Harnessing the EHR for the Delivery of Supportive Care in an Oncology Setting

Project Summary Symptom management and supportive care are essential to high-quality cancer care and optimal patient outcomes, but many barriers exist to their integration in routine oncology settings. Despite the availability and cost-effectiveness of validated symptom assessment tools, evidence-based supportive care interventions and clinical guidelines, adoption of supportive care using patient-reported outcomes in clinical practice remains low, leaving many patients with poor symptom control, unmet needs, and preventable suffering. Patient-reported outcomes offer one approach to symptom assessment by capturing the unique needs and values of each patient. This strategy is effective in identifying patients' needs, but does not necessarily help oncology providers address and manage these needs in their clinical interactions. Novel approaches are needed to facilitate systematic symptom assessment and management, and guide the appropriate provision of supportive care in real-world oncology settings. To address this critical gap in cancer care, this project will involve the development and pilot testing of a supportive care tool, embedded in the existing electronic health record, that collects patient-reported assessments of symptoms and supportive care needs, using well-established tools, and links these data to a system of evidence-based algorithms for supportive care. Specific aims of this project are: 1) to develop the content, design and technical infrastructure of an EHR-integrated supportive care tool, based on a pre- intervention assessment of stakeholder input and the local context; 2) to implement the EHR-integrated supportive care tool over an [18-month] intervention period in 5 HNCP outpatient clinics, with potential exposure of the tool to more than [300] eligible HNC patients and clinicians; and 3) to evaluate the [feasibility, acceptability, and] initial implementation of the EHR-integrated supportive care tool using a mixed methods approach. Findings from this project will provide the preliminary data to inform the design of a larger pragmatic randomized trial across multiple cancer clinics. The proposed K08 Career Development Award is designed to support the candidate's advanced training in cancer care delivery research, with formal training in the fields of clinical informatics and implementation science, while developing and pilot testing an electronic supportive care tool for use in routine oncology care. These broad goals are consistent with the National Cancer Institute's mission and scientific priorities.