Feasibility of Rapid Assessment of Patient-Reported Outcomes Following Renal Tumor Ablation
Gina R. Schultz, RN; Thomas D. Atwell, MD: Lori A. Ness, RN; Jill R. McKittrick, RN, Matthew R. Callstrom, MD; R. Houston Thomson, MD; A. Nicholas Kurup, MD; Grant D. Schmit, MD; Kathleen J. Yost, PhD
Background: There is growing interest to conduct symptom monitoring following renal tumor ablation using patient-reported outcomes. Symptom monitoring enables clinical staff to identify patients who are not recovering as expected shortly after discharge and intervene quickly, as needed, to improve function and quality of life.
Objective: To evaluate the feasibility of implementing a patient-reported outcome monitoring system in our percutaneous renal ablation practice.
Methods: We designed a remote symptom monitoring system for brief, rapid assessment of pain, physical function and social function, and we implemented it for assessments on Days 1-6 post discharge. For daily assessments to be feasible, they were extremely brief; thus, we relied on numerical rating scale questions on a 0-10 scale measuring the 3 outcomes, 1 question on overall recovery, 1 question on pain medication, and a comment field. The system utilized Qualtrics, a web-based survey vendor commonly used by medical institutions. Several automated features that are standard in Qualtrics were used to minimize the impact on clinical workflow. For example, actions were triggered based on responses to certain survey questions, and patient reported outcome (PRO) reports were automatically generated and sent to nursing staff daily. The web-based system was supplemented with telephone interviews conducted by nursing staff to assess PROs 7 and 30 days post-discharge. The pre-procedure, Day 7 and Day 30 surveys were longer and included the brief pain inventory – short, the Physical Function and Ability to Participate in Social Activities short forms from PROMIS. Day 7 and 30 surveys also included the question on recovery, and ability to return to daily activities and work.
Results: We initiated a pilot study of this system from 2/10/2016 to 4/27/2016. During that time period, we enrolled 38 patients who had a renal tumor ablation at our tertiary medical center. Participation in the daily web-based symptom monitoring was high
(74%) and compliance with the daily assessments was very good; 100% completed at least 1 and 42% completed all 5 daily assessments, and 92% provided comments. Day 7 and Day 30 surveys were completed by 95% and 88%, respectively. One patient with a severe complication was identified through this monitoring system, and we confirmed that appropriate actions were taken.
Conclusions: We demonstrated that a remote symptom monitoring system is feasible and can potentially be used to improve care for renal tumor ablation patients.