JMIR Publications

ABSTRACT

Background:

Electronic prospective surveillance models (ePSMs) have the potential to improve the detection and management of cancer-related impairments by systematically screening patients using electronic patient-reported outcomes (ePROs) during and after treatment, and linking them to tailored self-management resources and rehabilitation programs. However, their successful implementation into routine care requires careful consideration of patient and provider needs and must align with clinical workflows, which may vary across settings and require adaptation to the local context.

Objective:

To describe the development of REACH, a web-based ePSM designed to screen for common cancer-related impairments and provide tailored rehabilitation resources.

Methods:

The development of REACH followed an integrated knowledge translation (iKT) approach, engaging key knowledge users including patients, clinicians, administrators, and information technology specialists. The development process involved collaboration across five working groups. The system content and logic group selected the impairments to be screened, measures used, frequency of screening, and resources recommended based on results of a survey with oncology providers and researchers, patient feedback, a literature review, and an environmental scan. The machine learning group explored predictive modeling approaches to optimize the assessment frequency using retrospective patient data. The implementation group identified features from existing systems that could be built to promote assessment completion and integration into clinical workflows through a scoping review, interviews with clinic staff, and focus groups with patients. The design group conducted co-design workshops and usability testing with patients to iteratively refine the interface and develop a prototype. Lastly, the development group converted the prototype to a web-based application and conducted privacy and security assessments and quality assurance of the system.

Results:

The integration of key knowledge users through an iKT approach played a critical role in determining the design and functionality of REACH, ensuring it aligned with patient needs, clinical workflows, and implementation considerations. Key system features include a structured process for managing high impairment scores, usability enhancements to improve navigation, and safeguards to ensure data security. REACH allows patients to remotely complete assessments tailored to their cancer type and treatment status on any electronic device. The system generates automated advice based on the assessment responses including educational resources for self-management, suggestions for community programs to register for, and recommendations to contact their oncology team for further assessment and possible referral to rehabilitation services.

Conclusions:

The development of REACH demonstrates how an iKT approach can be used to design an ePSM that is user-friendly, clinically relevant, and aligned with implementation considerations. By integrating best practices for ePRO system design and actively engaging key knowledge users, REACH was designed to support the detection and management of cancer-related impairments. The system has been implemented at four Canadian cancer centres, and its implementation is being evaluated to inform future refinements.