A Randomized Controlled Trial Evaluating Electronic Outpatient Symptom Monitoring After Ambulatory Cancer Surgery
- PMID: 34132697
- DOI: 10.1097/SLA.0000000000005005
A Randomized Controlled Trial Evaluating Electronic Outpatient Symptom Monitoring After Ambulatory Cancer Surgery
Abstract
Objective: We implemented routine daily electronic monitoring of patient-reported outcomes (PROs) for 10 days after discharge after ambulatory cancer surgery, with alerts to clinical staff for worrying symptoms. We sought to determine whether enhancing this monitoring by adding immediate automated normative feedback to patients regarding expected symptoms would further improve the patient experience.
Summary of background data: PRO monitoring reduces symptom severity in cancer patients. In ambulatory cancer surgery, it reduces potentially avoidable urgent care center (UCC) visits, defined as those UCC visits without readmission.
Methods: Patients undergoing ambulatory cancer surgery (n = 2624) were randomized to receive standard PRO monitoring or enhanced feedback. The primary study outcome was UCC visits without readmission within 30 days; secondary outcomes included patient anxiety and nursing utilization.
Results: There was no significant difference in the risk of a potentially avoidable UCC visit [1.0% higher in enhanced feedback, 95% confidence interval (CI) -0.2-3.1%; P = 0.12]. There were similarly no significant differences in UCC visits with readmission or readmission overall (P = 0.4 for both). Patients randomized to enhanced feedback demonstrated a quicker reduction in anxiety (P < 0.001) and required 14% (95% CI 8-19%; P < 0.001) and 10% (95% CI 5-16%, P < 0.001) fewer nursing calls over 10 and 30 days postoperatively.
Conclusions: Providing patients with feedback about symptom severity during recovery from ambulatory cancer surgery reduces anxiety and nursing workload without affecting UCC visits or readmissions. These results support wider incorporation of normative feedback in systems for routine PRO monitoring.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Conflict of interest statement
The authors report no conflicts of interest.
Comment in
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Comment on: "A Randomized Controlled Trial Evaluating Electronic Outpatient Symptom Monitoring After Ambulatory Cancer Surgery".Ann Surg. 2022 Dec 1;276(6):e1121-e1123. doi: 10.1097/SLA.0000000000005445. Epub 2022 Jul 6. Ann Surg. 2022. PMID: 35793457 Clinical Trial. No abstract available.
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References
-
- Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Nat Health Stat Rep 2009; 1–25.
-
- Hall MJ, Schwartzman A, Zhang J, et al. Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. Nat Health Stat Rep 2017; 1–15.
-
- Hollenbeck BK, Dunn RL, Suskind AM, et al. Ambulatory surgery centers and outpatient procedure use among Medicare beneficiaries. Med Care 2014; 52:926–931.
-
- Gillis C, Gill M, Marlett N, et al. Patients as partners in enhanced recovery after surgery: a qualitative patient-led study. BMJ Open 2017; 7:e017002.
-
- Odom-Forren J, Wesmiller S. Managing symptoms: enhancing patients self-management knowledge and skills for surgical recovery. Semin Oncol Nurs 2017; 33:52–60.
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