A visualized nurse-led ePRO system for chemotherapy toxicity: Content design and validation

Chemotherapy is a cornerstone treatment for patients with cancer but frequently induces toxicities. Standard text-heavy symptom monitoring tools often induce visual fatigue, compromising treatment adherence, quality of life, and survival.

This study aimed to design and validate the content of a visualized chemotherapy toxicity self-assessment system. The goal was to integrate patient-reported outcomes (PROs) with standardized severity grading and nurse-developed graphic interventions for systematic post-discharge monitoring.

The Chemotherapy Toxicity Self-Assessment Questionnaire (CTSAQ) evaluates 12 chemotherapy-related symptoms using a four-grade severity scale. Symptoms and interventions were identified and refined via a Delphi-based consensus with 11 multidisciplinary experts. Reliability testing included internal consistency and test-retest reliability. Construct validity was examined using an exploratory structure analysis with varimax rotation. Feasibility was assessed in patients with cancer completing weekly CTSAQ reports after discharge.

The CTSAQ demonstrated excellent content validity (S-CVI 0.98), acceptable internal consistency (Cronbach's α = 0.744), and high test-retest reliability (Spearman's ρ = 0.788-1.000) in a clinical cohort (n = 56). Five symptom clusters were identified, psychological, functional, digestive, systemic, and peripheral clusters, explaining 74.13% of the total variance. Weekly completion rates exceeded 90% (mean completion time, 10-12 min).

The CTSAQ is a valid and feasible nurse-led ePRO instrument for post-discharge monitoring. Its visualized guidance is designed to facilitate symptom self-assessment; preliminary feedback suggests it may enhance patients' sense of security and nursing support during home recovery. Future comparative studies are required to formally evaluate its clinical efficacy and user burden.