Cited by 63Telemedicine and Telehealth ImplementationHealth Policy Implementation ScienceMobile Health and mHealth Applications

Adaptation of remote symptom monitoring using electronic patient-reported outcomes for implementation in real-world settings

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Rocque, Gabrielle B., Dent, D’Ambra N., Ingram, Stacey A., Caston, Nicole E., Thigpen, Haley B., Lalor, Fallon R., Jamy, Omer H., Giri, Smith +12 more·2022·JCO Oncology Practice

Abstract

PURPOSE: Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. METHODS: This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman's Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (phase I) and workflow (phase II and III) using electronic health data; qualitative evaluation with semistructured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. RESULTS: Core components of remote symptom monitoring included electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed > 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. CONCLUSION: Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.

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Authors
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., McGowen, C. L., Daniel, C. L., Andrews, C. J., Huang, C.-H. S., Dionne-Odom, J. N., Weiner, B. J., Howell, D., Jackson, B. E., Basch, E. M., & Stover, A. M.
Affiliations
  • University of Alabama at Birmingham (US)
  • University of Alabama at Birmingham School of Nursing, Birmingham, AL
  • University of South Alabama Mitchell Cancer Institute, Mobile, AL
  • USA Mitchell Cancer Institute (US)
  • University of Washington (US)
  • Princess Margaret Cancer Centre (CA)
  • University of North Carolina at Chapel Hill (US)
Venue
JCO Oncology Practice
Published
2022-12
Volume
18
Issue
12
Pages
e1943-e1952
ISSN
  • 2688-1527 (ISSN-L)
  • 2688-1535
OpenAlex
W4307585142
Cited by
62
References
17
Citations by year
2026: 13 · 2025: 15 · 2024: 22 · 2023: 11 · 2022: 1
FWCI
11.02
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • JCO Oncology Practice (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • AstraZeneca
  • Henry Ford Health System
  • Association of Community Cancer Centers
  • UroGen Pharma
  • National Institute of Nursing Research (R01NR019058)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
remote symptom monitoring, patient-reported outcomes, implementation adaptation, cancer care, symptom monitoring, alarm fatigue, digital health literacy, workflow barriers, nurse training, implementation outcomes, formative assessment
MeSH terms
Patient Reported Outcome Measures, Humans, Pilot Projects, Surveys and Questionnaires

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