Duke University Health System (DUHS) has been awarded funding from the Patient-Centered Outcomes Research Institute (PCORI) to implement electronic monitoring of patients’ self-reported symptoms during cancer treatment — potentially transforming cancer care at Duke.
Patients undergoing cancer treatment often experience troubling symptoms, so managing them is a key part of high-quality cancer care, which research shows can enhance patient well-being, decrease hospital visits, and improve treatment adherence.
The project brings together Duke's expertise in digital health and implementation science to revolutionize and ensure the highest quality of care for patients with cancer by making electronic symptom monitoring part of routine clinical care.
“By routinely monitoring patients with advanced cancer to assess their symptoms, we can address problems before they become serious or require hospitalization," said Co-Investigator Dr. Michael Pignone, Department of Medicine vice chair of quality and innovation.
Patient-Centered Clinical Effectiveness
Co-PIs Chief Medical Officer for Duke University Health System Dr. Richard P. Shannon and Dr. Thomas LeBlanc, patient experience and safety officer for Duke Cancer Institute and founding director of the Duke Cancer Patient Experience Research Program, will implement findings from a PCORI patient-centered comparative clinical effectiveness study. The study demonstrated improved symptom control, physical function and health-related quality of life. PCORI is a nonprofit organization that funds research on evidence-based information to empower decision making.
DUHS is a participant in PCORI’s Health Systems Implementation Initiative (HSII), a multi-year effort to advance uptake of practice-changing comparative clinical effectiveness research results in care delivery settings, led by Dr. Shannon. HSII aims to reduce the estimated 17-year gap between evidence publication and clinical application.
“The overall goal of this project is to implement a system to collect and respond to information about patients’ symptoms and quality of life, to improve the lives of patients living with cancer and receiving care at Duke Health,” Dr. LeBlanc said. “The collection of symptom and quality of life data enhances our ability to understand patients’ experiences of illness, particularly between clinic visits. Clinical trials show that when we collect and act upon these kinds of data we can significantly improve quality of life, reduce the need for acute care visits (Emergency Department use and hospitalizations), and even improve survival.”
Most cancer centers and health systems have not yet implemented a system to collect and respond to symptom and quality of life data — a challenging task, he added.
“Such an implementation requires new clinical and electronic tools, updates to clinical workflows, and widespread training of team members,” said Dr. LeBlanc. “This PCORI Health Services Implementation Initiative funding provides us with the support to do exactly this, to improve our patients’ lives.”
Duke will reach patients through 44 oncology clinics. A potential pool of 8,500 patients has been identified with 6,500 targeted during the implementation phase, which rolls out to the clinics in two to three-month phases with the remaining sites implemented over a total of four years.
DUHS’s Robust Capabilities
DUHS as an academic research institution with robust capabilities is a strength that factored highly into winning the funding.
With Duke Cancer Institute’s (DCI) history of quality cancer care as a National Cancer Institute-designated cancer center, expanding into electronic patient-reported outcomes is a natural extension of its mission and patient care evolution. DCI’s resources will be utilized to provides multiple patient interaction and outcomes reporting modalities.
In addition, DUHS organizational structures include Duke Clinical and Translational Science Institute and the Cancer Prevention and Control Program at DCI. This, along with Duke’s robust quality management program and CACHE program — which is led by Dr. Pignone and focuses on using data science to identify and eliminate health care disparities — make for an especially well-rounded implementation team, PCORI reviewers noted.
The diverse and complementary expertise of DUHS’s multidisciplinary implementation team with dual PI roles, PCORI reviewers further noted, is also particular strength. The project includes faculty and clinicians from across the School of Medicine and Duke Health, IT staff, and biostatisticians. Drs. Shannon and Pignone's expertise in care delivery innovation and quality improvement provide further support.
Beyond co-PIs LeBlanc and Shannon, these include: Amanda Brucker (Biostatistics), Armando Bedoya (Pulmonary/Critical Care Medicine, DHTS), Ben Goldstein (Biostatistics and Duke AI Health), Catherine Stanton (Emergency Medicine), Emily Norboge (DCI), Joanna Cavalier (Hospital Medicine, DHTS), Kris Herring (DCI Cancer Prevention and Control), Leah Zullig (Population Health; DCI Cancer Prevention and Control), Michael Pignone (Department of Medicine), Michelle Lyn (Community & Family Medicine), Mina Silberberg (Community & Family Medicine), Nrupen Bhavsar (Department of Surgery), Sandra Campo-Manton (DCI), Shelley Rusincovitch (Duke AI Health), and Tarun Saxena (Duke AI Health).
The Duke Digital Strategy Office led by Matt Roman will establish the information technology foundation to enable equitable, sustainable, and reliable symptom data collection and actionability. Dr. Cavalier, associate medical director, will oversee integration with the electronic health record, patient portal, and personal devices while ensuring privacy and data integrity.