Challenges in the implementation of electronic systems for patient report of symptoms in oncology: a scoping review

Under-recognition and under-treatment of symptoms are prevalent throughout the health care system in the United States. While the reasons for this are complex, it is widely recognized that electronic symptom reports can improve clinicians' ability to manage symptoms. However, electronic symptom reporting has yet to be widely implemented. Electronic systems are most effective when tailored to the specific patient population or clinical setting. For example, numerous oncology-focused electronic symptom reporting systems have been developed for patients with cancer undergoing treatment in the United States. The objective of this scoping review was to identify challenges that arose in the implementation of electronic systems for patient-reported symptoms in oncology clinical practice, and approaches that were taken or recommended to overcome those challenges.

This scoping review involved comprehensive searches of Medline, CINAHL, and the Cochrane Central Register of Controlled Trials, which yielded 3,133 articles. Following screening, 20 research studies met the inclusion criteria and were included in this review. Data were systematically extracted from the articles using a qualitative content analysis.

Challenges identified were thematically categorized as technical issues, system usability issues, patient lack of comfort/knowledge of technology, incomplete/missing data, lack of patient use of the system, other patient issues, difficulties timing completion with clinical processes, lack of clinic staff involvement/engagement, and lack of clinician comfort/knowledge regarding the use of patient-reported outcome data.

The findings of this review highlight challenges that need to be addressed when implementing an electronic symptom reporting system for patients with cancer, and potential strategies for overcoming these challenges. This review may help hospital administrators and clinicians prepare for and improve the implementation of electronic symptom reporting systems into clinical practice, thereby providing evidence to enable their broader use.