Adaptation of Remote Symptom Monitoring Using Electronic Patient-Reported Outcomes for Implementation in Real-World Settings

Abstract

QUESTION ASKED: Remote symptom monitoring facilitated by electronic patient-reported outcomes has demonstrated clinical benefits in efficacy within ran-domized clinical trials; however, experience with implementation in real-world settings is limited. In this manuscript, we assess what are the core components and barriers requiring adaptations for implementation of remote symptom monitoring using electronic patient-reported outcomes in real-world settings. SUMMARY ANSWER: Core components of remote symptom were documented. Adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. WHAT WE DID: This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman's Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (phase I) and workflow (phase II and III) using electronic health data; qualitative evaluation with semi-structured interviews of clinical team members; and capture of field notes regarding barriers and recommended adaptations for future implementation. WHAT WE FOUND: In the pilot studies, most patients completed. 50% of expected surveys. From pilot work, the following core components of remote symptom monitoring were identified: electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real time, the capacity to generate alerts, training nurses to manage alerts, and identification of responsible personnel. Key adaptations to enhance feasibility and acceptability of implementation are shown in the table. BIAS, CONFOUNDING FACTOR(S), REAL-LIFE IMPLICATIONS: This study was conducted at two academic medical centers; other sites may differ in their institutional culture, staffing expectations, implementation readiness , and individual barriers experienced. Additionally , this study focused on early adaptation of remote symptom monitoring and does not capture adaptations that are made to maintain a well-established program. Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability. abstract PURPOSE Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. METHODS This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman's Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (phase I) and workflow (phase II and III) using electronic health data; qualitative evaluation with semistructured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. RESULTS Core components of remote symptom monitoring included electronic delivery of surveys with ac-tionable symptoms, patient education on the intervention, a system to monitor survey compliance in real time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed. 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. CONCLUSION Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.