ePRO-based individual follow-up care for women treated for early breast cancer: impact on service use and workflows

Abstract

The increasing population of breast cancer survivors highlights the need to (re)consider how we utilize available services for survivorship care in oncology clinics. Electronic Patient-Reported Outcomes (ePROs) can be used to identify patients’ individual care needs and triage them to the right services. We examined the impact on service use, workflow and workload following the introduction of an ePRO-based individual follow-up (PIFU) for women treated for early breast cancer. A multi-method approach was used. In a pilot randomized controlled trial, the use of consultations, telephone calls, and specialist referrals were systematically recorded. Comparison was done between PIFU and standard follow-up care (SFU). Focus group interviews with nurse navigators evaluated the impact on workflow and workload qualitatively. The 64 women randomized to attend SFU used a mean of 3.8 (95% CI: 3.5–4.1) planned consultations during the 2-year study period compared with a mean of 1.9 consultations (95% CI: 1.4–2.4) for the 60 women randomized to PIFU (P\u2009<\u20090.001). Urgent appointments were more frequent in SFU (mean of 0.47 vs 0.22 per patient, P\u2009=\u20090.03). No statistically significant differences were observed in the use of telephone calls and specialist referrals. The nurse navigators did not experience an increase in their workload, but implementation of PIFU may require a re-structured workflow. The ePRO-based individual follow-up could change organization of care and re-allocate services for those in need of it. ePRO-based individual follow-up could potentially ensure more time for those most in need of face-to-face care.