Using Remotely Collected Patient-Reported Outcomes to Triage Attendance at On-Treatment Review Visits: Early Findings

Abstract

Purpose/Aim

To determine the impact of Radiation Therapists using remotely collected patient-reported outcomes (PROs) to triage attendance at on-treatment review visits.

Methods/Process

Patients who were able to communicate about medical issues in English, and were about to receive radical external beam radiation therapy (RT) for breast or prostate cancer, were approached for informed consent. Participants were randomly assigned to one of two groups: the standard of care (SOC) group attended every weekly on-treatment visit. For the intervention group (INT), their attendance was triaged by Radiation Therapists, based on PRO responses. PROs were entered by the the participants in an unsupervised manner via a smartphone application (App) less than18 hours before each scheduled review. The triggers to attend the on-treatment visit were: a PRO entry of ‘moderate’ grade or above in any domain; a specific request to attend the review visit by the participant; or last week of RT course. If these criteria were not met, the participant would skip the on-treatment review visit. Less than 24 hours after the review visit, all participants completed an evaluation of that week's on-treatment review using the App.

Results or Benefits/Challenges

To date, 36 patients have agreed to participate (30% of planned accrual). 56% were diagnosed with breast cancer, and 58% were randomized into the INT arm. The PRO completion rate was very high in both arms (97%). In the SOC arm, participants attended 96% of review visits. INT participants skipped 28% of review visits, none of these required alternative supportive services. More INT participants reported the review visits lasted more than 10 minutes compared to the SOC arm (39% vs. 18%; p 0.04). INT participants, who were triaged to attend the review visit were significantly more likely to report that all of their side effects were discussed, compared to the SOC arm (81% vs 56%; p 0.04). 100% of INT participants felt the questions in the PRO surveys helped them talk about their side effects with their RT team. There were no differences in Patient Satisfaction with Cancer Care scores between the cohorts (p 0.59). Both cohorts were very satisfied with the review visits (69%), but those in the INT arm were more likely to report that the visits were a valuable use of their time (66% vs. 55%). 92% of study arm participants felt that Radiation Therapists always or frequently made a correct triage decision.

Conclusions/Impact

The early findings from this study suggests that PRO-based triage by Radiation Therapists allowed almost 30% of patients to skip unnecessary on-treatment review visits. This improved the perceived value of on-treatment review visits, while reducing the burden on patients and healthcare systems, without compromising satisfaction with cancer care.