Background:
Post-COVID-19, patient-reported outcome measures (PROMs) are valuable tools that can direct care in conjunction with a hybrid model of healthcare.
Aims:
To assess the impact of real-time PROMs administered prior to breast oncology outpatient consultations on emergency department (ED) presentations and overall survival (OS), and identify symptoms most associated with unplanned presentations.
Methods:
Between February and August 2023, breast cancer patients were invited to electronically complete the EQ-5D-5L, Edmonton Symptom Assessment System-Revised, and Supportive Care Needs Survey-Short-Form (SCNS-SF34) prior to scheduled appointments. Participant and non-participant data were extracted from medical records. Chi-squared and t-tests were used for between-group analyses. OS was assessed using the Kaplan-Meier method with Cox regression.
Conclusion:
Data were extracted from 993 clinic consultations (31% telehealth) involving 363 patients (mean age 62 (SD 13); 99% female; 61% undergoing treatment with palliative intent). PROMs participation was lower among telehealth attendees (36.1% vs 50.1% face-to-face, p<0.001), and among people speaking a language other than English (55% vs 72%, p=0.01). No significant differences were observed between participants and non-participants in age, stage, treatment intent, or treatment received. An ED presentation occurred within 30 days of 8.1% of participating and 7.8% of non-participating consultations (p=0.91). Among PROMs participants, ED presentations were associated with higher mean scores for the EQ-5D-5L anxiety/depression dimension (2.1 vs 1.8, p=0.045) and the SCNS-SF34 psychological domain standardised scale (49 vs 36, p=0.003) at the preceding oncology consultation. 1-year OS was 88.0% for participants vs 81.4% for non-participants. Treatment intent and PROMs participation, but not age, were associated with OS (p<0.001, p=0.034, and p=0.92, respectively).
While completion of PROMs before breast oncology consultations was not associated with likelihood of ED presentations, it was associated with improved OS. Targeted interventions focussing on symptoms associated with ED presentations and to support participation among people who speak a language other than are warranted.