Bringing PROMIS to practice: Brief and precise symptom screening in ambulatory cancer care
Open accessAbstract
BACKGROUND: Supportive oncology practice can be enhanced by the integration of a brief and validated electronic patient‐reported outcome assessment into the electronic health record (EHR) and clinical workflow. METHODS: Six hundred thirty‐six women receiving gynecologic oncology outpatient care received instructions to complete clinical assessments through Epic MyChart, an EHR patient communication portal. Patient Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial concerns, informational and nutritional needs, and risk factors for inadequate nutrition. Assessment results, including PROMIS T scores with documented severity thresholds, were immediately populated in the EHR. Clinicians were notified of clinically elevated symptoms through EHR messages. EHR integration was designed to provide automated triage to social work providers for psychosocial concerns, to health educators for information, and to dietitians for nutrition‐related concerns. RESULTS: Four thousand forty‐two MyChart messages sent, and 3203 (79%) were reviewed by patients. The assessment was started by 1493 patients (37%), and once they started, 93% (1386 patients) completed the assessment. According to first assessments only, 49.8% of the patients who reviewed the MyChart message completed the assessment. Mean PROMIS CAT T scores indicated a lower level of physical function and elevated anxiety in comparison with the general population. Fatigue, pain, and depression scores were comparable to those of the general population. Impaired physical functioning was the most common basis for clinical alerts and occurred in 4% of the patients. CONCLUSIONS: PROMIS CATs were used to measure common cancer symptoms in routine oncology outpatient care. Immediate EHR integration facilitated the use of symptom reporting as the basis for referral to psychosocial and supportive care. Cancer 2015;121:927–934. © 2014 American Cancer Society.
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PROMIS measures were initially developed with cancer patients' input, and a growing body of research has documented their reliability and validity for use with cancer patients, including those with advanced disease.
“PROMIS measures were initially developed with cancer patients’ input [32], and a growing body of research has documented the measures’ reliability and validity for use with cancer patients, including those with advanced disease [33–35].”
From Symptom experiences in metastatic breast cancer patients: relationships to activity engagement, value-based living, and psychological inflexibility (2017) · cites this paper as [34]
The Methods > Measures section says PROMIS CATs generate reliable and valid symptom scores and use normative data from cancer patients. The paper describes their use in gynecologic oncology outpatient care, but does not establish reliability or validity specifically for patients with advanced disease. The separate claim about cancer patients’ input is attached to citation [32], not this source. (LLM, conf=0.84)
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- Authors
- Wagner, L. I., Schink, J., Bass, M., Patel, S., Diaz, M. V., Rothrock, N., Pearman, T., Gershon, R., Penedo, F. J., Rosen, S., & Cella, D.
- Affiliations
- Northwestern University (US)
- Spectrum Health (US)
- City Of Hope National Medical Center (US)
- Corresponding author
- Wagner, Lynne I.
- ORCID
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2014-11-06
- Volume
- 121
- Issue
- 6
- Pages
- 927-934
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- PMC
- PMC4352124
- OpenAlex
- W1597614727
- Cited by
- 233
- References
- 30
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 20 · 2023: 18 · 2022: 23 · 2021: 27 · 2020: 25 · 2019: 23 · 2018: 24 · 2017: 21 · 2016: 19 · 2015: 10
- FWCI
- 8.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cancer (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01 CA60068)
- Coleman Foundation
- National Institutes of Health (U5 AR057951)
- William W. Wirtz Cancer Innovation Fund
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- PROMIS, computerized adaptive testing, patient-reported outcomes, electronic health record integration, symptom screening, gynecologic oncology, fatigue, pain interference, physical function, depression, anxiety, nutritional risk, cancer supportive care
- MeSH terms
- Adult, Aged, Aged, 80 and over, Ambulatory Care, Female, Genital Neoplasms, Female, Humans, Middle Aged, Palliative Care, Surveys and Questionnaires, Treatment Outcome, Young Adult, Electronic Health Records, Self Report
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