simple zero to ten response to such questions as, "Have you had nausea," calibrated to a seven day recall period, it takes about eight minutes to complete the survey.

The answers are immediately routed to a paper report, and simultaneously to the electronic medical record for a permanent recording. This system allows the provider to quickly see which symptoms have gotten better, and which have worsened from visit to visit. The patient care monitor is now available on any mobile device. Patients can communicate rapid changes in their condition quickly and efficiently. The notifications configured such that a particular member of the care delivery team, such as a nurse practitioner or a psychologist, receives appropriate answers in a timely fashion. Using these capabilities, patient issues - be they new symptoms or a difficulty in transportation for a chemotherapy appointment - can be addressed early before they become an insurmountable problem.

A prospective clinical trial recently addressed the use of ePROs compared to standard care at a major academic cancer center. The investigators found that by using the electronic system to measure 12 patient-reported symptoms and reporting them directly to providers, the participants' quality of life was better maintained through chemotherapy. Fewer patients visited the emergency department, and even patients' survival at one year was improved. This impressive result for a low-cost intervention suggests implementations of ePRO systems are very valuable to patient wellbeing.

ePRO systems are now being expanded to allow custom survey implementation, such as patient satisfaction score, and use advance scheduling functions to allow surveys at particular time intervals. For instance, yearly inquiries into vaccinations to keep track of individual patients' needs. Mobile two-way interactions through text messages may allow patients to avoid additional clinic visits, express their concerns better, and serve as a learning system for providers and the entire team. More practices and institutions are adopting these systems, and patients should consider asking their physicians to implement an electronic patient-reported outcome system so that they can more directly participate in their own care. Please view my article online at asco.org/edbook for a more in depth discussion of this topic. Thank you very much.

ASCO: Thank you, Dr. Schwartzberg. Please visit asco.org/edbook to read the full article. And for expert interviews and stories from people living with cancer, visit the Cancer.Net blog at www.cancer.net/blog.

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