Patient self-reported follow-up for radiation oncology patients during COVID-19: feasibility and patient-clinician agreement

Abstract

Introduction COVID-19 required health services to be innovative and quickly adapt their health service delivery, including adopting health technology in cancer clinical practice. COVID-19 restrictions forced us to introduce follow-up consultations for many patients via telehealth. At the same time, we adapted an existing Patient Reported Outcome messaging service that linked to the patient’s medical record to allow patients to self-report their health and disease status before their telehealth follow-up consultation. This study aimed to evaluate the feasibility of self-reporting for cancer follow-up care, and determine the patient-clinician level of agreement.

Methods Cross-sectional clinical practice study. Patients on radiation oncology follow-up care were sent a text message with a weblink to a survey to self-report their health before their radiation oncologist appointment. Radiation oncologists completed the same set of questions during or within a day of the telehealth follow-up consultation. Descriptive statistics were analysed to evaluate the uptake of self-reporting. Percent agreement and Cohen’s Kappa were used to determine patient-clinician agreement.

Results A moderate response rate of 62% was achieved from the 145 patients. There was no difference in the age of patients that were able to complete the assessment. Percent agreement between the patient-reported and the clinician-reported for weight change, appetite, physical performance, side effects was acceptable (>75%). However, percent agreement was moderate for pain and sleep. For most items, Cohen’s Kappa indicated moderate agreement, with pain, side effects, and recurrence being fair. Patients were more likely to report themselves worse than the clinician for all items, except for side effects.

Conclusion Patient self-reported health can provide useful information for clinicians to remotely follow-up their patients. This holds promise for future models of follow-up care, particularly for rural and remote patients, and during pandemics and other disasters where clinic attendance is not possible.