Implementation of electronic patient-reported outcomes and biometrics surveillance for the management of chemotherapy-related symptom burden: Results from a decentralized feasibility pilot study.
Authors: Offodile Anaeze Chidiebele , Delgado Domenica , Lin Yu-Li , Geyen Danielle , Miller Christopher , Jain Sanchita , Finder Janice , Shete Sanjay , Overman Michael J. , Peterson Susan K. 
Published: September 2022

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Background: Monitoring patient-reported outcomes (PROs) in the ambulatory setting is an effective modality for chemotherapy-related symptom management. However, much is unknown about the utility of active surveillance of vital signs (i.e. biometrics) in this context. Such an undertaking is also highly complex with technology, workflow, and patient experience components. This decentralized pilot study aimed to investigate the implementation and feasibility of nurse-led active surveillance of chemotherapy-related symptom burden via the electronic collection of PROs and biometrics. Methods: Consecutive adult patients with gastrointestinal (GI) or thoracic cancer, at high risk for emergency room (ER) visits based on published criteria, were approached. Consenting patients performed daily reporting of symptom burden via the Patient reported Outcomes version of the Common Terminology Criteria for Adverse Events and biometrics over a one-month period. Biometric data (pulse, blood pressure, oxygen saturation, weight, and temperature) was captured via Bluetooth-enabled sensors which were integrated with a HIPAA-compliant, secure tablet interface that also enabled the provision of self-care materials and video conferencing. Data, including pre-specified threshold alerts, were sent to a web-based dashboard monitored by a registered nursing team, who triaged patient alerts based on standard operating procedures. Acceptability, appropriateness, and feasibility were measured via validated instruments. Program adherence was defined as the completion of > 70% of PRO survey and biometric reporting requirements ≥ 4 days per week. Patient satisfaction, technology ease of use, and ER admission rates were also collected. Results: Over an eight-month period, thirty-six patients consented to participate, and twenty-five (60% GI) completed the study. Participants had a mean age of 58.0 (range 36-74), mean ECOG score of 0.88, were 52% female, and were predominantly stage IV or recurrent disease (72%). Program adherence rate was 73% and mean scores for acceptability, feasibility, and appropriateness were 4.63, 4.56, and 4.46 respectively. Alert distribution were 28% PROs, 70% biometrics and 2% patient-initiated communication. System usability scale and Net Promoter Score were 88 and 55 respectively. Scores for patient satisfaction score and technology ease of use were 94% and 100% respectively. The rate of ER visits over the pilot period was 8%. Conclusions: Implementation of active surveillance of chemotherapy-related symptom burden via self-reporting of PROs and biometrics is highly acceptable, feasible, and appropriate to patients. It is also associated with low ER visitation rates relative to historical values and high rates of patient satisfaction and ease of use. Clinical trial information: NCI202107464.