Implementing an EHR-Integrated Symptom and Needs Screening and Referral System for Spanish-Speaking Oncology Patients

Researchers developed an assessment tool called “My Wellness Check,” to assess the feasibility of using an electronic health record (EHR)-integrated system to identify symptoms and needs of Spanish-speaking patients with cancer through reports made directly by patients (JCO Oncol Pract. 2022; doi:10.1200/OP.21.00706). 

“Historically, non-English-speaking populations have been excluded from such initiatives, given the lack of availability of Spanish-translated measures,” wrote Frank Penedo, PhD, Cancer Survivorship Program, Miami, FL, and colleagues. “Our study is the first to demonstrate uptake of patient-reported outcomes screening initiatives among Spanish speakers, thereby informing future efforts to reach racial/ethnic minority populations.”

Because cancer patients’ psychosocial needs and practical concerns are typically not addressed sufficiently, particularly among U.S. Hispanic/Latino populations, the National Comprehensive Cancer Center Network has established standards for screening for and managing these needs and concerns. To meet these standards, My Wellness Check was designed to screen ambulatory patients before health care appointments by assigning an online assessment for them to complete at each appointment starting at the second clinic visit, but not more than once during a 30-day period. 

Approximately one-quarter of the patient population being served was predominantly Spanish-speaking. Therefore, assessments were made available in both English and Spanish, and patients were allowed to select the language they preferred. 

Results of the assessment were then used to alert the care team to symptom exacerbations, unmet nutritional needs, and barriers to care such as a lack of transportation or childcare so that patients could be directed to appropriate support services that addressed these challenges. 

The researchers evaluated the feasibility and acceptability of the system by measuring the rate of assessment initiation among patients stratified by the language of the assigned assessment (English or Spanish). Data were collected from October 2019 to January 2021.

These evaluations revealed that 739 (60%) of the 1232 screening assessments assigned to patients were started, and 506 patients started an assessment. The breakdown by language for beginning an assigned assessment was 65% for assessments in English and 50% for those in Spanish. Most assessments (85%) were completed online at home through the My Chart patient portal. 

The lower rates of assessment initiation and completion noted among Spanish speakers suggest “targeted efforts are needed to increase engagement among this population,” the researchers wrote.

The challenges most commonly reported through the system were nutritional needs (33%), emotional symptoms such as anxiety or depression (28%), practical needs (eg[JB5] , financial) (22%), and physical symptoms (18%). In response, 77% of physical symptom reports were addressed by an oncology health professional, nearly all the social work alerts (99.7%) were addressed by a social work team member, and 79% of the nutrition alerts were addressed by a dietitian.

“The results demonstrate encouraging feasibility and initial acceptability of implementing and EHR-integrated symptom and needs screening and referral system among diverse oncology patients,” the researchers concluded.