Background
Electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID) is a programme aiming to develop and evaluate an online system for cancer patients to self-report treatment adverse events (AE). The system will allow AE reporting from home/hospital, be integrated into electronic patient records (EPR), generate clinicians’ alerts and provide patient self-management advice.
The development programme aimed to deliver the electronic platform and to review care pathways to explore how eRAPID can be integrated into practice.
Methods
1. A web-based questionnaire system (QTool) was developed. QTool was integrated into the EPR achieving secure and confidential data linkage. Usability tests were performed with 9 patient Research Advisory Group members.
2. To describe existing care-pathways we performed: interviews with health professionals (n=12), chemotherapy patients (n=20), patients acutely admitted with AEs (n=27) and an audit of emergency telephone calls triage-forms (n=180).
Results
1. Ten-to-fifteen toxicity items were uploaded on QTool (see www.erapid.leeds.ac.uk), with automated immediate patient advice. Modifications were made to content/design following usability tests. A secure anonymised interface between QTool and the Leeds-Cancer-Centre EPR (800,000 patients; 2500 users) was developed. The interface underwent 3 iterations of testing to identify errors/usability issues.
2. Interviews with oncology professionals mapped the chemotherapy management/admission pathway and identified training requirements. The audit of patient calls found 40% were 1-7 days post-treatment; common symptoms were pain, nausea/vomiting, temperature/infection, diarrhoea, breathlessness; 48% patients had Grade-1 AE, 14%-Grade-2, 18%-Grade-3; 83% of patients with Grade-3 AE were admitted, whereas 68% with Grade-1 received advice. If half of calls were for Grade-1 AE, and 2/3 didn’t need admission, eRAPID monitoring/advice could reduce this workload and increase the proportion of appropriate calls.
Conclusion
The system is undergoing usability tests in breast cancer patients on chemotherapy. A pilot study in systemic treatment is planned followed by a Randomised-Controlled-Trial to evaluate efficacy and cost-efficiency.