Background Screening for unmet needs using patient reported outcomes (PRO) has been associated with improved patient satisfaction, reduced emergency room presentations and improved survival, but is not yet routinely adopted in Australia.
Method A prospective, single arm, pragmatic intervention study aimed to evaluate the implementation of a web-based system of screening for unmet needs using the Edmonton Symptom Assessment Scale in people with diverse cancers in a tertiary level hospital in Australia. After local adaptation of the portal and staff training, cancer nurses were asked to register patients to use the portal for screening in clinic, with the nurse assisting, or online at home, following an email link. Responses were scored according to severity and those who reached predetermined cut-off of severity reported to nurses for assessment and management according to best practice.
Results Fifteen nurses across diverse tumour types agreed to approach patients for screening. During the 7 months recruitment, 7 nurses approached 68 patients with 5 nurses approaching more than 1. Forty-seven (69%) patients completed screening and 22 rescreened at least once. Thirty-two (68%) patients reported at least one symptom at their first screening. Overall, 56 (75%) out of 75 screens identified at least one unmet need/symptom with 24% of symptoms severe. Forty-eight (86%) screens were followed up by a nurse assessment which led to an intervention – most commonly reassurance or earlier review by the clinical team. The most common symptoms were tiredness reported by 27 (57%) individuals; reduced wellbeing 24 (42%); anxiety and depression (24; 42%) and drowsiness (17; 36%).
Conclusions Screening for unmet needs using a web-based PRO collection portal identified a high number of unmet needs, but the uptake of this intervention by nurses and patients was lower than expected. Future research needs to focus on multilevel approaches to addressing barriers to PRO use.