Abstract
Introduction
Remote symptom monitoring (RSM) allows patients to electronically self-report symptoms to their healthcare team for individual management. Clinical trials have demonstrated overarching benefits; however, little is known regarding patient-perceived benefits and limitations of RSM programs used during patient care.
Methods
This prospective qualitative study from December 2021 to May 2023 included patients with cancer participating in standard-of-care RSM at the University of Alabama at Birmingham (UAB) in Birmingham, AL, and the Univeristy of South Alabama (USA) Health Mitchell Cancer Institute (MCI) in Mobile, AL. Semi-structured interviews focused on patient experiences with and perceptions surrounding RSM participation. Interviews occurred over the phone, via digital videoconference, or in person, at the convenience of the patient. Grounded theory was used to conduct content coding and identify recurring themes and exemplary quotes using NVivo.
Results
Forty patients (20 UAB, 20 MCI) were interviewed. Participants were predominately female (87.5%), aged 41-65 (50%), and married (57.5%). Data is consistent with local demographics, comprising mainly White (72.5%) and 27.5% Black individuals. Three main themes emerged regarding perceived benefits of RSM: (1) Facilitation of Proactive Management, identifying the patient’s needs and intervening earlier to alleviate symptom burden; (2) Promotion of Symptom Self-Management, providing patients autonomy in their cancer care; and (3) Improvement in Patient-Healthcare Provider Relationships, fostering genuine connections based on healthcare team’s responses. However, participants also noted Perceived Limitations of RSM; particularly when support of symptom management was unnecessary, ineffective, or felt impersonal.
Conclusion
This study focused on patient experiences when utilizing a RSM program while undergoing treatment for cancer and found benefits to its implementation that extended beyond symptom management. At the same time, patients noted drawbacks experienced during RSM, which can help with future tailoring of RSM programs. Patient perceptions should be regularly assessed and highlighted for successful and sustained implementation.
Plain language summary
Cancer and its treatment can cause patients to experience many forms of symptoms. This can have a major effect on their overall well-being: physically, mentally, and emotionally. Early symptom detection and management has been shown to significantly improve the quality of life of patients with cancer. Remote symptom monitoring (RSM) allow patients to report their symptoms to their healthcare team and receive personalized feedback and management from them, without having to leave the comfort of their home. Although previous studies have shown the overarching benefits of implementing RSM during care, little is known regarding how patients perceive its implementation. This research team wanted to gain a better understanding of perceptions patients had, whether good or bad, of RSM’s implementation while they were actively undergoing cancer care. A total of 40 patients were interviewed with patients commenting on RSM’s ability to facilitate proactive management, promote symptom self-management, and improve patient-healthcare provider relationships. Patients also had feelings that under certain circumstances, RSM did have some limitations. This study was able to help identify some of the perceived benefits and limitations to RSM implementation. This feedback will not only help to ensure the successful implementation of future RSM programs but will also let patients know that they are heard and that their feedback is pivotal.
Introduction
Patients with cancer experience a multitude of symptoms, due to both cancer and corresponding treatments.1,2 This can infringe on a patient’s quality of life, negatively affecting their daily routine, psychological wellbeing, and interpersonal relations.3,4 Timely, sufficient symptom detection and management are imperative in oncology care, yet research suggests persistent discrepancies between a patient’s reported symptomology and clinician’s assessment.5-7 Electronic patient reported outcomes (ePROs) can help bridge this gap by capturing aspects of a patient’s physical, mental, and psychosocial health status through patient self-reporting. 8 ePROs allow providers the ability to monitor patient symptoms outside of traditional clinic visits and better understand the patient’s overall care experience.
Healthcare systems are increasingly utilizing ePROs to collect data pertaining to a patient’s health, quality of life, or functional status.9,10 Evidence is mounting on the importance of ePRO implementation across various settings to aid in and improve patient outcomes.11-14 ePROs in the form of weekly symptom surveys can be used to conduct remote symptom monitoring (RSM) programs. 5 Previous studies have identified that the integration of RSM into patient care can enhance patient-clinician communication, 15 reduce emergency department visits and hospitalizations,16,17 increase a patient’s quality of life, 16 and increase a patient’s overall survival rate.12,18,19 However, these studies are predominantly quantitative, focusing on overarching benefits of RSM, and do not fully capture the nuances of individual-level patient experiences.
Oncology practices and cancer centers are now implementing RSM programs in real-world settings, and early results show promising feasibility and effectiveness.5,20-22 As RSM expansion continues, it is unknown how patients’ experiences may differ from those in clinical trial contexts. During implementation, real-world RSM programs require adaptations and modifications to mesh with clinic symptom management workflows, which may impact patient experience. Further, expansion of access increases the heterogeneity of patients and providers participating, including individuals from populations traditionally unrepresented in healthcare delivery clinical trials.
Due to limited real-world data on RSM implementation, many oncology practices and cancer centers have delayed implementation. The adaptation of more evidence-based RSM programs is crucial in large-scale implementation at diverse community and academic sites. Patient experience data and feedback will aid in understanding how to tailor programs to site specific needs while further dissiminating RSM to all future patients with cancer. Although some studies have further explored patient experiences and perceptions surrounding symptom monitoring platforms,23-25 the literature is still lacking in depth experiences of patients at sites who have transitioned fully to utilizing RSM programs as standard-of-care. To address this knowledge gap and gain a more holistic view of patient experience, this study sought to explore first-hand experiences of patients with cancer participating in RSM as standard-of-care to identify perceived benefits and limitations to help improve implementation of programs in both initial and scale-up phases and to provide insight and guidance for future RSM implementation.
Methods
Setting
This prospective qualitative study explored individual patient experiences, specifically focusing on patient-perceived benefits and limitations, of participating in a standard-of-care RSM program implemented at two academic cancer centers in the deep South, the University of Alabama at Birmingham (UAB) and the University of South Alabama (USA) Health Mitchell Institute (MCI) in Mobile, AL. 5 Both institutions serve a large African American, rural, and disadvantaged population and have similar catchment areas.22,26 Interviews at each institution occurred at two time-points [initial implementation (Year 1; December 2021 to April 2022 ) and scale-up implementation (Year 2; February 2023 to May1 2023 )]. The reporting of this study conforms to COREQ guidelines. 27 This study was approved by the UAB single Institutional Review Board (sIRB-300007406) on June 25, 2021.
Implementation
RSM using ePROs was implemented as a standard-of-care at each institution specifically for patients receiving chemotherapy, immunotherapy, or targeted therapy. Roll-out occured sequentially in different disease types (eg, breast, gyncologic cancers). After a patient, is seen by their provider and treatment is selected, they are enrolled by non-clinical navigators into the Carevive PROmpt® platform, 28 a web-based RSM tool that captures patient-reported data via weekly symptom surveys. The platform is embedded within the electronic health record (EHR) system at UAB and MCI and allows for the integration of collected data to be displayed on clinician- and patient-facing dashboards. 29 During enrollment, patients were prompted to select their preferred method of contact (email or text) and a day of the week most convenient for surveys to be sent. Patients were then prompted to complete a weekly symptom survey. Patients were sent several reminders throughout the week to notify them if a new survey was made available or if their survey was incomplete; this was to ensure survey completion and reduce missed survey data. If patients experienced technical issues, non-clinical navigators and Carvive® technical support were available as additional support.
Individual patient’s survey responses were routed directly to their personal healthcare team (i.e., their oncologist, clinic nurse, and other members of the clinical team). If a patient experienced a moderate or severe symptom, the healthcare team was immediately alerted in the EHR and symptoms were addressed per institutional protocols. In Year 2, modifications were made to enable patients to determine when they did not want or need a call-back in cases of chronic symptoms or when management was ongoing. If the healthcare team still deemed a call necessary, the patient was called anyway. Regardless of symptom severity, patients automatically received a symptom self-management plan detailing ways to help mitigate their reported symptom(s). This guide, alongside other patient documents and treatment summaries, clinician notes, and healthcare team details, was made accessible to patients through the Carevive PROmpt® platform.
Participants
Patients were identified for participation in this study based on clinician and navigator referral with a recruitment goal of 10 patients from each institution each year, for a total of 40 unique patients. A sample size of forty patients was appropriate for this study, since thematic saturation was expected at ∼20 based on previous studies conducted by the team. Thematic saturation is a point during data analysis in which no new themes emerge. Saturation was assessed throughout data collection and the initial anticipated sample of 40 unique individuals was adequate. Purposive and convenience sampling techniques were utilized to ensure representation across race and socioeconomic status. All patients were 18 years or older, able to read and speak English, and undergoing active cancer treatment during the time of interview. Patients provided written informed consent before participating in 30-to-60-minute semi-structured interviews. Interviews were conducted with a trained female interviewer (PhD psychologist (CSH) in Year 1; PhD medical anthropologist (NLH) in Year 2) over the phone, via digital videoconference, or in person, depending on patient preference, with data being collected at these specific time points (eg, in clinic or remotely via phone or digital videoconference). Patients were informed of the interviewer’s interest in knowing about their experiences with RSM (eg, benefits and limitations) and ways it could be improved, therefore interviews were centered around these experiences. However, outside of this, no other prior relationship was established between the patient and interviewer. In some cases, the patient’s caregiver was present. In these situations, the patient was asked if they were comfortable conducting the interview with the caregiver present. Of note, everyone that was approached consented to be interviewed with no drop outs. Supplemental Appendix A provides the interview guide used during patient interviews.
Statistical Analysis
Interviews were recorded, transcribed verbatim, and uploaded into NVivo software 30 for analysis. Two independent coders (NH; EH) utilized grounded theory and a constant comparative method to develop a qualitative codebook representing key benefits and limitations experienced by Year 1 patients.31-35 In Year 2, a combination of deductive coding utilizing the Year 1 codebook and inductive coding to identify new salient constructs was conducted by 3 coders (EH; TP; CS).36,37 Identified constructs were reviewed with the study team, which included a medical anthropologist, oncologists, and non-clinical navigators involved with RSM implementation. Any discrepancies were examined, and conflicts were resolved through team discussion to achieve consensus. Inter-rater reliability was assessed among reviewers by calculating Kappa statistics in NVivo.
Results
Patient Characteristics
Patient Demographics.
Themes
Major Themes and Subthemes Emerging From Remote Symptom Monitoring Patient Interviews.
Perceived Benefits of RSM
Facilitation of Proactive Management
The first major theme included benefits related to proactive management, which provided patients with earlier intervention for their experienced symptoms. Within this theme, five subthemes emerged: (1) Prevention of Symptom Worsening, (2) Reduction in Patient Calls/Need for Calls and/or Patient/Caregiver Responsibility, (3) Faster Responses to Patient Need, (4) Increase in Patient Centered Care/Individualized Attention, and (5) More Regular Check-Ins. Patients recognized that earlier intervention prevented significant downstream consequences, such as symptoms worsening. For instance, one patient reported how when feeling unwell, the care team would immediately call in a medication or provide a potential remedy, and later checked to make sure the “symptoms had subsided” (UAB, patient 6). Patients also appreciated the reduced need for patient-initiated contact and responsibility for self-managing symptoms: “It's really helpful to be able to let someone know my symptoms and how I'm feeling without having to call…” (MCI, patient 9). Patients also noted faster responses to their problems and how to manage concerns. For example, when asked about the swiftness of care team-initiated survey responses, one patient said that they get a response, “Immediately. The second I submit it,” (MCI, patient 8), while another said, “They get right back to me” (UAB, patient 11). In addition, patients valued the individualized patient-centered care provided to them. For example, one patient said, “it makes it really seem like your care team and then the doctors and everything are doing the best they can to keep tabs on you, on how you’re doing” (MCI, patient 9). Lastly, patients commented on the more regular check-ins exhibited by the care team, with one patient saying, “it seemed like I was getting routine callbacks” (UAB, patient 17).
Promotion of Self-Management
The second major theme pertained to benefits related to self-management, which allowed patients to maintain a sense of control in their life while undergoing cancer treatment. Within this theme, four subthemes emerged: (1) Facilitation of Patient Progress Tracking, (2) Patients More Comfortable Expressing Through Survey, (3) Centralized Location for Information, and (4) Encouragement of Patient Self-Care or Action. Primarily, patients noted that through RSM they were better able to self-track their symptom progression. This aided in patients’ comprehension of treatment progression, as they saw how their symptomology changed over time. For example, one patient spoke on how this helped them realize the improvement of symptoms that were slow to change:“it’s hard to recognize that you’re making progress” (UAB, patient 15). Some patients reported that they were more comfortable expressing their concerns through the survey than verbally in clinic or over the phone. One patient discussed how the surveys allowed them extended time to say what they “needed to say without … get[ting] frustrated” (MCI, patient 10). RSM also provided patients with a centralized location for information, through the Carevive website. This centralized location included their treatment plan, symptom management plan suggestions, and healthcare team details. One patient commented on how they liked that they could just“go back and look at it anytime” (MCI, patient 13). Finally, patients expressed they felt encouraged to internally reflect and take necessary action concerning their care: “…it forces me to do a check-in with myself and say, ‘Okay, how are you doing?’” (MCI, patient 8).
Improvement in Patient-Healthcare Provider Relationships
The third major theme corresponded to benefits of improved patient-healthcare provider relationships. Within this theme, three subthemes emerged: (1) Increased Sense of Safety or Being Cared For, (2) Greater Support for Patients, and (3) Strengthening of the Patient-Care Team Relationship and Communication. Patients reported that the RSM-facilitated to their healthcare team allowed them to feel a sense of comfort, as one patient commented, “…just to know that we’ve got someone on the other end that’s looking out for us as opposed to not…knowing that there’s someone there that’s on the other end of things, keeping track and making sure you’re okay, that’s super helpful” (MCI, patient 9). Several patients emphasized how they felt more supported by the team throughout the treatment process, with one patient mentioning that RSM allowed them to be more “in tune” with their clinician (UAB, patient 13). Patients also noticed that as a result of continuous check-ins, their relationship and communication with their healthcare team was strengthened. For example, one patient said, “We pretty much kept in touch with what’s going on every time that they see me, so they knew” (MCI, patient 3).
Perceived Limitations of RSM
Although the majority of patients perceived that RSM improved their cancer treatment experience, patients also commented on six contextual situations which may have limited the ability to fully maximize the benefits of RSM: (1) Experience of No or Only Mild Symptoms, (2) Experience of Expected or Inactionable Symptoms, (3) Symptom Management Plan Not Working or Isn’t Useful, (4) Ability to Self-Manage Symptoms, (5) Preference of Calling or Using Patient Portal when Needed, and (6) Felt Impersonal. There were several patients who commented on their lack of need for symptom monitoring, with one patient saying they did not “have…very many symptoms” (MCI, patient 4) or those they experiencied were “mild” (MCI, patient 3). Other patients experienced expected and inactionable side effects: “…some things just... That's just what happens, and it's a side effect. They can't control that…” (UAB, patient 4). As a result, some patients found the symptom management plan to be “generic” (MCI, patient 2; UAB, patient 12) or “too vague” (MCI, patient 8). Because some symptoms experienced by patients were common, patients reported the ability to self-manage, with one patient saying, “I’m pretty involved in managing what I do and managing my own care” (UAB, patient 7). In other cases, patients utilized the option of declining a call-back in the system, stating, “I knew how to handle them, and so I didn’t feel like I needed extra help or anything like that” (MCI, patient 10). Some patients also preferred calling or using the patient portal, while others perceived that RSM de-personalized their experience. For example, one patient said, “I feel like I’m being more studied than I am healed…and that bothers me…because I want to be healed instead of studied” (UAB, patient 16).
Discussion
This study highlights patient-perceived benefits and limiations of RSM and adds to existing literature on benefits of clinical and healthcare utilization outcomes of RSM by providing an in-depth account of patient experiences gained directly through listening to patient experiences and concerns. This study found that RSM enhanced proactive symptom management during cancer treatment, as noted in prior studies. 39 It also highlighted that RSM improved the patient-healthcare team relationship, which is consistent with previous work suggesting that RSM fosters a sense of connection between the patient and their healthcare team. 40 This relational aspect is noteworthy because it counters concerns that the integration of technology into medicine will contribute to loss of connection between patients and their healthcare teams. 41 Our findings suggest that this technology-based intervention can more efficiently foster communication and provide consistent connection between patients and healthcare teams without adding significant burden to either party. This finding is important in the context of threats to the patient-clinician relationship, such as lack of provider engagement and attention during shortened clinic visits. 42 The sense of connection and being listened to, recognized by patients in this study, supports the importance of the patient-clinician relationship.
Another key finding of this study was the importance of clear feedback loops in which the patient reports symptoms through weekly RSM surveys and the care team directly responds to provide timely symptom management. This is consistent with prior literature, which recognizes the importance of immediate check-ins with patients. 43 This immediacy provides patients with reassurance and a sense of security. 44 In prior work, Coolbrandt and colleagues revealed that only half of the participants initially perceived that their reports were being assessed by the healthcare team. 45 In our interviews, patients commented on how the clinical team mentioned information reported on their survey during their appointment, which abated concerns about whether this information would be used. This data aligns with a trial conducted by Basch and his colleagues, in which oncologists reported that they did review and utilize patient-reported information. 15 They also obtained data on nurses’ perceptions of response time evaluation, and nurses reported that it only took 20 minutes or less to review an alert. 15 Collectively, these studies emphasized the importance of both timely responses and integration into clinical workflow.
Patient perception of technology providing an enhanced connection to the healthcare team may have also been, in part, more acceptable due to COVID-19 related shifts toward at-home care and use of electronic mediums for commuication.46-48 This study was conducted during the COVID-19 pandemic, when isolation was a societal norm 40 and expansion of remote services was essential to care delivery. 49 Further attention is needed to understand how to capitalize on this shift and provide potentially better care to patients through digital tolls.
Although overall viewed positively, it is also important to note that not all patients found electronic delivery appealing, as seen through the contradiction of some perceived benefits and limitations. Utilization of electronic surveys was considered impersonal by some, which highlights a well-recognized barrier that some individuals prefer in-person contact. This finding is supported by prior work demonstrating high satisifaction in face-to-face bedside evaulations. 50 In a study conducted by Mirzaei and Kashian, surveyed patients felt that although information-technology based mediums were just as effective as face-to-face communication, patients preferred and had a better sense of appreciation for face-to-face communication. 51 This is often a trade-off seen when discussing technology-based avenues of healthcare, not only because of the communical aspect but also because of digital disparities that tend to arise when technology is used. Another key concern was redundancy and lack of need. Future directions may include updating survey content to include questionnaires based on individual or cancer characteristics in order to maximize the likelihood of capturing actionable symptoms, while limiting questions of minimal utility.
There were a few limitations to this study. First, this study was conducted at two academic cancer centers in Alabama, limiting the generalizability to other regions of the country or practice settings. However, findings are consistent with experiences from the Texas Oncology practice that also implemented ePROs during the pandemic. 52 Second, a purposive and convenience samplng technique was used to identify interview patients, which may have resulted in bias for patients who the clinical teams anticipated would view the intervention favorably and be likely to participate. Additionally, although nearly one-third of the sample was Black and this perspective was included in the analysis, the sample size was insufficient to assess for differences in perceptions of RSM on the basis of race, and further work will be needed to understand how different subpopulations experience RSM. Furthermore, specifics surrounding a patient’s disease and treatment status, outside of actively receiving chemotherapy, immunotherapy, or targeted therapy, were not collected since the intervention was not specifically focused on this. However if collected, future studies could delve into the specifics and any differences in perceptions that could result. Additionally, we did not specifically assess for infrastrcuture differences and make comparisons across sites, as the focus was on overall implementation experience. Finally, it is noteworthy that interviews were conducted during the intial implementation phase, and further exploration is needed to understand challenges encountered in mature programs.
Conclusion
In conclusion, patients recognized benefits beyond RSM’s ability to acheive proactive symptom management including enhanced self-management and improved connection with their healthcare team. However, patients also found times when RSM lacked in utility, primarily when they experienced no or repeated symptoms, in which case they felt that the symptom management guide was too repetitive or found alternative ways to manage their symptom(s). These patient-perceived benefits and limitations should be highlighted to help support continued expansion of RSM into real-world settings.
Supplemental Material
Supplemental Material - Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment
Supplemental Material for Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment by Catherine S. Smith,Nicole L Henderson,Emma K. Hendrix,Tanvi Padalkar,Chao-Hui Sylvia Huang,D’Ambra N. Dent,Stacey A. Ingram,Chelsea McGowan, J. Nicholas Odom, Tara Kaufmann, Bryan Weiner, Doris Howell, Angela M. Stover, Ethan Basch,Jennifer Young Pierce, and Gabrielle B. Rocque Cancer Control
Supplemental Material
Supplemental Material - Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment
Supplemental Material for Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment by Catherine S. Smith,Nicole L Henderson,Emma K. Hendrix,Tanvi Padalkar,Chao-Hui Sylvia Huang,D’Ambra N. Dent,Stacey A. Ingram,Chelsea McGowan, J. Nicholas Odom, Tara Kaufmann, Bryan Weiner, Doris Howell, Angela M. Stover, Ethan Basch,Jennifer Young Pierce, and Gabrielle B. Rocque Cancer Control
Supplemental Material
Supplemental Material - Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment
Supplemental Material for Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment by Catherine S. Smith,Nicole L Henderson,Emma K. Hendrix,Tanvi Padalkar,Chao-Hui Sylvia Huang,D’Ambra N. Dent,Stacey A. Ingram,Chelsea McGowan, J. Nicholas Odom, Tara Kaufmann, Bryan Weiner, Doris Howell, Angela M. Stover, Ethan Basch,Jennifer Young Pierce, and Gabrielle B. Rocque Cancer Control
Supplemental Material
Supplemental Material - Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment
Supplemental Material for Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment by Catherine S. Smith,Nicole L Henderson,Emma K. Hendrix,Tanvi Padalkar,Chao-Hui Sylvia Huang,D’Ambra N. Dent,Stacey A. Ingram,Chelsea McGowan, J. Nicholas Odom, Tara Kaufmann, Bryan Weiner, Doris Howell, Angela M. Stover, Ethan Basch,Jennifer Young Pierce, and Gabrielle B. Rocque Cancer Control
Supplemental Material
Supplemental Material - Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment
Supplemental Material for Patient-Perceived Benefits and Limitations of a Standard of Care Remote Symptom Monitoring Program During Cancer Treatment by Catherine S. Smith,Nicole L Henderson,Emma K. Hendrix,Tanvi Padalkar,Chao-Hui Sylvia Huang,D’Ambra N. Dent,Stacey A. Ingram,Chelsea McGowan, J. Nicholas Odom, Tara Kaufmann, Bryan Weiner, Doris Howell, Angela M. Stover, Ethan Basch,Jennifer Young Pierce, and Gabrielle B. Rocque Cancer Control
Footnotes
Author Contributions
G.R., J.Y.P., E.B., A.S., D.H., J.N.O., and B.W. participated in the study conception and design. G.R., E.B., A.S., D.H., B.W., and N.H. led implementation science framing of the study. D.D., S.I., C.M., J.Y.P., N.H., and G.R. led subject identification and recruitment. D.D., S.I., C.M., J.Y.P., N.H., and G.R. supported in subject recruitment, scheduling of interviews, data collection. N.H., T.K., and C.S.H. conducted interviews for the study. C.S., N.H., E.H., T.P., and G.R. conducted the coding and primary analysis of the data. All authors participated in data interpretation of analysis, manuscript writing. All authors approved the final version of the manuscript.
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Stover has received unrelated research funding in the past two years from non-profit organizations [PCORI, NIH, AHRQ, Bladder Cancer Advocacy Network, Hematology/Oncology Pharmacy Association, Cancer and Aging Research Group (CARG), and the American Society of Clinical Oncology] and for-profit organizations [Sivan Innovation, UroGen Pharma Ltd., and Pfizer Global]). Dr. Basch has received payments as a scientific advisor for Navigating Cancer, AstraZenenca, Resilience, N-Power Medicine, and Verily). Dr. Rocque: Research/Contracts to Institution: Pfizer, Genetech, Armada, and Daiichi Sankyo and Consulting: Pfizer and Gilead). All other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work and Dr. Rocque were supported by the National Institute of Nursing Research [R01NR019058]. Dr. Henderson was supported by the Cancer Prevention and Control Training Program Grant [NIH T32 CA47888]. Dr. Kaufmann was supported by an American Cancer Society Clinician Scientist Development Grant [CSDG-23-1019130-01-CTPS]. Dr. Stover was supported by the North Carolina Translational and Clinical Science Institute [1UL1TR002489].
Trial Registry Name
Evaluating the Implementation and Impact of Navigator-Delivered ePRO Home Symptom Monitoring and Management.
Registration Number
NCT04809740
Ethical Statement
ORCID iDs
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
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