Patients’ and Clinicians’ Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study
Authors: McCann Lisa , Lewis Liane , Oduntan Olubukola , Harris Jenny , Darley Andrew , Berg Geir V , Lubowitzki Simone , Cheevers Katy , Miller Morven , Armes Jo , Ream Emma , Fox Patricia , Furlong Eileen Patricia , Gaiger Alexander , Kotronoulas Grigorios , Patiraki Elisabeth , Katsaragakis Stylianos , McCrone Paul , Miaskowski Christine , Cardone Antonella , Orr Dawn , Flowerday Adrian , Skene Simon , Moore Margaret , De Souza Nicosha , Donnan Peter , Maguire Roma 
Published: September 2024

Background
Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention—Advanced Symptom Management System (ASyMS)—after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries.

Objective
In this qualitative study, both patients’ and clinicians’ experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients’ experiences, clinical practice, and supportive care delivery.

Methods
For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients’ and clinicians’ experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways.

Results
Thematic analysis identified several themes that describe patients’ and clinicians’ experiences using ASyMS. One central orienting theme—ASyMS as a facilitator of change—was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is “normal” and what is to be expected, enhancing cancer care experiences, and informing future cancer care.

Conclusions
This study is the first to evaluate both patients’ and clinicians’ experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients’ and clinicians’ perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place.

Trial Registration
ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081

International Registered Report Identifier (IRRID)
RR2-10.1136/bmjopen-2016-015016