Leveraging Digital Technologies to Reduce Time Burden for Patients with Advanced Cancer

DESCRIPTION
Patients with advanced cancer spend a significant portion of their remaining survival time interacting with the health system: commuting to, waiting for, and receiving care. For instance, those receiving immunotherapy spend a substantial amount of time prior to each treatment first undergoing toxicity assessments, which consist of lab tests, clinical examinations, and symptom assessments. However, most patients treated with immunotherapy do not experience significant toxicity, thus prompting a consideration of innovative ways to relieve the time burden for this majority of patients.

To address this time burden and improve the patient experience, this study will leverage and evaluate a text messaging e-triage tool in order to screen patients in advance of their office visits. Patients would be asked to monitor and report on symptoms. Those without identified side effects could then proceed directly to treatment when they arrive at the clinic.

First, this study aims to measure the efficacy and performance of a text-based mobile intervention, which will assess toxicity prior to a patient’s immunotherapy treatment. The e-triage assessment will consist of 16 questions sent via a two-way text messaging system 96 hours prior to a patient’s scheduled immunotherapy. The texts will prompt patients to share presence and severity of symptoms over the week prior. Second, a randomized control trial (RCT) will compare total care times (time spent commuting to, waiting for, and receiving care) between those assigned to the text-based triage system and those receiving standard screening and care.

IMPACT
If found to be effective, the e-triage system will be implemented across practice models within the Penn Medicine health system. If the e-triage tool is not found to be significantly superior to standard office visits, data will be used to refine the target population. Either way, findings can be used to provide more patient-centered care by improving accessibility and the patient experience.

PEOPLE
Erin Bange, MD; Ronac Mamtani, MD, MSCE; Kerry Coughlin, MSW; Timothy J Brown, MD; Daniel Ragusano; Wenrui Li, PhD; Elizabeth Moriarty, BSN; Kelly Getz, PhD; Yimei Li, PhD, MS; Dawn Hershman, MD, MS, FASCO; Roger Cohen, MD; Carmen Guerra, MD, MSCE, FACP; Mohan Balachandran, MA, MS; Lawrence Shulman, MD; Justin Bekelman, MD; Roy Rosin, MBA

FUNDING
Marjorie and Bryan Weingarten Fellowship Grant
ASCO Conquer Cancer YIA

FOCUS
Clinical Transformation