Background: Patients undergoing major cancer surgery frequently require post-acute care for complications and\nadverse effects. Enhanced recovery after surgery programmes mean that patients are increasingly discharged home\nearlier. Symptom/complication detection post-discharge is sub-optimal. Systematic patient monitoring post-discharge\nfollowing surgery may be optimally achieved through routine electronic patient-reported outcome (ePRO) data\ncapture. ePRO systems that employ clinical algorithms to guide management of patients and automatically alert\nclinicians of clinically-concerning symptoms can improve patient outcomes and decrease hospital admissions. ePRO\nsystems that provide individually-tailored self-management advice and integrate live ePRO data into electronic health\nrecords (EHR) may also advance personalised health and patient-centred care. This study aims to develop a hospital\nEHR-integrated ePRO system to improve detection and management of complications post-discharge following\ncancer-related surgery.\nMethods: The ePRO system was developed in two phases: (1) Development of a web-based ePRO symptom-report\nfrom validated European Organisation for Research and Treatment of Cancer (EORTC) questionnaires, clinical opinion\nand patient interviews, followed by hospital EHR integration; (2) Development of clinical algorithms triggering\nsymptom severity-dependent patient advice and clinician alerts from: (i) prospectively-collected patientcompleted\nePRO symptom-report data; (ii) stakeholder meetings; (iii) patient interviews. Patient advice was\ndeveloped from: (i) clinician-patient telephone consultations and patient interviews; (ii) review of hospital\npatient information leaflets (PIL) and patient support websites.\nResults: Phase 1, including interviews with 18 patients, identified 35 symptom-report items. In phase 2, 130/300\n(43%) screened patients were eligible. 61 (47%) consented to participate and 59 (97%) provided 444 complete selfreports.\nStakeholder meetings (9 clinicians, 1 patient/public representative) and patient interviews (n = 66) refined\nadvice/alert accuracy. 15 telephone consultations, 7 patient interviews and review of 28 PILs and 3 patient support\nwebsites identified 4 themes to inform self-management advice. Comparisons between ePRO symptom-report data,\ntelephone consultations and clinical events/outcomes (n = 27 patients) further refined clinical algorithms.
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