PURPOSE: Previous randomized controlled trials have demonstrated benefit from remote symptom monitoring (RSM) with electronic patient-reported outcomes. However, the racial diversity of enrolled patients was low and did not reflect the real-world racial proportions for individuals with cancer. METHODS: This secondary, cross-sectional analysis evaluated engagement of patients with cancer in a RSM program. Patient-reported race was grouped as Black, Other, or White. Patient address was used to map patient residence to determine rurality using Rural-Urban Commuting Area Codes and neighborhood disadvantage using Area Deprivation Index. Key outcomes included (1) being approached for RSM enrollment, (2) declining enrollment, (3) adherence with RSM via continuous completion of symptom surveys, and (4) withdrawal from RSM participation. Risk ratios (RR) and 95% CI were estimated from modified Poisson models with robust SEs. RESULTS: Between May 2021 and May 2023, 883 patients were approached to participate, of which 56 (6%) declined RSM. Of those who enrolled in RSM, a total of 27% of patients were Black or African American and 67% were White. In adjusted models, all patient population subgroups of interest had similar likelihoods of being approached for RSM participation; however, Black or African American patients were more than 3× more likely to decline participation than White participants (RR, 3.09 [95% CI, 1.73 to 5.53]). Patients living in more disadvantaged neighborhoods were less likely to decline (RR, 0.49 [95% CI, 0.24 to 1.02]), but less likely to adhere to surveys (RR, 0.81 [95% CI, 0.68 to 0.97]). All patient populations had a similar likelihood of withdrawing. CONCLUSION: Black patients and individuals living in more disadvantaged neighborhoods are at risk for lower engagement in RSM. Further work is needed to identify and overcome barriers to equitable participation.

Introduction: Remote symptom monitoring (RSM) allows patients to electronically self-report symptoms to their healthcare team for individual management. Clinical trials have demonstrated overarching benefits; however, little is known regarding patient-perceived benefits and limitations of RSM programs used during patient care. Methods: This prospective qualitative study from December 2021 to May 2023 included patients with cancer participating in standard-of-care RSM at the University of Alabama at Birmingham (UAB) in Birmingham, AL, and the Univeristy of South Alabama (USA) Health Mitchell Cancer Institute (MCI) in Mobile, AL. Semi-structured interviews focused on patient experiences with and perceptions surrounding RSM participation. Interviews occurred over the phone, via digital videoconference, or in person, at the convenience of the patient. Grounded theory was used to conduct content coding and identify recurring themes and exemplary quotes using NVivo. Results: Forty patients (20 UAB, 20 MCI) were interviewed. Participants were predominately female (87.5%), aged 41-65 (50%), and married (57.5%). Data is consistent with local demographics, comprising mainly White (72.5%) and 27.5% Black individuals. Three main themes emerged regarding perceived benefits of RSM: (1) Facilitation of Proactive Management , identifying the patient’s needs and intervening earlier to alleviate symptom burden; (2) Promotion of Symptom Self-Management , providing patients autonomy in their cancer care; and (3) Improvement in Patient-Healthcare Provider Relationships , fostering genuine connections based on healthcare team’s responses. However, participants also noted Perceived Limitations of RSM ; particularly when support of symptom management was unnecessary, ineffective, or felt impersonal. Conclusion: This study focused on patient experiences when utilizing a RSM program while undergoing treatment for cancer and found benefits to its implementation that extended beyond symptom management. At the same time, patients noted drawbacks experienced during RSM, which can help with future tailoring of RSM programs. Patient perceptions should be regularly assessed and highlighted for successful and sustained implementation.

PURPOSE: Remote symptom monitoring (RSM) using electronic patient-reported outcomes (ePROS) connects patients and health care teams between appointments. Patient-perceived benefits and drawbacks of RSM are well-known, but health care team members' perceptions are less clear. METHODS: Health care team members from the University of Alabama at Birmingham and the University of South Alabama Health Mitchell Cancer Institute participated in semi-structured qualitative interviews to explore their experiences and perspectives on RSM benefits and limitations. Interviews were audio-recorded, transcribed, and analyzed inductively using NVivo software to identify recurring themes and exemplary quotes. RESULTS: Thirty oncology health care team members, including physicians (n = 9), nurse practitioners (n = 2), nurses (n = 8), nonclinical navigators (n = 7), and administrators (n = 4), were interviewed. Findings were organized into five major themes: three benefits ( Proactive, Improved Patient-Health Care Team Relationship , and Patient Engagement and Symptom Reporting ) and two limitations ( Health Care Team-Perceived Limited Patient Buy-In or Awareness and Workload and Workflow Issues ). Health care team members perceived that RSM improved their ability to support patients and the quality of care delivered to patients by promoting proactive management, strengthening the patient-health care team relationship, and engaging patients in symptom reporting. Despite positive perceptions, health care team members also voiced drawbacks of RSM related to the lack of patient buy-in or awareness and increased workload and disrupted workflow. CONCLUSION: Although health care team members recognized the benefits of RSM as a standard of care, future work is necessary to address identified limitations to support wide-scale implementation of RSM in oncology practices.

#Implementation of #ePROs in real world settings, lessons learned

As healthcare and health services become increasingly digitized, individuals with low digital health literacy (DHL) may experience inequitable care and outcomes. We explored factors impacting DHL and recommendations for improvement from community health coordinators and advisors (CHAs) in Alabama and Mississippi in United States. Semi-structured interviews were conducted with CHAs to gather insights on their perspectives on and experiences with DHL. Interviews were transcribed and analyzed using a grounded coding schema, with key barriers and recommendations mapped onto the Taplin Multi-Level Intervention model to help identify influences across various levels. Thirty-two CHAs participated, predominantly female (94%) and Black or African American (94%). At the individual level, factors involved demographic characteristics, increased patient workload, and attitudes towards technology. Social support was captured at the relationships level. At the provider level, provider–patient communication and injustices were involved, compounded by health system infrastructure and culture at the practice-setting level. Resource landscape and shared knowledge and beliefs were significant at the community level. The COVID-19 pandemic further highlighted these challenges at the societal level. CHAs provided targeted recommendations for addressing barriers at each level. CHAs identified multi-level factors contributing to DHL and emphasized levels based on comprehensive interventions.

PURPOSE: Remote symptom monitoring (RSM) using electronic patient-reported outcomes leverages digital technologies to gather real-time information on patient experiences for symptom management. This study reports a formative evaluation of technology-related barriers encountered by patients participating in RSM and implementation strategies used to address those barriers in real-world, large-scale RSM implementations. METHODS: Purposive sampling was conducted to recruit patients diagnosed with cancer and participating in RSM at the University of Alabama at Birmingham and USA Health Mitchell Cancer Institute for semi-structured interviews. Interviews were coded to identify technology-related barriers using a constant comparative method. Expert Recommendations for Implementing Change list was used to address the barriers to optimize RSM implementation. Barrier-associated themes from the interviews were mapped to implementation strategies. RESULTS: Forty participants age 24-77 years, half of whom were 60 years or older, were interviewed from December 2021 to February 2024. Three barrier themes relevant to technology utilization in RSM were identified: (1) accessibility concerns , (2) digital health literacy , and (3) user interface challenges . Themes were mapped to the implementation strategies as identified by the implementation team. Eight total implementation strategies were used to address these technology barriers: (1) assess for readiness and identify barriers and facilitators, (2) obtain and use patients/consumers and family/caregiver feedback, (3) involve patients/consumers and family members/caregivers, (4) access new funding, (5) change physical structure and equipment, (6) centralize technical assistance, (7) prepare patients/consumers to be active participants, and (8) intervene with patients/consumers to enhance uptake and adherence. CONCLUSION: Technology-related barriers may limit the uptake of RSM by patients. Addressing these barriers through multimodel assessment and intervention strategies is crucial to ensuring successful implementation of RSM in real-world settings.