A PRO-cision medicine intervention to personalize cancer care using patient-reported outcomes: intervention development and feasibility-testing

Claire Snyder; Susan M Hannum; Sharon White; Amanda Montanari; Dara Ikejiani; Benjamin Smith; Amanda Blackford; Elissa Thorner; Katherine C Smith; Michael A Carducci; Vered Stearns; Karen Lisa Smith

doi:10.1007/s11136-022-03093-3

A PRO-cision medicine intervention to personalize cancer care using patient-reported outcomes: intervention development and feasibility-testing

Qual Life Res. 2022 Aug;31(8):2341-2355. doi: 10.1007/s11136-022-03093-3. Epub 2022 Feb 8.

Authors

Claire Snyder^{1

2

3}, Susan M Hannum⁴, Sharon White^{5

4}, Amanda Montanari⁵, Dara Ikejiani⁵, Benjamin Smith⁶, Amanda Blackford^{7

5}, Elissa Thorner⁵, Katherine C Smith^{5

4}, Michael A Carducci^{7

5}, Vered Stearns^{7

5}, Karen Lisa Smith^{7

5}

Affiliations

¹ Johns Hopkins University School of Medicine, Baltimore, MD, USA. csnyder@jhu.edu.
² Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA. csnyder@jhu.edu.
³ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. csnyder@jhu.edu.
⁴ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
⁶ Johns Hopkins Health System, Baltimore, MD, USA.
⁷ Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

Purpose: PRO-cision medicine refers to personalizing care using patient-reported outcomes (PROs). We developed and feasibility-tested a PRO-cision Medicine remote PRO monitoring intervention designed to identify symptoms and reduce the frequency of routine in-person visits.

Methods: We conducted focus groups and one-on-one interviews with metastatic breast (n = 15) and prostate (n = 15) cancer patients and clinicians (n = 10) to elicit their perspectives on a PRO-cision Medicine intervention's design, value, and concerns. We then feasibility-tested the intervention in 24 patients with metastatic breast cancer over 6-months. We obtained feedback via end-of-study surveys (patients) and interviews (clinicians).

Results: Focus group and interview participants reported that remote PRO symptom reporting could alert clinicians to issues and avoid unneeded/unwanted visits. However, some patients did not perceive avoiding visits as beneficial. Clinicians were concerned about workflow. In the feasibility-test, 24/236 screened patients (10%) enrolled. Many patients were already being seen less frequently than monthly (n = 97) or clinicians did not feel comfortable seeing them less frequently than monthly (n = 31). Over the 6-month study, there were 75 total alerts from 392 PRO symptom assessments (average 0.19 alert/assessment). Patients had an average of 4 in-person visits (vs. expected 6.5 without the intervention). Patients (n = 19/24) reported high support on the end-of-study survey, with more than 80% agreeing with positive statements about the intervention. Clinician end-of-study interviews (n = 11/14) suggested that PRO symptom monitoring be added to clinic visits, rather than replacing them, and noted the increasing role of telemedicine.

Conclusions: Future research should explore combining remote PRO symptom monitoring with telemedicine and in-person visits.

Keywords: Breast cancer; Clinical care; Patient-reported outcomes; Prostate cancer; Symptom monitoring.

MeSH terms

Breast Neoplasms*
Feasibility Studies
Humans
Male
Patient Reported Outcome Measures
Quality of Life* / psychology
Surveys and Questionnaires

Abstract

MeSH terms

Grants and funding