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

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Electronic Symptom Management (eSyM) shows moderate normalization and sustainability among clinical staff. Nurses and APPs reported lower sustainability, highlighting a need for improved workflows and tools to support symptom management.

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Area of Science:

  • Health Informatics
  • Clinical Practice Improvement
  • Patient Symptom Management

Background:

  • Electronic Symptom Management (eSyM) programs are increasingly integrated into healthcare systems to support patients undergoing chemotherapy and post-surgery.
  • Assessing the normalization and sustainability of such digital health tools is crucial for their long-term success and impact on clinical practice.

Purpose of the Study:

  • To evaluate the perspectives of healthcare staff on the normalization and sustainability of an electronic Symptom Management (eSyM) program.
  • To identify factors influencing the integration of eSyM into routine clinical workflows across different healthcare roles.

Main Methods:

  • A cluster randomized stepped-wedge trial design was employed to integrate eSyM into clinical practice.
  • Cross-sectional surveys using the Normalization MeAsure Development (NoMAD) and Clinical Sustainability Assessment Tool (CSAT) were administered to diverse healthcare staff (physicians, nurses, APPs, administrators, IT, research).

Main Results:

  • A total of 169 out of 211 (80%) staff completed the survey, reporting moderate familiarity (mean 5.90/10) and integration (mean 4.84/10) of eSyM.
  • Nurses reported higher familiarity but lower scores in coherence, cognitive participation, and reflexive monitoring compared to physicians.
  • Overall moderate sustainability (mean 4.52/7) was observed, with significant variations across roles (e.g., lower for APPs, higher for IT staff).

Conclusions:

  • Clinical staff perceive eSyM as moderately normalized and sustainable, though with role-specific differences.
  • Lower sustainability scores among nurses and Advanced Practice Providers (APPs) suggest a need for targeted support.
  • Future research should focus on developing innovative workflows and tools to enhance clinical staff support in symptom management.