Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May:128:107171.
doi: 10.1016/j.cct.2023.107171. Epub 2023 Mar 28.

Implementation and evaluation of an expanded electronic health record-integrated bilingual electronic symptom management program across a multi-site Comprehensive Cancer Center: The NU IMPACT protocol

David Cella  1 , Sofia F Garcia  2 , September Cahue  3 , Justin D Smith  4 , Betina Yanez  5 , Denise Scholtens  6 , Nicola Lancki  7 , Michael Bass  8 , Sheetal Kircher  9 , Ann Marie Flores  10 , Roxanne E Jensen  11 , Ashley Wilder Smith  12 , Frank J Penedo  13
Affiliations

Implementation and evaluation of an expanded electronic health record-integrated bilingual electronic symptom management program across a multi-site Comprehensive Cancer Center: The NU IMPACT protocol

David Cella et al. Contemp Clin Trials. 2023 May.

Abstract

Background: People with cancer experience symptoms that adversely affect quality of life. Despite existing interventions and clinical guidelines, timely symptom management remains uneven in oncology care. We describe a study to implement and evaluate an electronic health record (EHR)-integrated symptom monitoring and management program in adult outpatient cancer care.

Methods: Our cancer patient-reported outcomes (cPRO) symptom monitoring and management program is a customized EHR-integrated installation. We will implement cPRO across all Northwestern Memorial HealthCare (NMHC) hematology/oncology clinics. We will conduct a cluster randomized modified stepped-wedge trial to evaluate patient and clinician engagement with cPRO. Further, we will embed a patient-level randomized clinical trial to evaluate the impact of an additional enhanced care (EC; cPRO plus web-based symptom self-management intervention) relative to usual care (UC; cPRO alone). The project uses a Type 2 hybrid effectiveness-implementation approach. The intervention will be implemented across seven regional clusters within the healthcare system comprising 32 clinic sites. A 6-month prospective pre-implementation enrollment period will be followed by a post-implementation enrollment period, during which newly enrolled, consenting patients will be randomly assigned (1:1) to EC or UC. We will follow patients for 12 months post-enrollment. Patients randomized to EC will receive evidence-based symptom-management content on cancer-related concerns and approaches to enhance quality of life, using a web-based tool ("MyNM Care Corner"). This design allows for within- and between-site evaluation of implementation plus a group-based comparison to demonstrate effectiveness on patient-level outcomes.

Discussion: The project has potential to guide implementation of future healthcare system-level cancer symptom management programs. http://ClinicalTrials.gov # NCT03988543.

Keywords: Cancer; Electronic health record; Implementation science; Patient engagement; Patient-reported outcomes; Symptom management.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Consented Patient Flow by Clinical Cluster and Implementation Phase *UC = Usual Care; EC = Enhanced Care
Figure 2.
Figure 2.
NU IMPACT CONSORT Diagram Template (Target overall eligible n = 12,000 [6,000 pre-implementation; 6,000 post-implementation])
Figure 3.
Figure 3.
Conceptual framework for a multi-level, multi-method evaluation plan for (a) implementation, (b) scalability and spread, and (c) patient and health system level outcomes
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It's not over when it's over: long-term symptoms in cancer survivors--a systematic review. Int J Psychiatry Med. 2010;40(2):163–81. doi:10.2190/PM.40.2.c - DOI - PubMed
    1. Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term and late effects of cancer. Cancer. Jun 1 2008;112(11 Suppl):2577–92. doi:10.1002/cncr.23448 - DOI - PMC - PubMed
    1. Cella D, Choi S, Garcia S, et al. Setting standards for severity of common symptoms in oncology using the PROMIS item banks and expert judgment. Qual Life Res. Dec 2014;23(10):2651–61. doi:10.1007/s11136-014-0732-6 - DOI - PMC - PubMed
    1. Wagner LI, Schink J, Bass M, et al. Bringing PROMIS to practice: brief and precise symptom screening in ambulatory cancer care. Cancer. Mar 15 2015;121(6):927–34. doi:10.1002/cncr.29104 - DOI - PMC - PubMed
    1. Yost KJ, Eton DT, Garcia SF, Cella D. Minimally important differences were estimated for six Patient-Reported Outcomes Measurement Information System-Cancer scales in advanced-stage cancer patients. J Clin Epidemiol. May 2011;64(5):507–16. doi:10.1016/j.jclinepi.2010.11.018 - DOI - PMC - PubMed

Publication types

Associated data