MOBILE PATIENT-REPORTED OUTCOME (PRO) ASSESSMENT TO DRIVE ADHERENCE

Transcription

1 MOBILE PATIENT-REPORTED OUTCOME (PRO) ASSESSMENT TO DRIVE ADHERENCE Heather Jim, PhD Moffitt Cancer Center There are no conflicts to disclose

2 LEARNING OBJECTIVES After reading and reviewing this material, the participant should be able to: Describe the benefits of collecting PROs as part of clinical trials and standard care Identify electronic methodologies for collecting PROs and other patient-generated data Discuss ways in which PROs can contribute to recovery after cystectomy

3 PATIENT-REPORTED OUTCOMES Any report of the status of a patient s health condition that comes directly from the patient, without interpretation of the patient s response by a clinician or anyone else. Disease Symptomatology Treatment Side Effects Quality of Life Kluetz et al., Clin Cancer Res 2016; 22:1553-8

4 PROVIDERS TEND TO UNDERESTIMATE PROS Comparison of PROs versus provider ratings of symptom severity in 1,933 patient-provider dyads % prevalence Pain Fatigue Anorexia Dyspnea Diarrhea Patient Provider Laugsand et al., Health Qual Life Outcomes 2010; 8:104

5 TOXICITY REPORTS AND OUTCOMES Comparison of PROs versus chart-abstracted CTCAE ratings for common symptoms in 163 patients receiving standard of care chemo Examined ratings as predictors of risk of death and ER visits HR death p HR ER visit p Moderate fatigue Patient Clinician 2.75 < Moderate pain Patient Clinician Basch et al., J Natl Cancer Inst 2009;101:

6 PROS CAN IMPROVE CLINICAL BENEFIT 766 patients starting chemotherapy randomized to clinicbased symptom monitoring (n=441) or standard care (325) Tablet or kiosk Printed report for providers Nurse alerts triggered for severe or worsening symptoms Followed for 6 months Basch et al., J Clin Oncol 2016; 34:557-65

7 PROS CAN IMPROVE CLINICAL BENEFIT Change in QOL Improved one-year survival (75% vs. 69%) Longer time on treatment (8.2 months vs. 6.3) Fewer patients treated at the ER (34% vs. 41%) -8 Intervention Control Basch et al., J Clin Oncol 2016; 34:557-65

8 PATIENT-REPORTED OUTCOMES MEASUREMENT SYSTEM (PROMIS) Numerous symptoms assessed Create web-based surveys through Assessment Center Templates available through data management and patient portal software Some measures will be available through EMR software

9 PATIENT REPORTED OUTCOMES VERSION OF THE CTCAE (PRO-CTCAE)

10 SYMPTOM MONITORING: FACILITATED BY TECHNOLOGY Americans Use the Internet Own a smartphone 18 years 90% 77% 51% 65 years 67% 51% 32% Own a tablet

11 PASSIVE ACTIVITY AND SLEEP MONITORING MiniMitter Actiwatches Actigraph Link R03 CA R01 CA Jim et al. Health Psychol 2013; 32:

12 Passive Activity and Sleep Monitoring Garmin Vivosmart HR FitBit Charge 2 Rosenberger et al. Med Sci Sports Exerc 2016; 48:

13 RECOVERY AFTER CYSTECTOMY Poorly controlled symptoms after cystectomy may indicate complications Complications occur in up to 50% of patients Primary driver for hospital readmissons Patients do not always report symptoms in a timely manner Home-based symptom reporting with provider alerts may improve outcomes Symbol Search Shabsigh et al. Eur Urol 2009;55:164-74

14 AIM 1: SELECT RELEVANT ITEMS Aim: To identify clinically-important symptoms that warrant home based monitoring Selected symptoms from existing measures, literature, PRO-CTCAE Clinician stakeholders ranked list, added symptoms Collaborated with NCI to adapt PRO-CTCAE items Symbol Search

15 AIM 1: SELECT RELEVANT ITEMS Nausea Vomiting Diarrhea Abdominal pain Fatigue Chills, sweats, feverish Bleeding, redness, discharge at surgical site Symbol Search

16 AIM 2: CREATE INTERFACE

17 AIM 3: USABLITY TESTING Evaluate patient perceptions of length of survey, content, question comprehension, electronic interface in 10 patients Pilot test during 6 week post-surgery period in 15 patients Obtain feedback from 12 providers about clinical integration and utility Symbol Search

18 CONCLUSIONS Monitoring and managing PROs have the potential to: Improve clinical benefit More accurately capture toxicity New technology can facilitate collection of PROs and other patient-generated data

19 QUESTIONS? Scientific American, November 1975