Implementation of electronic patient-reported outcomes for symptom monitoring in a large multisite community oncology practice: dancing the Texas two-step through a pandemic
Open accessAbstract
PURPOSE: Among patients receiving chemotherapy, symptom monitoring with electronic patient-reported outcomes (ePROs) is associated with improved clinical outcomes, satisfaction, and compliance with therapy. Standard approaches for ePRO implementation are not established, warranting evaluation in community cancer practices. We present implementation findings of ePRO symptom monitoring across a large multisite community oncology practice network. METHODS: Patients initiating a new systemic therapy at one of the 210 practice sites at Texas Oncology were invited to use the Navigating Cancer ePRO platform, with stepped-wedge implementation from July to December 2020. Participating patients received a weekly prompt by text message or e-mail to self-report common symptoms and well-being. Severe self-reported symptoms triggered a real-time notification to nursing triage to address the symptom. Enrollment and compliance were systematically tracked weekly with evaluation of barriers and facilitators to adoption and sustainability. RESULTS: Four thousand three hundred seventy-five patients planning systemic treatment were enrolled and participated. Seventy-three percent (1,841 of 2,522) of enrolled patients completed at least one ePRO assessment. Among these individuals, 64% (16,299 of 25,061) of available weekly ePRO assessments were completed. Over a 10-week period, compliance declined from 72% to 52%. Barriers currently being addressed include lack of a second reminder text or e-mail prompt, inconsistent discussion of reported ePROs by clinicians at visits, and COVID-related changes in workflow. Facilitators included ease of use and patient and staff engagement on the importance of PROs for symptom management. CONCLUSION: ePROs can be effectively implemented in community oncology practice. Utilization of ePROs is high but diminishes over time without attention to barriers. Ongoing work to address barriers and optimize compliance are underway.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Cherny et al. and Patt et al. reported approximately 64% adherence to weekly ePRO reporting in routine oncology care in community practices in the United States, with lower engagement among elderly patients.
“However, Cherny et al. and Patt et al. have published their experiences implementing RPM in routine oncology care in community practices in the United States outside a clinical trial.20,29 In these studies, patients’ adherence to weekly ePRO reporting was approximately 64%, with lower engagement among elderly patients.”
From Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium (2024) · cites this paper as [29]
Cites
Evaluating the public health impact of health promotion interventions: the RE-AIM framework.
Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999) · American Journal of Public Health · doi:10.2105/ajph.89.9.1322 · Cited by 7,217 · see citing works
Basch, E., Deal, A. M., Dueck, A. C., Scher, H. I., Kris, M. G., Hudis, C., & Schrag, D. (2017) · JAMA · doi:10.1001/jama.2017.7156 · Cited by 2,302 · see citing works
Self-citationDesign and analysis of stepped wedge cluster randomized trials.
Hussey, M. A., & Hughes, J. (2007) · Contemporary Clinical Trials · doi:10.1016/j.cct.2006.05.007 · Cited by 1,297 · see citing works
Henry, D. H., Viswanathan, H. N., Elkin, E. P., Traina, S., Wade, S. M., & Cella, D. F. (2008) · Supportive Care in Cancer · doi:10.1007/s00520-007-0380-2 · Cited by 384 · see citing works
Kluetz, P. G., Chingos, D. T., Basch, E., & Mitchell, S. A. (2016) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk_159514 · Cited by 363 · see citing works
Self-citationBasch, E., Stover, A. M., Schrag, D., Chung, A., Jansen, J., Henson, S., Carr, P., Ginos, B., Deal, A., Spears, P. A., et al. (2020) · JCO Clinical Cancer Informatics · doi:10.1200/cci.20.00081 · Cited by 194 · see citing works
Self-citationPanattoni, L. E., Fedorenko, C. R., Greenwood-Hickman, M. A., Kreizenbeck, K. L., Walker, J. R., Martins, R. G., Eaton, K. D., Rieke, J. W., Conklin, T., Smith, B. R., et al. (2018) · Journal of Oncology Practice · doi:10.1200/jop.2017.028191 · Cited by 105 · see citing works
Basch, E., Dueck, A. C., Rogak, L. J., Mitchell, S. A., Minasian, L. M., Denicoff, A. M., Wind, J. K., Shaw, M. C., Heon, N., Shi, Q., et al. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2018.78.8620 · Cited by 77 · see citing works
Self-citationSandhu, S., King, Z., Wong, M., Bissell, S., Sperling, J., Gray, M., Ratliff, W., Herring, K., & LeBlanc, T. W. (2020) · JCO Oncology Practice · doi:10.1200/op.20.00357 · Cited by 44 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Rocque, G. B., Dent, D. N., Ingram, S. A., Caston, N. E., Thigpen, H. B., Lalor, F. R., Jamy, O. H., Giri, S., Azuero, A., Young Pierce, J., et al. (2022) · JCO Oncology Practice · doi:10.1200/op.22.00360 · Cited by 62 · see citing works
Self-citationFranzoi, M. A., Ferreira, A. R., Lemaire, A., Rodriguez, J., Grosjean, J., Ribeiro, J. M., Polastro, L., Grellety, T., Artignan, X., Le Du, K., et al. (2024) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2024.101005 · Cited by 50 · see citing works
“20,29 In these studies, patients ’ adherence to weekly ePRO reporting was approximately 64%, with lower engagement among elderly patients.”
BackgroundSelf-citationCherny, N. I., Parrinello, C. M., Kwiatkowsky, L., Hunnicutt, J., Beck, T., Schaefer, E., Thurow, T., & Kolodziej, M. (2022) · JCO Oncology Practice · doi:10.1200/op.22.00180 · Cited by 28 · see citing works
- Authors
- Patt, D., Wilfong, L., Hudson, K. E., Patel, A., Books, H., Pearson, B., Boren, R., Patil, S., Olson-Celli, K., & Basch, E.
- Affiliations
- Texas Oncology (US)
- Navigating Cancer, Seattle, WA
- University of North Carolina at Chapel Hill (US)
- Venue
- JCO Clinical Cancer Informatics
- Published
- 2021-12
- Volume
- 5
- Issue
- 5
- Pages
- 615-621
- ISSN
- 2473-4276 (ISSN-L)
- OpenAlex
- W3165578091
- Cited by
- 91
- References
- 9
- Citations by year
- 2026: 11 · 2025: 20 · 2024: 19 · 2023: 18 · 2022: 21 · 2021: 2
- FWCI
- 5.46
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- JCO Clinical Cancer Informatics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- electronic patient-reported outcomes, symptom monitoring, community oncology practice, chemotherapy, stepped wedge design, patient engagement, symptom management, COVID-19 pandemic, medication adherence, nurse triage, barriers and facilitators
- MeSH terms
- Patient Reported Outcome Measures, COVID-19, SARS-CoV-2, Electronics, Humans, Surveys and Questionnaires, Texas, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
