Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Patient-reported outcome measures (PROMs) are vital for understanding patient perspectives in cancer care, but their real-world application is often hindered by low completion rates. Reminders have proven effective in enhancing survey and PROM completion rates in different clinical settings. This mixed methods study aims to evaluate the feasibility of implementing reminders for PROMs among patients with head and neck cancer (HNC) and to explore patient perceptions regarding PROMs and the utility of reminders.
Methods: This prospective pilot study examined the feasibility of telephone and Short Message Service (SMS) reminders for completing PROMs among individuals treated for HNC at Henry Ford Cancer (between 7/1/23-1/31/24). Utilizing a factorial design, participants were randomly assigned to one of four groups: control, SMS only, phone only, or combined reminders. SMS reminders were sent three days before appointments, while phone reminders were made using hospital-associated phone numbers, 24 hours prior to appointments if PROMs had not been completed. After completion of the pilot, three virtual focus groups (FGs) were conducted to better understand patient experiences. Patients with HNC were recruited using email and phone and were compensated for their time. To ensure a representative sample, we oversampled non-white participants. The FG guide was based on the Technology Acceptance Model and Health Equity Integration Framework. Content analysis was conducted on FG transcripts to identify key themes.
Results: Reminders were assessed in four groups: 14 control-, 15 SMS-, 15 phone-, and 14- hybrid-based reminder groups, with a mean age of 68.2 years (71.4% male, 63.6% white, 21.8% black). PROMs completion rates were 25% for the control group, 31% for the phone group, 17% for the SMS group, and 20% for the hybrid group (p=0.29). Three patients in the hybrid group were unreachable by phone, while eight in the phone group received only voicemails. In the FGs, most participants preferred completing PROMs before clinic visits but were often unclear about PROMs’ purpose; technology was a significant potential barrier. While some patients were hesitant to answer sensitive questions about depression, one participant noted that electronic completion facilitated the disclosure of sensitive issues, reducing the pressure of discussing these topics during in-person visits. FGs indicated that the MyChart mobile application and email notifications (standard reminders in Control group) enhanced completion rates. Participants favored SMS and email reminders, particularly when aligned with appointment notifications, while phone calls were least preferred. Many expressed a desire for customizable reminders, ideally sent 2-3 days before visits, and indicated no need for reminders if they had already completed their PROMs. Overall, patients preferred using MyChart to complete PROMs over separate third-party applications and requested more educational materials about PROMs, highlighting the importance of discussing their responses during consultations.
Conclusions: The implementation of reminders for facilitating routine clinical PROMs completion is feasible in a HNC setting. Patients preferred completing PROMs via the patient portal rather than in-clinic or through third-party applications, with SMS and email reminders the most favored notification methods.