How Patient-Centered Cancer Symptom Management Can Help Improve Patient Outcomes

At the 2023 Clinical Pathways Congress + Cancer Care Business Exchange, David F. Lobach, MD, PhD, vice president of Health Informatics Research for Elimu Informatics, participated in a panel session titled "Treating the Individual." In this interview, Dr. Lobach provides an overview of the Cancer Symptom Management system as a clinical decision support tool for a patient-centered treatment approach.

Transcript

David F. Lobach, MD, PhD: I am David Lobach. I'm the vice president of Health Informatics Research for Elimu Informatics.

Could you please talk a little about the importance of clinical decision support in managing patient symptoms?

Dr Lobach: Clinical decision support is very important for managing patient symptoms because it enables us to take the things that are known from the research and from clinical practice guidelines and bring those to the point of care in a more streamlined fashion. Without decision support, it takes five years or more for a clinical practice guideline to be integrated into care, but through technology and particularly clinical decision support, we can expedite the delivery of this information to the point of care and thus use the best practices for symptom management.

Why is it important to include the patient's voice in cancer care?

Dr Lobach: Capturing the patient voice in cancer care is critical. The patients are the ones who really understand their situation and they want to be heard. And currently, if there is any symptom management that's being done, it just asks the severity of the symptom, and we really want to know more from the patient. We want to understand the patient's context. What have they tried themselves to manage the care? Do they have any comorbidities or other problems that could affect the type of recommendations we would give for managing the symptom? For example, if a patient has a falls risk, we would recommend supervised exercise instead of just starting an exercise program. So understanding where the patient's coming from, it's just critical and it helps the patients feel more engaged when they get guidance and recommendations that fits their needs. They can see that the system's being responsive to them, and it really helps them feel that they're a part of their own care.

Can you give a brief overview of the Cancer Symptom Management system and how it works?

Dr Lobach: We've had the opportunity to create a system for using evidence into or bringing evidence into the cancer care setting through a project from the National Cancer Institute and this particular system, we have multiple steps. We begin by engaging the patient through a text message, just inviting them to complete a survey, and we specifically contact patients about 24 to 48 hours before an upcoming appointment. Patient receives a message on their smartphone, they can then tap on this link that will take them to a survey. And in that survey we assess the severity of the symptoms. But if someone has moderate or severe severity, we'll then ask them for detailed questions like, tell us more about the characteristics of the symptom. If you're having pain, is it somatic or neuropathic? Because that's going to affect the guidance that's given.

So once we get this information from the patient, the next step is to combine that information with evidence from the patient's medical record, and then using this combination of evidence, we expose it or throw it into a system that has logic that was created by a panel of experts at a leading cancer institution. And this combines the best evidence for managing the symptom, takes into account the patient's information and the EHR information, and then provides recommendations to a clinician at the point of care where they can then act on those recommendations and begin to intervene with evidence-based guidance for managing the symptom, and hopefully that's giving them the best practices that are customized specifically to the needs of that particular patient.

How does patient-centered cancer symptom management differ from standard care and how does it improve patient outcomes?

Dr Lobach: Using patient-centered decision support really brings the patient into the center of the process. I think that's important when compared to the standard of your usual standard of care that's not as patient centered, where it's one size fits all, all the patients get a survey that says, what's the severity of your symptom? And then you know how severe the symptom is, but you don't know anything else about the symptom. You don't know what the patient's already tried or any other factors about the patient that may impact how that symptom should be addressed. So it really takes it to another level. It gets the patient more engaged, makes the patient feel they're part of the process, and they're understood, and then they get a recommendation that fits their needs.

What challenges have you seen in effectively incorporating the voice of the patient into oncology care?

Dr Lobach: Incorporating the voice of the patient in oncology care has been a bit challenging. First of all, we have to be able to engage the patients in a way that's very intuitive because we can't really be there holding their hand when they're providing this information on their phone. So that was an initial challenge we had, particularly around collecting medication information. Another challenge that we encountered is being able to manage this extra information that goes beyond just the symptom severity, but also now includes all these other details, and it's made the logic and the information that's underneath this much more complex because we now have many more variables and many more things to consider when we generate recommendations.