Reflection of patient-reported anxiety via ePRO in routine pharmacist documentation during cancer chemotherapy: A...

Electronic patient-reported outcome (ePRO) systems are increasingly used in oncology practice to capture patient-reported symptoms, including psychological distress. However, it remains unclear to what extent anxiety reported via ePRO is reflected in pharmacist documentation.

This retrospective single-center study included patients receiving outpatient chemotherapy who were registered in an ePRO system. We characterized how anxiety reported via ePRO was reflected in routine pharmacist documentation at the patient level within a 28-day observation window. The primary definition of ePRO-reported anxiety was moderate or greater severity (Grade ≥2) reported at least once. The relationship between the two information sources was descriptively characterized using Cohen's kappa coefficient, McNemar's test, matched-pairs odds ratios, and overall, positive, and negative agreement. Sensitivity analyses varied the anxiety severity thresholds and number of reporting days required to define ePRO-positive anxiety.

Among 115 registered patients, 108 submitted at least one ePRO report and were included in the paired analyses. In the primary analysis, Grade ≥2 anxiety was reported via ePRO in 19, whereas anxiety-related pharmacist documentation was identified in 11 patients. Four patients had both Grade ≥2 ePRO-reported anxiety and anxiety-related pharmacist documentation, 15 had Grade ≥2 ePRO-reported anxiety without corresponding pharmacist documentation, and seven had pharmacist documentation without Grade ≥2 ePRO-reported anxiety. The matched-pairs odds ratio was 2.14 (95% CI, 0.82-6.21), with no statistically significant asymmetry (McNemar p = 0.134). Agreement estimates varied according to the severity threshold and number of reporting days used to define ePRO-positive anxiety.

Patient-reported anxiety captured through ePRO monitoring was not always reflected in routine pharmacist documentation during outpatient chemotherapy care. Because pharmacists directly reviewed ePRO data and pharmacist documentation was neither an independent nor a standardized assessment of anxiety, differences between the two information sources should not be interpreted as failure by pharmacists to recognize anxiety. Rather, ePRO and routine pharmacist documentation captured anxiety-related information within different clinical contexts and may provide complementary information for multidisciplinary care.