||1UM1CA233080-01 Interpret this number
||Dana-Farber Cancer Inst
||Simpro Research Center: Integration and Implementation of Pros for Symptom Management in Oncology Practice
In 2018, more than 1.7 million Americans will receive a new cancer diagnosis and nearly 600,000 will die from
their disease. Cancer treatments, including major surgical resection and palliative chemotherapy, are
associated with frequent adverse symptoms. The primary burden for managing symptoms falls on patients and
their caregivers, and there is ample evidence that untreated symptoms impair quality of life, lead to inefficient
use of emergency care, avoidable hospitalizations, and even shorten survival. Electronic tracking of patient-
reported outcomes (ePROs) between face-to-face clinic visits has been shown to both reduce symptom burden
and decrease the need for acute care. Although there is abundant evidence that symptom monitoring can
improve cancer care, current experience has been largely limited to single centers or as part of clinical trials.
Using ePROs to facilitate symptom control is an attractive strategy but, evidence for effectiveness in different
treatment contexts and across varied populations is needed. Further, ePRO tracking systems have not been
fully integrated into health systems' electronic health records (EHR) and this deficit prevents them from
delivering the maximal benefits of proactive symptom management.
To fill gaps in the evidence base about the optimal strategy for deploying ePROs, a multidisciplinary team from
6 health systems have formed the Symptom Management IMplementation of Patient Reported Outcomes in
Oncology (SIMPRO) Research Center. SIMPRO's overarching goal is to develop, implement, and evaluate a
multi-component ePRO reporting and management system to improve symptom control for patients recovering
from cancer surgery or patients receiving palliative chemotherapy in small, rural, and community cancer
centers. The Specific Aims of the project are to: (1) Adapt existing ePRO symptom management systems and
integrate them into the EHR and routine clinical workflow at six health systems; (2) Determine the effectiveness
of an EHR-integrated ePRO symptom management system on health outcomes; and (3) Evaluate the
facilitators and barriers to implementation of an EHR-integrated ePRO symptom management system from the
patient, clinical and organizational perspectives. Following the adaptation of operational ePRO prototypes and
full integration into an EHR, the SIMPRO investigators will conduct a pragmatic cluster randomized trial with
stepped wedge rollout to investigate the effectiveness of a symptom monitoring system from a patient, clinician
and health system perspective. Across all study phases, the implementation process itself, including ePRO
adoption, appropriateness, acceptability, penetration/scalability, and adaptation, will be critically evaluated.
This approach will create knowledge that can be used to guide dissemination of ePROs and other interventions
to improve cancer care delivery.