Cancer Care Team's Management of Clinical Alerts Generated by Electronically Collected Patient Reported Outcomes: We Could Do Better

Abstract

Electronically administered patient-reported outcome measures (ePROMs) are effective digital health tools for informing clinicians about cancer patients' symptoms and facilitating timely patient-centred care. This paper describes the delivery of healthcare activities supported by the PROMPT-Care model, including ePROMs generated clinical alerts, cancer care team (CCT) response to alerts, and patients' perceptions of the CCT response and ePROMs system. This mixed-methods study includes cancer patients from four cancer therapy centres in New South Wales, Australia. Quantitative and qualitative data were collected regarding clinical alert activity, CCT response, and patient perceptions of the CCT responses and ePROMs system. Qualitative data were thematically analysed. Of the 328 participants whose care was informed by the digital health tool, 70.8% (n = 233) generated at least one alert during the trial period, with 877 alerts generated in total. Although 43.7% (n = 383) were actioned by the CCT, at least 80% of participants found follow-up CCT phone calls beneficial, with multiple benefits confirmed in interviews. The cancer care delivery arm of the PROMPT-Care trial involving clinical alerts to the CCT was positively perceived by most participants, resulting in a diverse range of benefits. However, further work is required, informed by implementation science, to improve the percentage of actioned clinical alerts.

Keywords: cancer; cancer care coordinators; clinical alerts; eHealth; electronic patient reported outcome measures (ePROMs); patient-centred care; referrals; symptom screening.

Figure 1

Clinical alert E-mail.

Figure 2

Sample clinical feedback report. Originally published in: [16].

Figure 3

Sample longitudinal feedback report. Originally published in: [20].

Figure 4

Clinical alerts generated and cancer care team responses. Note 1: A clinical alert might generate multiple actions. For instance, two separate phone calls on different days (in the first phone call, the CCT provided information, while during the second phone call, a referral was offered).

Figure 5

Thematic map.