Motivation for and feasibility of postoperative electronic patient-reported outcome symptom monitoring in thoracic surgery patients: A qualitative study.
Authors: O'Leary Meghan C. , Leeman Jennifer , Gentry Amanda , Stover Angela M. , Teal Randall , Vu Maihan B. , Carda-Auten Jessica , Mody Gita N 
Published: October 2023

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Background: Digital health systems can be used to engage patients in remote symptom monitoring to support their postoperative care, but understanding of patient motivation and experiences monitoring their symptoms after thoracic surgery are limited. We enrolled patients who had undergone thoracic surgery in an electronic patient-reported outcome (ePRO) system. We report our qualitative findings about their motivation for and feasibility of ePRO symptom monitoring. Methods: In-depth interviews were conducted by phone with adult patients who had undergone thoracic surgery and enrolled in ePROs. Patients were sent 10-item ePRO surveys twice weekly for 2 weeks and then weekly for 4 weeks after returning home, with clinicians alerted about severe symptoms. Interviews focused on understanding patients' motivation for completing ePROs, experience with completing, and perceived importance of ePROs. The interview guide and data analysis were informed by the Capability, Opportunity, Motivation model for behavior change (COM-B) and the Theoretical Domains Framework (TDF). Interviews were audio recorded, transcribed verbatim, and four team members used a coding-based content analysis to identify emerging themes. Themes were discussed with the project team and used to identify opportunities to improve patients’ experiences with ePROs. Results: From July-October 2022, we interviewed 25 patients, of whom more than half (56%) had a history of lung cancer or another malignancy. Participants had a mean age of 58 years, were 56% female, 80% White, and 12% Black, and completed a mean of 5.2 out of 6 possible ePRO surveys. Motivating factors for completing ePROs included receiving a direct response from their clinical team to their reported symptoms; wanting to support their clinical team in understanding patients’ full recovery journey to improve care; and, the emotional benefits of tracking their progress and feeling more seen/less alone. There was some concern over creating unnecessary follow-ups for their care teams by reporting symptoms. For feasibility, participants reported the ease and convenience of completing ePROs, though some cautioned that standardized ePROs may not capture the complexities of their experiences, and that ePRO completion can be emotionally burdensome if reminded of a painful experience. Regarding perceived importance, participants recommended ePROs for other patients as a way to set expectations for their health experiences and improve care for themselves and others. Conclusions: Patients generally described being motivated to complete ePROs, and found ePROs relatively feasible to complete and valuable to the post-discharge care experience. Consideration of how ePROs can be used to better set expectations for symptom burden and capture patients’ complex health experiences may support long-term surgical oncology care.