Dr. Ethan Basch is a Professor of Medicine at the University of North Carolina Lineberger Comprehensive Cancer Center. Prostatepedia spoke with him about having patients report symptoms via web-based portal.
Why did you become a doctor? What is it about patient care that attracts you?
Dr. Ethan Basch: I became a doctor because I like people and value direct service. Patient care is rewarding when I feel I can help people by providing medical knowledge that helps them make decisions, listening, and providing support and compassion, and by connecting them to other professionals or resources that can help them during difficult moments.
Do patients commonly report the majority of cancer treatment side effects to their doctors? What are some of the obstacles to those conversations?
Dr. Basch: Studies show that clinicians (doctors and nurses) are unaware of up to half of their patients’ symptoms. The reasons for this are complex. Between clinic visits, patients may be reluctant to call the office with problems or have difficulties getting through. At visits, clinicians might not ask about specific symptoms amidst other pressing discussion topics. There are also interpersonal dynamics that play a role. Patients might not want to “let their doctor down” by admitting to difficulties. Similarly, doctors might downplay patients’ problems because they are emphasizing positive rather than negative aspects of treatment. Electronic questionnaires bypass these various barriers. They enable patients to respond honestly to straightforward and systematic questions about issues they experience. This information is then conveyed automatically to clinicians.
How are doctors currently using newer technologies—like web-based portals or mobile apps—to make it easier for patients to communicate with them?
Dr. Basch: An increasing number of patient portal systems used by hospitals and clinics enable patients to self-report problems they experience. Clinicians can respond to patients within their usual workflow. There are also a growing number of mobile apps to facilitate this communication between patients and clinicians. These systems lower the barriers to reaching clinicians and facilitate better communication during and between visits.
Can you tell us about your study that looked at having patients use a web-based portal to report side effects?
Dr. Basch: We conducted a study asking a simple question: If we provide an online system for patients to report symptoms to their doctors and nurses during cancer treatment, will that improve outcomes? The answer was a resounding yes. In this study, we randomly assigned 766 patients to either usual care or to self-reporting common symptoms on a weekly basis from home or clinic with automated email alerts sent to nurses for severe or worsening problems. We found that compared to usual care, the patients who self-reported had significantly fewer emergency room visits, better quality of life, and were able to remain on chemotherapy longer because their symptoms were better controlled.
These findings together likely account for the most striking finding of the study, that the median overall survival was five months longer among those who self-reported.
Do you think such web-based portals can help doctors address side effects faster and more effectively?
Dr. Basch: Yes.
Are there any financial implications for reporting side effects electronically?
Dr. Basch: We found a significant decrease in emergency room visits when symptoms are managed through proactive electronic symptom monitoring, which is a potential cost savings.
Do you think patients are more likely to report certain side effects if given the opportunity to do so electronically than if they have to report them during an office visit?
Dr. Basch: Yes, this has been shown in prior scientific studies. Patients are more likely to disclose symptom information through questionnaires than in face-to-face discussions.
This is likely due to some of the reasons I mention above.
Is there anything else you’d like patients to know about your study or its implications?
Dr. Basch: It is important to reach out to your care team when you have symptoms.
If you were to do the study again, would you make any changes to the way you had patients report side effects—e.g., mobile app versus desktop portal versus text or newer apps/etc.?
Dr. Basch: We started this study more than a decade ago, and there have been substantial advances since then in health information technology and in patient/clinician familiarity with electronic tools. Today, we use newer approaches, including automated telephone systems and downloadable apps. Bots are on the horizon that will automatically elicit symptoms from patients and give advice, and wearable activity trackers will be integrated.
Any thoughts for doctors who may be reading this?
Dr. Basch: It is important to monitor patients’ symptoms between visits during systematic cancer treatment—treatment for most chronic symptomatic conditions, actually. Although there are logistical and workflow challenges associated with integrating patient reported outcomes into a practice, there are many benefits: improved communication, patient satisfaction, and clinical outcomes.