Implementation of a patient-reported symptom tool in low-resource settings with high demand for services: A pilot feasibility study (PROMISE-Pilot).

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Background: Patients often experience cancer and treatment-related symptoms that can be under-elicited and under-reported especially in busy oncology clinics and not be prioritised appropriately. This is especially true in Asia with widespread resources and workforce constraints. Systematic symptom monitoring using patient reported outcome measures tools (PROMs) has been shown to improve outcomes in the West, but feasibility and acceptability in Asian contexts remain uncertain. Four oncology services in Thailand, India, Singapore and the Philippines evaluated the feasibility of implementing PROMs in routine outpatient oncology care. Methods: PROMiSE was a prospective, multi-center feasibility study evaluating integration of PROMs using Edmonton Symptom Assessment Scale-revised (ESAS-r) into outpatient oncology practice in Asia. Clinicians at four hospitals in Singapore, Manila, Bangkok, and Hyderabad participated, with participating patients completing paper-based ESAS-r prior to each clinic visit. The primary endpoint was completion of ESAS-r, defined as ≥85% of patients completing ≥5 of 10 ESAS-r items. Secondary endpoints included completion of ≥8 and all 10 items, patient- and clinician-reported satisfaction using study-developed surveys. Results: A total of 819 patients answered the ESAS-r with 817 (99.8%) completing ≥5 items and 811 (99.0%) completing ≥8 items. Majority were ECOG performance status ≤2 (728; 93.9%).The majority of ESAS-r forms were answered by the patients (524; 67.6%), while the remainder required caregiver assistance. Patient-reported feedback (1 = strongly agree, 5 = strongly disagree) demonstrated high acceptability: ESAS-r was easy to answer (mean 1.34±0.60), easy to understand (1.34±0.58), relevant to them (1.41±0.64), improved discussion with clinicians (1.49±0.72), was used by their clinicians (1.58±0.81), increased their sense of control (1.55±0.74), and they will recommended to others (1.55±0.75). Most clinicians agreed that ESAS-r improved quality of care, consultation efficiency, and clinical discussions, and reported intent for future use. Conclusions: The study demonstrates feasibility and patient and clinician acceptability of ESAS-r, a low-cost but potentially high-value tool that can improve quality of care, across different sites in Asia. The high completion rates, positive patient and clinician feedback indicate that ESAS-r can be considered for a wider scale adoption in routine outpatient oncology clinics in Asia. However, local institutional, guideline and policy level changes will be required to enable sustainable uptake and implementation of PROMs into practice.