Implementing REmote SymPtom mOnitoring and maNagement (RESPONd)

Implementing REmote SymPtom mOnitoring and maNagement (RESPONd): Evaluating the Impact on Cancer Patients, System Efficiency, and Economic Outcomes

The goal of this study is to understand if the implementation of a remote symptom monitoring and management program improves outcomes. The program will provide patients the opportunity to complete electronic Patient Reported Outcomes (PROs) questionnaires from home between appointments and receive tailored advice from a study nurse. A second goal of this study is to examine the impact of electronic symptom monitoring on clinic efficiencies.

The main question it aims to answer is:

• What impact does implementing digitally enabled remote symptom monitoring and management (RESPONd) between ambulatory oncology visits have on patient outcomes and system efficiencies?

Participants will:

• Report their symptoms and concerns from home by completing the electronic symptom monitoring questionnaire.
• Discuss their symptoms and concerns with a study nurse.
• Provide feedback about their experience at important timepoints during the study.
• Participate as usual in ambulatory clinic appointments.

Rationale:

In recent years, cancer care has increasingly shifted from acute to ambulatory settings as a strategy to manage healthcare costs. While some emergency department (ED) visits are unavoidable due to the complexity of cancer-related issues, many could be prevented through timely symptom management and coordinated care in ambulatory oncology. The integration of Patient Reported Outcomes (PROs) into routine cancer care has been shown to reduce ED visits, enhance quality of life, and improve overall survival.

Within Cancer Care Alberta, PROs are routinely collected during clinic visits and electronically, using a standardized questionnaire that assesses common symptoms and supportive care needs experienced by cancer patients. Despite this, the use of electronic PROs data for real-time symptom management remains inconsistent, and there is currently no established workflow in Alberta for remote symptom monitoring. As a result, healthcare providers often lack advance insight into patients' symptoms prior to appointments.

Study Design:

The study is a stepped-wedge effectiveness-implementation type 1 hybrid design. RESPONd will be implemented over 1.5 years in six clinics, spanning tertiary, regional, and community cancer centres. Study nurses will monitor electronic PROs questionnaires completed between clinic visits and contact patients to provide personalized support. Collected electronic PROs information will also be utilized during weekly triage discussions in each clinic, where the route of care will be tailored for patients based on their symptom complexity. Participant quality of life will be measured at baseline, 3, and 6 months. Health care utilization compared to non-RESPONd patients will be evaluated. The implementation of this study will be evaluated using the RE-AIM framework, utilizing all constructs.

Following completion of the quantitative phase (stepped-wedge effectiveness-implementation type 1 hybrid design), a qualitative component will be conducted using semi-structured interviews with a subset of participants. This phase aims to explain and provide deeper insight into the quantitative results, including patient experiences, contextual factors influencing implementation, and perceived barriers and facilitators to intervention uptake.

Potential impact on practice:

The study will explore a person-centered, proactive approach to remote symptom management and the effects on patient experience, outcomes, and clinical teams. RESPONd represents an innovative opportunity to shift the model of care in oncology clinics to optimize efficiency and utilization of limited clinic resources and create a responsive care team that is ready and able to provide personalized symptom management and supportive care within the cancer journey.

Inclusion Criteria:

• Age ≥ 18
• Have cancer
• Receiving care in one of the participating clinics.
• Able to sign up for MyAHS Connect and consent.
• Have access to a digital device at home
• Able to complete their electronic PROs questionnaire without support from the clinic team on a weekly (patients on active treatment) or monthly (patients on follow-up) basis, for the duration of the intervention or until they are discharged from the clinic.
• Regular access to a telephone in order for the study nurse to call patients to provide symptom management support.

Exclusion Criteria:

• Patients with cognitive disabilities or who cannot reliably report symptoms independently.
• Patients not residing in Alberta, as government-issued ID is required to register for MyAHS Connect.
• Patients who do not have regular access to a telephone, as the study nurse needs to be able to call patients to provide symptom management support.
• Patients who do not speak English, or who do not have an English-speaking friend, family member, or caregiver to assist them, as the electronic PROs questionnaire is only available in English at this time.