Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial

Abstract

Purpose: Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment-Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians.

Patients and methods: This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians.

Results: The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful.

Conclusion: The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.

Fig 1.

Number of patients enrolled onto the study, randomly assigned to a control or intervention group, and included in the analysis. T1, time 1; T2, time 2.

Fig 2.

Odds ratio estimates and 90% CIs for symptoms and quality-of-life issues (SQLIs) that had significant effect modification. Note: For each SQLI, separate odds ratio estimates are shown for whether the SQLI was reported at threshold (RTh; no [N] or yes [Y]) and are from the SQLI-specific logistic regression model with the interaction term included. The observed frequencies associated with each odds ratio estimate are also shown. The numerator is the observed odds of being discussed in the intervention group, and the denominator is the observed odds of being discussed in the control group. Odds ratios computed from observed frequencies will not necessarily be the same as the odds ratio estimates from models. ESRA-C, Electronic Self-Report Assessment–Cancer.

Fig 3.

Odds ratio estimates and 90% CIs for symptoms and quality-of-life issues (SQLIs) for which there is no evidence of effect modification. Note: The odds ratio estimates are for the group main effect in the SQLI-specific logistic regression main-effect model. For each SQLI odds ratio, estimates are shown for the group main effect in the SQLI-specific logistic regression main-effect model. The observed frequencies associated with each odds ratio estimate are also shown. The numerator is the observed odds of being discussed in the intervention group, and the denominator is the observed odds of being discussed in the control group. Odds ratios computed from observed frequencies will not necessarily be the same as the odds ratio estimates from models. ESRA-C, Electronic Self-Report Assessment–Cancer; QOL, quality of life.