Tenets for Implementing Electronic Patient-Reported Outcomes for Remote Symptom Monitoring During Cancer Treatment
Open accessAbstract
PURPOSE: Symptoms are common in patients receiving systemic treatment for metastatic cancer. Monitoring patients with electronic patient-reported outcomes (ePROs) detects severe and worsening symptoms early, enabling care teams to intervene and prevent downstream complications and thereby improving outcomes. The Centers for Medicare & Medicaid Services will require patient-reported outcome (PRO) monitoring in the upcoming Enhancing Oncology Model, and many practices will likely attempt to implement PROs in patient care for the first time. METHODS: To assist practices with the design and implementation of ePRO remote symptom monitoring programs, tenets were drawn from prior ePRO program experiences and research. RESULTS: Successful implementation requires a quality improvement approach to change management with attention to software functionality, measured outcomes, personnel deployment, leadership and culture, workflow, equity, and patient engagement. Specific approaches in each of these areas can optimize program participation and effectiveness. Continuous program monitoring to identify and address barriers is essential to success. Initial challenges with personnel acceptance and patient participation are common and can be overcome by using these tenets. CONCLUSION: Remote symptom monitoring with ePROs is a key component of quality cancer care and population health management that requires organizational commitment and a deliberate approach by practices using established tenets to assure successful implementation.
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The implementation of the RPM pathway followed the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation science framework and other validated implementation techniques.
“The implementation of the RPM pathway followed the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation science framework and other validated implementation techniques.17,26,27”
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 [17]
The Tenets section on practice commitment, culture, continuous assessment, and sustainability recommends quality-improvement methods and says program assessment may use tools from implementation science frameworks. It does not name EPIS or establish that the citing paper’s RPM pathway followed EPIS or any particular validated technique. No page number is available in our copy. (LLM, conf=0.84)
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References 26 · Cited by 58
Research works printed but not linked: 19
- [2]Basch E, Barbera L, Kerrigan CL, Velikova G. Implementation of Patient-Reported Outcomes in Routine Medical Care. Am Soc Clin Oncol Educ Book. 2018 May 23; 38: 122– 134. 30231381
- [4]Denis F, Basch E, Septans AL, Bennouna J, Urban T, Dueck AC, Letellier C. Two-Year Survival Comparing Web-Based Symptom Monitoring vs Routine Surveillance Following Treatment for Lung Cancer. JAMA. 2019 Jan 22; 321(3): 306– 307. 30667494 PMC6439676
- [5]Mir O, Ferrua M, Fourcade A, Mathivon D, Duflot-Boukobza A, Dumont S, Baudin E, Delaloge S, Malka D, Albiges L, Pautier P, Robert C, Planchard D, de Botton S, Scotté F, Lemare F, Abbas M, Guillet M, Puglisi V, Di Palma M, Minvielle E. Digital remote monitoring plus usual care versus usual care in patients treated with oral anticancer agents: the randomized phase 3 CAPRI trial. Nat Med. 2022 Jun; 28(6): 1224– 1231. 35469070
- [6]Barbera L, Sutradhar R, Seow H, Mittmann N, Howell D, Earle CC, Li Q, Thiruchelvam D. The impact of routine Edmonton Symptom Assessment System (ESAS) use on overall survival in cancer patients: Results of a population-based retrospective matched cohort analysis. Cancer Med. 2020 Aug 14; 9(19): 7107– 15. 32794634 PMC7541161
- [7]Barbera L, Sutradhar R, Seow H, Earle CC, Howell D, Mittmann N, Li Q, Thiruchelvam D. Impact of Standardized Edmonton Symptom Assessment System Use on Emergency Department Visits and Hospitalization: Results of a Population-Based Retrospective Matched Cohort Analysis. JCO Oncol Pract. 2020 Sep; 16(9): e958– e965. 32463762
- [10]Snyder CF, Aaronson NK, Choucair AK, Elliott TE, Greenhalgh J, Halyard MY, Hess R, Miller DM, Reeve BB, Santana M. Implementing patient-reported outcomes assessment in clinical practice: a review of the options and considerations. Qual Life Res. 2012 Oct; 21(8): 1305– 14. 22048932
- [12]Patt D, Wilfong L, Hudson KE, Patel A, Books H, Pearson B, Boren R, Patil S, Olson-Celli K, Basch E. Implementation of Electronic Patient-Reported Outcomes for Symptom Monitoring in a Large Multisite Community Oncology Practice: Dancing the Texas Two-Step Through a Pandemic. JCO Clin Cancer Inform. 2021 May; 5: 615– 621. 34085537
- [13]Basch E, Stover AM, Schrag D, Chung A, Jansen J, Henson S, Carr P, Ginos B, Deal A, Spears PA, Jonsson M, Bennett AV, Mody G, Thanarajasingam G, Rogak LJ, Reeve BB, Snyder C, Kottschade LA, Charlot M, Weiss A, Bruner D, Dueck AC. Clinical Utility and User Perceptions of a Digital System for Electronic Patient-Reported Symptom Monitoring During Routine Cancer Care: Findings From the PRO-TECT Trial. JCO Clin Cancer Inform. 2020 Oct; 4: 947– 957. 33112661 PMC7768331
- [14]Cherny NI, Parrinello CM, Kwiatkowsky L, Hunnicutt J, Beck T, Schaefer E, Thurow T, Kolodziej M. Feasibility of Large-Scale Implementation of an Electronic Patient-Reported Outcome Remote Monitoring System for Patients on Active Treatment at a Community Cancer Center. JCO Oncol Pract. 2022 Oct 14:OP2200180. PMC9750604 36240475
- [15]Dumais KM, Dias N, Khurana L, Gary ST, Witherspoon B, Evans CJ, Dallabrida SM. Preferences for Use and Design of Electronic Patient-Reported outcomes in Patients with Chronic Obstructive Pulmonary Disease. Patient. 2019 Dec; 12(6): 621– 629. 31313271
- [17]Reilly CM, Bruner DW, Mitchell SA, Minasian LM, Basch E, Dueck AC, Cella D, Reeve BB. A literature synthesis of symptom prevalence and severity in persons receiving active cancer treatment. Support Care Cancer. 2013 Jun; 21(6): 1525– 50. 23314601 PMC4299699
- [18]Panattoni L, Fedorenko C, Greenwood-Hickman MA, Kreizenbeck K, Walker JR, Martins R, Eaton KD, Rieke JW, Conklin T, Smith B, Lyman G, Ramsey SD. Characterizing Potentially Preventable Cancer- and Chronic Disease-Related Emergency Department Use in the Year After Treatment Initiation: A Regional Study. J Oncol Pract. 2018 Mar; 14(3): e176– e185. 29452549
- [19]de Souza JA, Yap BJ, Wroblewski K, Blinder V, Araújo FS, Hlubocky FJ, Nicholas LH, O’Connor JM, Brockstein B, Ratain MJ, Daugherty CK, Cella D. Measuring financial toxicity as a clinically relevant patient-reported outcome: The validation of the COmprehensive Score for financial Toxicity (COST). Cancer. 2017 Feb 1; 123(3): 476– 484. 27716900 PMC5298039
- [25]Al-Rashdan A, Sutradhar R, Nazeri-Rad N, Yao C, Barbera L. Comparing the Ability of Physician-Reported Versus Patient-Reported Performance Status to Predict Survival in a Population-Based Cohort of Newly Diagnosed Cancer Patients. Clin Oncol (R Coll Radiol). 2021 Feb 3:S0936–6555(21)00008-X. 33549463
- [26]Giri S, Chakiba C, Shih YY, Chan WL, Krok-Schoen JL, Presley CJ, Williams GR, Subbiah IM. Integration of geriatric assessment into routine oncologic care and advances in geriatric oncology: A young International Society of Geriatric Oncology Report of the 2020 American Society of Clinical Oncology (ASCO) annual meeting. J Geriatr Oncol. 2020 Nov; 11(8): 1324– 1328. 32732011
- [28]Philipson RG, Wu AD, Curtis WC, Jablonsky DJ, Hegde JV, McCloskey SA, Kaprealian TB, Steinberg ML, Kishan AU, Raldow AC. A Practical Guide for Navigating the Design, Build, and Clinical Integration of Electronic Patient-Reported Outcomes in the Radiation Oncology Department. Pract Radiat Oncol. 2021 Jul-Aug; 11(4): e376– e383. 33460827
- [29]Stabile C, Temple LK, Ancker JS, Basch E, Carter J, Miranda M, Stein D, Stetson PD, Vickers A, Simon BA, Pusic AL. Ambulatory cancer care electronic symptom self-reporting (ACCESS) for surgical patients: a randomised controlled trial protocol. BMJ Open. 2019 Sep 17; 9(9): e030863. PMC6756418 31530612
- [30]Simon BA, Assel MJ, Tin AL, Desai P, Stabile C, Baron RH, Cracchiolo JR, Twersky RS, Vickers AJ, Laudone VP. Association Between Electronic Patient Symptom Reporting With Alerts and Potentially Avoidable Urgent Care Visits After Ambulatory Cancer Surgery. JAMA Surg. 2021 Aug 1; 156(8): 740– 746. 34076691 PMC8173461
- [31]Cleeland CS, Wang XS, Shi Q, Mendoza TR, Wright SL, Berry MD, Malveaux D, Shah PK, Gning I, Hofstetter WL, Putnam JB Jr, Vaporciyan AA. Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial. J Clin Oncol. 2011 Mar 10; 29(8): 994– 1000. 21282546 PMC3068055
- Authors
- Basch, E., Rocque, G., Mody, G., Mullangi, S., & Patt, D.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Alabama at Birmingham (US)
- Memorial Sloan Kettering Cancer Center (US)
- Texas Oncology (US)
- Venue
- JCO Clinical Cancer Informatics
- Published
- 2023-02
- Volume
- 7
- Issue
- 7
- Pages
- e2200187-e2200187
- ISSN
- 2473-4276 (ISSN-L)
- PMC
- PMC11770894
- OpenAlex
- W4322753745
- Cited by
- 58
- References
- 26
- Citations by year
- 2026: 16 · 2025: 22 · 2024: 16 · 2023: 4
- FWCI
- 7.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JCO Clinical Cancer Informatics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- Eli Lilly and Company
- Pfizer
- Gilead Sciences
- Flatiron Health
- Eisai
- Genentech
- National Heart, Lung, and Blood Institute (K23HL157765)
- National Institute of Nursing Research (R01NR019058)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- electronic patient-reported outcomes, remote symptom monitoring, cancer therapy, metastatic cancer, quality improvement, change management, workflow integration, patient engagement, health equity, organizational culture, population health management
- MeSH terms
- Patient Reported Outcome Measures, Aged, Electronics, Medicare, Humans, Medical Oncology, Neoplasms, Patient Participation, United States
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