Staff Perspectives on Normalizing and Sustaining Electronic Patient-Reported Outcomes Monitoring at Six US Health...

We assessed the perspectives of staff from six health systems to understand how electronic Symptom Management (eSyM), an eSyM program that supports patients during chemotherapy and after surgery, is normalized and sustained.

Starting in 2019, we integrated eSyM into routine clinical practice and assessed its effectiveness using a cluster randomized stepped-wedge trial design. At least 1 year after implementation, we administered cross-sectional surveys to elicit the perspectives of physicians, nurses, advanced practice providers (APPs), hospital administrators, information technology, and research staff using the Normalization MeAsure Development (NoMAD) and the Clinical Sustainability Assessment Tool (CSAT).

Of the 211 staff who initiated the survey, 169 (80%) completed it. Respondents included 64 nurses (38%), 38 physicians (23%), 20 research staff (12%), 17 APPs (10%), 16 administrators (10%), and nine information technologists (5%). The mean NoMAD familiarity score was 5.90 (standard deviation [SD], 3.06) and the mean score for eSyM becoming a part of routine practice was 4.84 (SD, 3.21), scored on a 0-10 scale. Compared with physicians, nurses reported higher familiarity scores and lower NoMAD domain scores for coherence, cognitive participation, and reflexive monitoring. CSAT scores (scored 1-7) demonstrated moderate sustainability (mean 4.52, SD, 1.61), ranging from a mean of 3.28 (SD, 1.48) among APPs to 5.75 (SD, 0.69) among IT staff. Of the CSAT items, engaged staff and leadership and organizational readiness had the highest (mean 4.89, SD, 1.73) and lowest (mean 4.18, SD, 1.73) scores, respectively (P < .05).

Clinical staff reported moderate levels of normalization and capacity for sustainability. Nurses and APPs reported lower levels of sustainability compared with physicians and administrators. Future studies should explore novel workflows and tools that support clinical staff who provide symptom management support.