A Randomized Controlled Trial Evaluating Electronic Symptom Monitoring After Ambulatory Cancer Surgery (pcori Contract #ihs-1602-34355)
Larissa Temple1, *Andrea Pusic2, *Jeanne Carter3, *Cara Stabile3, *Andrew Vickers3, *Kate Niehaus3, *Peter Stetson3, *Brett Simon3
1University of Rochester, Rochester, NY;2Brigham and Women's Hospital, Boston, MA;3Memorial Sloan Kettering Cancer Center, New York, NY
OBJECTIVE(S): An increasing proportion of cancer surgeries are ambulatory. Symptom monitoring and support after discharge may optimize patient experience and outcomes. The most effective way to monitor and manage self-reported symptoms is unknown. Therefore, the objective of this study was to compare two methods of managing patient-reported symptoms after ambulatory cancer surgery (ACS).
METHODS: 2823 patients undergoing ACS at a single institution completed an electronic portal-based symptom survey, modified from the validated PRO-CTCAE, daily for 10 days after discharge. Patients were randomized to Monitoring (alert-based monitoring by the clinical team) or Feedback (immediate automated normative feedback reports to patients regarding symptom management). The primary study outcomes were unplanned Urgent Care (UCC) visits and readmissions within 30 days; secondary outcomes were patient anxiety and nursing utilization.
RESULTS:2,624 patients were analyzed: 1,310 Monitoring and 1,314 Feedback. There were no differences in UCC visits or readmissions within 30 days between the groups (95% CI: -0.84-3.2; p=0.4 and 95% CI: -0.89%-3.0%, p=0.4). Patients randomized to Feedback demonstrated a quicker reduction in anxiety than those in Monitoring and required fewer calls from clinic nurses (14% fewer in first 10 days and 10% fewer over 30 days post-operatively).
CONCLUSIONS: This study represents a large randomized trial evaluating approaches to electronic symptom reporting after ACS. Compared to clinical team monitoring, automated feedback decreased patient anxiety and nursing interventions with no significant differences in UCC visits or readmissions. This suggests that automated normative feedback may be an effective and cost-effective approach to support patients after ACS.
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