The impact of real-time patient reported outcome measures on emergency department presentations and overall survival in people with gynaecological cancer.

Abstract

Introduction We assessed the impact of real-time PROMs prior to outpatient gynaecological cancer consultations on Emergency Department (ED) presentations and overall survival (OS), and explored PROMs data predictive of subsequent unplanned presentations. Methods Patients with gynaecological cancer were invited to complete the EQ-5D-5L, ESAS-R and the SCNS-SF prior to scheduled appointments, on waiting room iPads (December 2019-March 2020) or remotely online (October 2020-April 2021). Clinical characteristics, ED presentations and OS were extracted from medical records and compared between participants and non-participants. Results 334 consultations (99 in-person; 235 telehealth) with 104 patients [mean age 61; 49% treated with palliative intent] were included. PROMs participation was 50%, with no significant difference by consultation mode. People speaking a language other than English had lower participation (28% vs 57%, p=0.01), but age, stage, primary site, treatment intent (curative vs palliative) and treatment received were comparable between groups. ED presentations occurred within 30 days of 7.6% of participating consultations vs 13.5% non-participating (p=0.10). Participants presenting to ED had higher mean ESAS scores at the preceding appointment for nausea (3.4 vs 1.0), poor appetite (3.6 vs 1.8) and dyspnoea (4.5 vs 1.8), and lower EQ-5D-VAS scores (58.3 vs 83.8), all p<0.05. Median OS was not reached for participants vs 37.6 months for non-participants (p=0.06). PROMs participation (p=0.008), age (p=0.030) and treatment intent (p<0.001) were associated with OS. Conclusion/Implications Completing PROMs prior to outpatient consultations was associated with trends to fewer ED presentations and overall survival. Targeted interventions to support participation among people who speak a language other than English are required. (Figure Presented).