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Cited by 68Mobile Health and mHealth ApplicationsCancer survivorship and careTelemedicine and Telehealth Implementation

A real-time electronic symptom monitoring system for patients after discharge following surgery: a pilot study in cancer-related surgery

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Richards, H. S., Blazeby, J. M., Portal, A., Harding, R., Reed, T., Lander, T., Chalmers, K. A., Carter, R. +4 more·2020·BMC Cancer
DOI 10.1186/s12885-020-07027-5PMC PMC7285449
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Abstract

Background: Advances in peri-operative care of surgical oncology patients result in shorter hospital stays. Earlier discharge may bring benefits, but complications can occur while patients are recovering at home. Electronic patient-reported outcome (ePRO) systems may enhance remote, real-time symptom monitoring and detection of complications after hospital discharge, thereby improving patient safety and outcomes. Evidence of the effectiveness of ePRO systems in surgical oncology is lacking. This pilot study evaluated the feasibility of a real-time electronic symptom monitoring system for patients after discharge following cancer-related upper gastrointestinal surgery. Methods: A pilot study in two UK hospitals included patients who had undergone cancer-related upper gastrointestinal surgery. Participants completed the ePRO symptom-report at discharge, twice in the first week and weekly post-discharge. Symptom-report completeness, system actions, barriers to using the ePRO system and technical performance were examined. The ePRO surgery system is an online symptom-report that allows clinicians to view patient symptom-reports within hospital electronic health records and was developed as part of the eRAPID project. Clinically derived algorithms provide patients with tailored self-management advice, prompts to contact a clinician or automated clinician alerts depending on symptom severity. Interviews with participants and clinicians determined the acceptability of the ePRO system to support patients and their clinical management during recovery. Results: Ninety-one patients were approached, of which 40 consented to participate (27 male, mean age 64 years). Symptom-report response rates were high (range 63–100%). Of 197 ePRO completions analysed, 76 (39%) triggered self-management advice, 72 (36%) trigged advice to contact a clinician, 9 (5%) triggered a clinician alert and 40 (20%) did not require advice. Participants found the ePRO system reassuring, providing timely information and advice relevant to supporting their recovery. Clinicians regarded the system as a useful adjunct to usual care, by signposting patients to seek appropriate help and enhancing their understanding of patients’ experiences during recovery. Conclusion: Use of the ePRO system for the real-time, remote monitoring of symptoms in patients recovering from cancer-related upper gastrointestinal surgery is feasible and acceptable. A definitive randomised controlled trial is needed to evaluate the impact of the system on patients’ wellbeing after hospital discharge.

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Research works printed but not linked: 55

  1. [1]Adam U Makowiec F Riediger H Schareck WD Benz S Hopt UT Risk factors for complications after pancreatic head resection Am J Surg 2004 187 2 201 208 14769305
  2. [3]DeOliveira ML Winter JM Schafer M Cunningham SC Cameron JL Yeo CJ Clavien PA Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy Ann Surg 2006 244 6 931 937 17122618 PMC1856636
  3. [4]Balentine CJ Naik AD Robinson CN Petersen NJ Chen GJ Berger DH Anaya DA Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery JAMA Surg 2014 149 3 244 251 24430092
  4. [5]Li LT Barden GM Balentine CJ Orcutt ST Naik AD Artinyan A Sansgiry S Albo D Berger DH Anaya DA Postoperative transitional care needs in the elderly an outcome of recovery associated with worse long-term survival Ann Surg 2015 261 4 695 701 24743615
  5. [6]Lightner AM Glasgow RE Jordan TH Krassner AD Way LW Mulvihill SJ Kirkwood KS Pancreatic resection in the elderly J Am Coll Surg 2004 198 5 697 706 15110802
  6. [7]Sacks GD Lawson EH Dawes AJ Gibbons MM Zingmond DS Ko CY Which patients require more care after hospital discharge? An analysis of post-acute care use among elderly patients undergoing elective surgery J Am Coll Surg 2015 220 6 1113 1121 25872686
  7. [8]Blazeby JM Sanford E Falk SJ Alderson D Donovan JL Health-related quality of life during neoadjuvant treatment and surgery for localized esophageal carcinoma Cancer 2005 103 9 1791 1799 15779022
  8. [9]Reynolds JV McLaughlin R Moore J Rowley S Ravi N Byrne PJ Prospective evaluation of quality of life in patients with localized oesophageal cancer treated by multimodality therapy or surgery alone Br J Surg 2006 93 9 1084 1090 16779881
  9. [10]Giacopuzzi S Weindelmayer J Treppiedi E Bencivenga M Ceola M Priolo S Carlini M de Manzoni G Enhanced recovery after surgery protocol in patients undergoing esophagectomy for cancer: a single center experience Dis Esophagus 2017 30 4 1 6 28375472
  10. [11]Pisarska M Malczak P Major P Wysocki M Budzynski A Pedziwiatr M Enhanced recovery after surgery protocol in oesophageal cancer surgery: systematic review and meta-analysis PLoS One 2017 12 3 e0174382 28350805 PMC5370110
  11. [12]van Dam RM Hendry PO Coolsen MM Bemelmans MH Lassen K Revhaug A Fearon KC Garden OJ Dejong CH Enhanced Recovery After Surgery G Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection Br J Surg 2008 95 8 969 975 18618897
  12. [13]Mitchell M Home recovery following day surgery: a patient perspective J Clin Nurs 2015 24 3–4 415 427 24811058
  13. [14]Mitchell AP Hirsch BR Abernethy AP Lack of timely accrual information in oncology clinical trials: a cross-sectional analysis Trials 2014 15 92 24661848 PMC3987844
  14. [15]Mooney KH Beck SL Friedman RH Farzanfar R Wong B Automated monitoring of symptoms during ambulatory chemotherapy and oncology providers' use of the information: a randomized controlled clinical trial Support Care Cancer 2014 22 9 2343 2350 24687538 PMC4290846
  15. [16]Warrington L Holch P Kenyon L Hector C Kozlowska K Kenny AM Ziegler L Velikova G An audit of acute oncology services: patient experiences of admission procedures and staff utilisation of a new telephone triage system Support Care Cancer 2016 24 12 5041 5048 27540738
  16. [17]Khuri SF Henderson WG DePalma RG Mosca C Healey NA Kumbhani DJ Participants in the VANSQIP Determinants of long-term survival after major surgery and the adverse effect of postoperative complications Ann Surg 2005 242 3 326 341 16135919 PMC1357741
  17. [18]Kotronoulas G Kearney N Maguire R Harrow A Di Domenico D Croy S MacGillivray S What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials J Clin Oncol 2014 32 14 1480 1501 24711559
  18. [19]Velikova G Use of electronic quality of life applications in cancer research and clinical practice Expert Rev Pharmacoecon Outcomes Res 2004 4 4 403 411 19807299
  19. [20]Kreuter MW Wray RJ Tailored and targeted health communication: strategies for enhancing information relevance Am J Health Behav 2003 27 Suppl 3 S227 S232 14672383
  20. [22]Ruland CM Maffei RM Borosund E Krahn A Andersen T Grimsbo GH Evaluation of different features of an eHealth application for personalized illness management support: cancer patients' use and appraisal of usefulness Int J Med Inform 2013 82 7 593 603 23507561
  21. [23]Slev VN Mistiaen P Pasman HR Verdonck-de Leeuw IM van Uden-Kraan CF Francke AL Effects of eHealth for patients and informal caregivers confronted with cancer: a meta-review Int J Med Inform 2016 87 54 67 26806712
  22. [24]Basch E Bennett A Pietanza MC Use of patient-reported outcomes to improve the predictive accuracy of clinician-reported adverse events J Natl Cancer Inst 2011 103 24 1808 1810 22157639
  23. [25]Cleeland CS Wang XS Shi Q Mendoza TR Wright SL Berry MD Malveaux D Shah PK Gning I Hofstetter WL Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial J Clin Oncol 2011 29 8 994 1000 21282546 PMC3068055
  24. [26]Bennett AV Jensen RE Basch E Electronic patient-reported outcome systems in oncology clinical practice CA Cancer J Clin 2012 62 5 337 347 22811342
  25. [28]Andikyan V Rezk Y Einstein MH Gualtiere G Leitao MM Jr Sonoda Y Abu-Rustum NR Barakat RR Basch EM Chi DS A prospective study of the feasibility and acceptability of a web-based, electronic patient-reported outcome system in assessing patient recovery after major gynecologic cancer surgery Gynecol Oncol 2012 127 2 273 277 22871467 PMC3641568
  26. [31]Kearney N McCann L Norrie J Taylor L Gray P McGee-Lennon M Sage M Miller M Maguire R Evaluation of a mobile phone-based, advanced symptom management system (ASyMS) in the management of chemotherapy-related toxicity Support Care Cancer 2009 17 4 437 444 18953579
  27. [32]Moradian S Krzyzanowska MK Maguire R Morita PP Kukreti V Avery J Liu G Cafazzo J Howell D Usability evaluation of a mobile phone-based system for remote monitoring and management of chemotherapy-related side effects in cancer patients: mixed-methods study JMIR Cancer 2018 4 2 e10932 30578238 PMC6320433
  28. [33]Cowan RA Suidan RS Andikyan V Rezk YA Einstein MH Chang K Carter J Zivanovic O Jewell EJ Abu-Rustum NR Electronic patient-reported outcomes from home in patients recovering from major gynecologic cancer surgery: a prospective study measuring symptoms and health-related quality of life Gynecol Oncol 2016 143 2 362 366 27637366 PMC5535805
  29. [34]Avery KNL Richards HS Portal A Reed T Harding R Carter R Bamforth L Absolom K O'Connell Francischetto E Velikova G Developing a real-time electronic symptom monitoring system for patients after discharge following cancer-related surgery BMC Cancer 2019 19 1 463 31101017 PMC6524308
  30. [35]Holch P Pini S Henry AM Davidson S Routledge J Brown J Absolom K Gilbert A Franks K Hulme C eRAPID electronic patient self-reporting of adverse-events: patient information and aDvice: a pilot study protocol in pelvic radiotherapy Pilot Feasibility Stud 2018 4 110 29992040 PMC5987546
  31. [36]Holch P Warrington L Bamforth LCA Keding A Ziegler LE Absolom K Hector C Harley C Johnson O Hall G Development of an integrated electronic platform for patient self-report and management of adverse events during cancer treatment Ann Oncol 2017 28 9 2305 2311 28911065 PMC5834137
  32. [38]Cella DF Tulsky DS Gray G Sarafian B Linn E Bonomi A Silberman M Yellen SB Winicour P Brannon J The functional assessment of cancer therapy scale: development and validation of the general measure J Clin Oncol 1993 11 3 570 579 8445433
  33. [41]Gurland B Alves-Ferreira PC Sobol T Kiran RP Using technology to improve data capture and integration of patient-reported outcomes into clinical care: pilot results in a busy colorectal unit Dis Colon Rectum 2010 53 8 1168 1175 20628281
  34. [42]Malhotra K Buraimoh O Thornton J Cullen N Singh D Goldberg AJ Electronic capture of patient-reported and clinician-reported outcome measures in an elective orthopaedic setting: a retrospective cohort analysis BMJ Open 2016 6 6 e011975 27324718 PMC4916591
  35. [43]Palmen LN Schrier JC Scholten R Jansen JH Koeter S Is it too early to move to full electronic PROM data collection?: a randomized controlled trial comparing PROM's after hallux valgus captured by e-mail, traditional mail and telephone Foot Ankle Surg 2016 22 1 46 49 26869500
  36. [44]Roberts N Bradley B Williams D Use of SMS and tablet computer improves the electronic collection of elective orthopaedic patient reported outcome measures Ann R Coll Surg Engl 2014 96 5 348 351 24992417 PMC4473930
  37. [45]van der Meij E Anema JR Leclercq WKG Bongers MY Consten ECJ Koops SES van de Ven PM Terwee CB van Dongen JM Schaafsma FG Personalised perioperative care by e-health after intermediate-grade abdominal surgery: a multicentre, single-blind, randomised, placebo-controlled trial Lancet 2018 392 10141 51 59 29937195
  38. [46]Berry DL Nayak MM Abrahm JL Braun I Rabin MS Cooley ME Clinician perspectives on symptom and quality of life experiences of patients during cancer therapies: implications for eHealth Psychooncology 2017 26 8 1113 1119 28497471
  39. [49]Nordan L Blanchfield L Niazi S Sattar J Coakes CE Uitti R Vizzini M Naessens JM Spaulding A Implementing electronic patient-reported outcomes measurements: challenges and success factors BMJ Qual Saf 2018 27 10 852 856 30021802
  40. [50]Absolom K Gibson A Velikova G Engaging Patients and Clinicians in Online Reporting of Adverse Effects During Chemotherapy for Cancer: The eRAPID System (Electronic Patient Self-Reporting of Adverse Events: Patient Information and aDvice) Med Care 2019 57 Suppl 5 Suppl 1 S59 S65 30985598
  41. [51]Hughes EF Wu AW Carducci MA Snyder CF What can I do? Recommendations for responding to issues identified by patient-reported outcomes assessments used in clinical practice J Support Oncol 2012 10 4 143 148 22609239 PMC3384764
  42. [52]Dorcaratto D Grande L Pera M Enhanced recovery in gastrointestinal surgery: upper gastrointestinal surgery Dig Surg 2013 30 1 70 78 23711427
  43. [53]Francis NK Mason J Salib E Allanby L Messenger D Allison AS Smart NJ Ockrim JB Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme Color Dis 2015 17 7 O148 O154 25988303
  44. [54]Fredericks S Guruge S Sidani S Wan T Postoperative patient education: a systematic review Clin Nurs Res 2010 19 2 144 164 20435785
  45. [55]Cook DJ Moradkhani A Douglas KS Prinsen SK Fischer EN Schroeder DR Patient education self-management during surgical recovery: combining mobile (iPad) and a content management system Telemed J E Health 2014 20 4 312 317 24443928 PMC3968874
  46. [56]Weinhouse GL Schwab RJ Watson PL Patil N Vaccaro B Pandharipande P Ely EW Bench-to-bedside review: delirium in ICU patients - importance of sleep deprivation Crit Care 2009 13 6 234 20053301 PMC2811939
  47. [57]Timmers T Janssen L Pronk Y van der Zwaard BC Koeter S van Oostveen D de Boer S Kremers K Rutten S Das D Assessing the efficacy of an educational smartphone or tablet app with subdivided and interactive content to increase patients’ medical knowledge: randomized controlled trial JMIR Mhealth Uhealth 2018 6 12 e10742 30578185 PMC6320423
  48. [58]Lee BT Chen C Yueh JH Nguyen MD Lin SJ Tobias AM Computer-based learning module increases shared decision making in breast reconstruction Ann Surg Oncol 2010 17 3 738 743 20039216
  49. [59]Marble N Loescher LJ Lim KH Hiscox H Use of technology for educating melanoma patients J Cancer Educ 2010 25 3 445 450 20336399 PMC6204127
  50. [60]Boyce MB Browne JP Greenhalgh J Surgeon's experiences of receiving peer benchmarked feedback using patient-reported outcome measures: a qualitative study Implement Sci 2014 9 84 24972784 PMC4227108
  51. [61]Nelson MC, Burke RL. Fielding the remote online veterinary record, a veterinary electronic health record to improve patient care and practice management. US Army Med Dep J. 2015;61–6. 25651147
  52. [63]Warrington L, Absolom K, Holch P, Gibson A, Clayton B, Velikova G. Online tool for monitoring adverse events in patients with cancer during treatment (eRAPID): field testing in a clinical setting. BMJ Open. 2019;9(1):e025185. PMC6361332 30782751
  53. [64]Blazeby JM. Recruiting patients into randomized clinical trials in surgery. Br J Surg. 2012;99(3):307–8. 22237652
  54. [65]Kaur G, Hutchison I, Mehanna H, Williamson P, Shaw R, Tudur Smith C. Barriers to recruitment for surgical trials in head and neck oncology: a survey of trial investigators. BMJ Open. 2013;3(4):e002625. 10.1136/bmjopen-2013-002625. PMC3641444 23585392 · DOI
  55. [66]Pinkney TD, Calvert M, Bartlett DC, Gheorghe A, Redman V, Dowswell G, Hawkins W, Mak T, Youssef H, Richardson C, et al. Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI trial). BMJ. 2013;347:f4305. PMC3805488 23903454

Cited by

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Authors
Richards, H. S., Blazeby, J. M., Portal, A., Harding, R., Reed, T., Lander, T., Chalmers, K. A., Carter, R., Singhal, R., Absolom, K., Velikova, G., & Avery, K. N. L.
Affiliations
  • University of Bristol (GB)
  • University Hospitals Bristol NHS Foundation Trust (GB)
  • University of Leeds (GB)
  • Queen Elizabeth Hospital Birmingham (GB)
Corresponding author
Richards, H. S.
ORCID
Venue
BMC Cancer
Publisher
Springer Science and Business Media LLC
Published
2020-06-10
Volume
20
Issue
1
Pages
543-543
ISSN
1471-2407 (ISSN-L)
DOI
10.1186/s12885-020-07027-5
PMC
PMC7285449
OpenAlex
W3032951322
Cited by
68
References
7
Citations by year
2026: 6 · 2025: 7 · 2024: 19 · 2023: 16 · 2022: 13 · 2021: 4 · 2020: 3
FWCI
9.40
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Cancer (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion, cc-by)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Bristol Research (University of Bristol) (submittedVersion, cc-by)
Funders
National Institute for Health Research (RP-PG-0611-20008)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
electronic patient-reported outcomes, remote symptom monitoring, upper gastrointestinal surgery, post-discharge recovery, early discharge, postoperative complications, self-management advice, feasibility and acceptability, electronic health records
MeSH terms
Patient Reported Outcome Measures, Enhanced Recovery After Surgery, Adult, Aged, Aged, 80 and over, Bile Duct Neoplasms, Continuity of Patient Care, Esophageal Neoplasms, Feasibility Studies, Female, United Kingdom, Humans, Male, Middle Aged, Online Systems, Patient Discharge, Pilot Projects, Prospective Studies, Stomach Neoplasms, Qualitative Research, Symptom Assessment

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