An"Early Adopter" of CPQR's Patient Reported Outcome (PRO) Initiative: Lessons Learned Through Implementation of an Electronic PRO Platform Across a Mulit-Center Radiation Oncology Department

ABSTRACT

Purpose: Beyond patient symptom management during treatment, patient reported outcomes (PRO) play a critical role in oncology survivorship. Although considered standard of care, PRO collection and use is challenging for radiotherapy (RT) centres lacking electronic PRO (ePRO) infrastructure. This work outlines facilitators and barriers to the implementation of an ePRO program across a multicentre radiation oncology department. Material(s) and Method(s) Dalhousie University's Department of Radiation Oncology (DRO) is composed of four RT centres across three provinces. Department-wide implementation of ePRO was precipitated by several key events In 2009, a Canadian Partnership Against Cancer (CPAC) grant enabled 2 centres to begin paper-based PRO using the Canadian Problem Checklist (CPC) and Edmonton Symptom Assessment System (ESASr). In 2015, the Department's research retreat set ePRO as a priority. In 2017, Accreditation Canada mandated routine evaluation of patient outcomes and in 2018, the Canadian Partnership for Quality Radiotherapy (CPQR) identified Dalhousie's DRO as an early adopter within the pan-Canadian PRO initiative. In 2019, three DRO centres were awarded CPAC funding to launch ePROs. The fourth centre now hopes to use lessons learned in order to facilitate their ePRO implementation. Result(s) ePRO was launched in September 2021 with a phased approach across centres and tumour sites so that user feedback can inform the roll out. Clinic workflows now includes ePRO at consultation, first and last RT review as well as follow-up. Within the ePRO application (Noona), CPQR-endorsed PRO tools include CPC, ESASr, and the Brief Pain Inventory (BPI), with use of other tumour-site specific questionnaires planned. Project charter included needs assessments (human resource, staff /patient education) and change management strategies required to obtain buy-in from front line staff. Although coordination of such a large-scale initiative was challenged by COVID restrictions, project priority was escalated with ePRO recognized as a powerful tool to assess patient symptoms in clinic or remotely. Research unit support was invaluable to navigate IT project complexities including vendor/collaborator contracts, processes of Privacy Impact Assessments and IT architectural reviews. From the advisory board to PRO working groups, mullti-stakeholder feedback and collaboration has been key, including representatives of patients, cancer program leadership, project managers/principle investigators, administrative staff, nurses, radiation therapists, radiation oncologists, industry, IT and legal. Conclusion(s) Multi-centre implementation of an ePRO program has been feasible but complex and time intensive. It is hoped that our lessons learned may benefit those RT centres aiming to transition from paper-based to ePRO systems. With critical electronic infrastructure now in place, we await data to analyze ePRO amongst other patient outcomes in ongoing RT Big Data initiatives. Copyright © 2022 Elsevier Ireland Ltd. This is an open access article under the CC-BY-NC-ND license (http//creativecommons.org/licenses/by-nc-nd/4.0/).