A Text Message Intervention to Minimize the Time Burden of Cancer Care

Area of Science:

• Oncology
• Health Services Research
• Digital Health

Background:

• Cancer patients experience significant time burdens related to healthcare appointments.
• Electronic patient-reported outcomes are used for toxicity monitoring but not yet for streamlining care delivery.
• Minimizing 'time toxicity' is crucial for improving the patient experience in ambulatory cancer care.

Purpose of the Study:

• To assess the effectiveness and implementation of text message-based symptom reporting electronic triage (e-triage) versus usual care.
• To determine if e-triage can minimize the time toxicity associated with ambulatory cancer care.
• To evaluate the feasibility and acceptability of e-triage among oncologists.

Main Methods:

• A hybrid type 1 effectiveness-implementation, unblinded, randomized controlled trial with sequential mixed-methods.
• Adult patients with solid tumors receiving single-agent immune checkpoint inhibitors (ICIs) were enrolled.
• The intervention involved text message-based symptom reporting for e-triage, allowing eligible patients to bypass pre-treatment office visits.

Main Results:

• The e-triage group experienced an average reduction of 66.0 minutes in total time per ambulatory encounter (P=0.03).
• Wait times were also reduced in the e-triage group, though not statistically significant (P=0.08).
• Oncologists found the e-triage system acceptable, appropriate, and feasible, despite identifying barriers like patient identification and reimbursement concerns.

Conclusions:

• Text message-based e-triage shows promise in reducing the time burden for cancer patients undergoing ambulatory care.
• The findings support further investigation into e-triage as a strategy to safely assess treatment readiness and minimize time toxicity.
• Implementation readiness among oncologists is positive, but identified barriers require attention for wider adoption.