Symptom Management Implementation of Patient Reported Outcomes in Oncology

Deficits in the management of common symptoms cause substantial morbidity for cancer patients.Because the health care delivery system is structured to be reactive and not proactive, there are missed opportunities to optimize symptom control. Growth in Internet access and proliferation of smartphones has created an opportunity to re-engineer cancer care delivery. Electronic symptom tracking and feedback is a promising strategy to improve symptom control. Electronic patient reported outcome (ePRO) monitoring of cancer symptoms has been shown to decrease symptom burden, improve quality of life, reduce acute care and even extend survival. SIMPRO will use functioning ePRO prototypes to create and refine the electronic symptom management system eSyM

A multi-disciplinary team of investigators from 6 health systems have formed the Symptom Management IMplementation of Patient Reported Outcomes in Oncology (SIMPRO) Research Center. SIMPRO will use functioning ePRO prototypes to create and refine the electronic symptom management system eSyM. eSyM is the name of the platform the team will refine, integrate, implement and evaluate. eSyM addresses each of the 4 evidence gaps by:

* Implementing eSyM in cancer centers in small, rural or community-based systems.
* Integrating eSyM into the EHR (electronic health record) of the predominant vendor used nationwide.
* Leveraging evidence-based tools, patient engagement, and population management.
* Executing this work using the Consolidated Framework for Implementation Research across all phases to maximize the chances that eSyM and similar systems achieve their intended goals and decrease the morbidity of cancer treatment at a population level.

This project contains 5 activities:

1. Obtain stakeholder feedback
2. Build and deploy eSyM
3. Pilot test eSyM
4. Pragmatic stepped-wedge cluster randomized trial
5. Integration of eSyM data to develop algorithms to estimate the risk of experiencing an outcome, including, but not limited to, ED usage and hospitalization among cancer patients

Eligibility Criteria:
Inclusion Criteria:

Activity 1 Population:

* Age ≥ 18 years
* The potential stakeholders are: patient advisory council members, health system leaders, clinicians, clinic support staff/administration, IT/Informatics staff

Activity 3 Population:

* Age ≥ 18 years
* Priority population will be patients who meet one of the following:

  * Suspected thoracic cancer \[lung or bronchus\] AND is inpatient following thoracic surgery.
  * Suspected gastrointestinal cancer \[colorectal, pancreas, liver/biliary, esophagus,or gastric\] AND is inpatient following gastrointestinal surgery.
  * Suspected gynecologic cancer \[ovary, uterus, or cervix\] AND is inpatient following gynecologic surgery.
  * Diagnosis of thoracic cancer \[lung or bronchus\] AND scheduled to start a new treatment plan for thoracic cancer.
  * Diagnosis of gastrointestinal cancer \[colorectal, pancreas, liver/biliary, esophagus,or gastric\] AND scheduled to start a new treatment plan for gastrointestinal cancer.
  * Diagnosis of gynecologic cancer \[ovary, uterus, or cervix\] AND scheduled to start a new treatment plan for gynecologic cancer.
* Total population allowed to use eSyM:

  * Any patient at any participating site.

Activity 4 Population:

* Age ≥ 18 years
* Priority population will be patients who meet one of the following:

  * Suspected thoracic cancer \[lung or bronchus\] AND is inpatient following thoracic surgery.
  * Suspected gastrointestinal cancer \[colorectal, pancreas, liver/biliary, esophagus,or gastric\] AND is inpatient following gastrointestinal surgery.
  * Suspected gynecologic cancer \[ovary, uterus, or cervix\] AND is inpatient following gynecologic surgery.
  * Diagnosis of thoracic cancer \[lung or bronchus\] AND scheduled to start a new treatment plan for thoracic cancer.
  * Diagnosis of gastrointestinal cancer \[colorectal, pancreas, liver/biliary, esophagus,or gastric\] AND scheduled to start a new treatment plan for gastrointestinal cancer.
  * Diagnosis of gynecologic cancer \[ovary, uterus, or cervix\] AND scheduled to start a new treatment plan for gynecologic cancer.
* Total population allowed to use eSyM:

  * Any patient at any participating site.