Remote patient-reported symptoms and passive activity monitoring to improve patient-clinician communication regarding symptoms and functional status: A randomized controlled trial (PROStep).
Authors: Manz Christopher , Ferrell William , Williamson Joelle , Schriver Emily , Wakim Jonathan , Khan Neda , Kopinsky Michael , Gabriel Peter Edward , Balachandran Mohan , Shulman Lawrence N. , Parikh Ravi Bharat 
Published: June 2022

1506

Background: Oncologists suboptimally assess patient symptoms and functional status, possibly leading to poor symptom management or over-treatment. Remote patient-reported symptoms and passive activity monitoring may provide objective measures of symptoms and functional status to improve patient-clinician communication and symptom understanding. We assessed the impact of a clinician-centered dashboard of longitudinal patient-reported symptoms and step counts on patient-clinician communication regarding symptoms and functional status. Methods: This randomized trial enrolled 108 patients with incurable GI or lung cancers treated with chemotherapy at a large academic health center. Patients were randomized to either of Arms A) control, B) weekly patient-reported symptoms via text message + step tracking from a wearable activity monitor, with summary dashboards given to clinicians at each visit, or C) arm B plus text message-based prompts to patients encouraging discussion of symptoms and functional status prior to each visit. We used Kruskal Wallis tests to compare co-primary outcomes (patient-reported perceptions of clinician symptom and functional status understanding at 6 months after enrollment) between control (A) and intervention (B+C) arms on a 5-point scale (1 = Not at all; 2 = Slightly; 3 = Moderately; 4 = Considerably; 5 = Completely). Results: 33, 37, and 38 patients were enrolled in arms A, B, and C, respectively. Patients were 54.6% male, mean age was 58.9 years, 77% had GI cancer, and 23% had lung cancer. At six months, there was no difference between control and intervention arms in patient perception of clinician understanding of symptoms (Arm A: 4.5, Arm B/C: 4.5, p = 0.85) or functional status (Arm A: 4.5, Arm B/C: 4.3, p = 0.59). Patients reported that their oncology team seldom discussed PROstep data during appointments (mean 2.3 on 5-point scale where 2 = seldom). Hospitalization rates were 42% and 45% for Arms A and B/C (p = 0.8), respectively, and new palliative care referrals were 9% and 10% (p = 0.8), respectively. Mean adherence to weekly patient reports and Fitbit data (at least 4 of 7 days in a week) was 64% and 53%, respectively. Net promoter score was 8.3 on a 10-point scale. Conclusions: Clinician and patient-directed dashboards based on patient-generated health data did not lead to higher patient-perceived clinician understanding of symptoms and functional status, although this was limited by moderate adherence to remote symptom and step count collection and low frequency of clinician discussion of PROStep data with patients, highlighting challenges to clinical application of these data sources. Further efforts are needed to improve patient-clinician communication about symptoms and functional status. Clinical trial information: NCT04616768.