Developing an electronic platform to monitor symptoms and generate adverse event alerts and patient feedback after discharge following upper gastrointestinal cancer surgery: eRAPID feasibility study


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Kerry Avery1,Hollie Richards2,Amanda Portal2,Trudy Reed3,Ruth Harding3,Robert Carter4,Kate Absolom4,Galina Velikova4,Jane Blazeby2
1,2University of Bristol,3University Hospitals Bristol NHS Foundation Trust,4University of Leeds

Abstract

Background

Surgery for upper gastrointestinal (UGI) cancer is associated with major morbidity. Some of this occurs after hospital discharge and prompt identification of serious adverse effects (AEs) is important to improve outcomes. The eRAPID feasibility study aims to develop an online questionnaire integrated within routine electronic patient records for patients to self-report AEs post-discharge. Here, we describe the system’s development to generate automatic online patient self-management feedback and/or advice to contact a healthcare professional (HCP) or, for concerning symptoms, trigger HCP email alerts to contact the patient. The system’s feasibility and acceptability to patients and HCPs are described.

Method

The eRAPID questionnaire (37 questions, 24 symptoms) was developed from validated EORTC questionnaires in consultation with clinicians and patients. Patients self-completed the questionnaire twice in the first week and then weekly thereafter for 8 weeks post-discharge. Patient feedback was developed from: patient information leaflets (PILs) and webpages; phone consultations between nurses and patients post-discharge; clinician interviews. Expert meetings (nurses, surgeons, dieticians, patient representatives) mapped ‘typical’/‘atypical’ recoveries, refined feedback and generated symptom severity thresholds to trigger feedback/alerts, which were compared to eRAPID participants’ self-reported symptoms.

Results

Patient feedback for symptoms was developed by analyses of 28 PILs, 3 websites, 15 phone consultations with 8 patients (5 men, mean 62 years) and 4 clinician interviews (3 surgeons, 1 CNS). Development of symptom severity thresholds was informed by two expert meetings (6 nurses, 2 dieticians, 1 surgeon, 1 patient representative) and eRAPID questionnaire data from 35 patients (21 men, mean 62 years).

Conclusion

Patient feedback and symptom severity thresholds for the eRAPID online AE reporting system were developed from multiple information sources. Next, feasibility and acceptability of feedback and HCP alerts will be evaluated in a multicentre prospective cohort study. The eRAPID system will help to improve patient outcomes after UGI cancer surgery.