Impact of the eSyM symptom monitoring program on nurse telephone encounters across six cancer centers.

Abstract

1541 Background: After developing an ePRO-based, EHR-integrated symptom monitoring program (eSyM) and implementing it across 6 health systems, we found lower odds of acute care utilization among those who used eSyM to report symptoms. Facilitating communication between patients and clinicians is a potentially important mechanism by which symptom monitoring programs may improve outcomes. We measured the association between eSyM deployment, symptom reporting and severe symptom reporting on the frequency and number of nurse telephone encounters (TELs). Methods: eSyM was deployed in a stepped wedge RCT from 2018-2023 for adults who started chemotherapy (CHEM) or were discharged following surgery (SURG) for a suspected or confirmed GI, GYN or thoracic cancer. We analyzed three cohorts: 1) for all patients, we compared those treated before vs. after eSyM deployment; 2) for post-deployment patients (eSyM eligible), we compared those who did vs. did not report symptoms within 30 days of first eSyM prompt; and 3) for symptom reporters (eSyM users), we compared those who did vs. did not report severe symptoms. Outcomes of interest were the proportion of patients with at least one TEL and total number of TELs within 30 days of first eSyM prompt. Poisson regression was used to estimate the number of TELs within 30 days accounting for cancer and treatment type, as well as age, gender, and other factors. Results: In total, 18,830 patients were and 21,112 were not exposed to eSyM (median age 64, 66% female). Among eligible patients, 8,298 (44%) reported symptoms within 30 days. Among eSyM users, 3,666 (44%) reported one or more severe symptoms within 30 days. The proportion of patients with TELs and the number of TELs per patient are below (Table). In regression analyses, there were more TELs within 30 days after eSyM deployment (SURG 0.09 [95%CI 0.07-0.11; P < .0001], CHEM 0.26 [95% CI 0.23-0.28; P < .0001]) and among severe symptom reporters (SURG 0.42 [95%CI 0.38-0.45; P < .0001], CHEM 0.43 [95% CI 0.38-0.48; P < .0001]). Conclusions: eSyM exposure and reporting severe symptoms were associated with a greater likelihood and larger number of TELs, supporting nurse intervention as a mediator of the association between ePRO monitoring and clinical outcomes. Future studies should explore the impacts of ePRO systems on nursing workload and health system costs. Clinical trial information: NCT03850912 . Cohort Treatment % patients reporting within 30 days, P value Mean number of TELs among those with at least one TEL (SD), P value All patients Control Intervention Control Intervention Surg 63% 69% <.0001 2.6 (2.5) 2.9 (2.5) <.0001 Chemo 60% 79% <.0001 3.9 (3.6) 4.0 (3.5) 0.08 eSyM eligible Non-reporter Reporter Non-Reporter Reporter Surg 66% 71% <.0001 3.0 (2.6) 2.9 (2.4) 0.23 Chemo 77% 81% <.0001 4.1 (3.6) 3.9 (3.4) 0.04 eSyM users No severe symptoms Severe symptoms No severe symptoms Severe symptoms Surg 67% 77% <.0001 2.6 (2.1) 3.3 (2.7) <.0001 Chemo 76% 89% <.0001 3.4 (3.0) 4.5 (3.5) <.0001