A real-time electronic symptom monitoring system for patients after discharge following surgery: a pilot study in cancer-related surgery

Abstract

Background: Advances in peri-operative care of surgical oncology patients result in shorter hospital stays. Earlier discharge may bring benefits, but complications can occur while patients are recovering at home. Electronic patient-reported outcome (ePRO) systems may enhance remote, real-time symptom monitoring and detection of complications after hospital discharge, thereby improving patient safety and outcomes. Evidence of the effectiveness of ePRO systems in surgical oncology is lacking. This pilot study evaluated the feasibility of a real-time electronic symptom monitoring system for patients after discharge following cancer-related upper gastrointestinal surgery.

Methods: A pilot study in two UK hospitals included patients who had undergone cancer-related upper gastrointestinal surgery. Participants completed the ePRO symptom-report at discharge, twice in the first week and weekly post-discharge. Symptom-report completeness, system actions, barriers to using the ePRO system and technical performance were examined. The ePRO surgery system is an online symptom-report that allows clinicians to view patient symptom-reports within hospital electronic health records and was developed as part of the eRAPID project. Clinically derived algorithms provide patients with tailored self-management advice, prompts to contact a clinician or automated clinician alerts depending on symptom severity. Interviews with participants and clinicians determined the acceptability of the ePRO system to support patients and their clinical management during recovery.

Results: Ninety-one patients were approached, of which 40 consented to participate (27 male, mean age 64 years). Symptom-report response rates were high (range 63-100%). Of 197 ePRO completions analysed, 76 (39%) triggered self-management advice, 72 (36%) trigged advice to contact a clinician, 9 (5%) triggered a clinician alert and 40 (20%) did not require advice. Participants found the ePRO system reassuring, providing timely information and advice relevant to supporting their recovery. Clinicians regarded the system as a useful adjunct to usual care, by signposting patients to seek appropriate help and enhancing their understanding of patients' experiences during recovery.

Conclusion: Use of the ePRO system for the real-time, remote monitoring of symptoms in patients recovering from cancer-related upper gastrointestinal surgery is feasible and acceptable. A definitive randomised controlled trial is needed to evaluate the impact of the system on patients' wellbeing after hospital discharge.

Keywords: Adverse events; Cancer, gastrointestinal; Electronic health record; Gastrointestinal surgical procedures; Internet; Patient-reported outcomes; Pilot studies; Self-management.

Fig. 1

Recruitment details for Centre 1 Bristol participants. ^a including: not undergoing planned procedure (n = 17), discharged home unexpectedly early or not discharged to home (n = 4), missed due to administration errors (n = 2), patient was under 18 (n = 1). ^b including: no home access to a PC/internet (n = 15), discharged home unexpectedly early or not discharged to home (n = 11), not fluent in English (n = 3), missed due to administration errors (n = 2), unable to comply with follow up (n = 3)

Fig. 2

Total levels of feedback generated by timepoint

Fig. 3

Frequency of Level 2 Advice generated by timepoint. ¹Higher scores indicate worse symptoms. ²Higher scores in physical function indicate better physical function

Fig. 4

Frequency of Level 1 self-management advice generated by timepoint. ¹Higher scores indicate worse symptoms. ²Higher scores in physical function indicate better physical function