JMIR Publications

ABSTRACT

Background:

Remote digital symptom monitoring systems (rSMS) have been increasingly utilized in recent years to monitor symptoms, health-related quality of life (HRQL) and other patient reported outcomes in lung cancer. Existing studies demonstrate variability in both study design, type of rSMS, and outcomes for patients and health care systems. There is a lack of synthesized evidence on the similarities and differences among rSMS, including their theoretical underpinnings, key functional components, and reported benefits or limitations. This review aims to synthesize existing research to map current applications of rSMS for patients with lung cancer, with a particular focus on their development and implementation, in order to inform the future implementation of this intervention effectively in future practice.

Objective:

This review aims to identify and synthesize existing research to map the current landscape of rSMS in lung cancer, including theoretical foundations for its development and implementation, types, applications, and outcomes.

Methods:

This scoping review followed the Joanna Briggs Institute Scoping Review Framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The search strategy was developed with the assistance of a librarian for the following keywords: "symptom monitoring", "ePROM" and "lung cancer". A comprehensive literature search was conducted in seven English databases, including PubMed, CINAHL (via EBSCOhost), Cochrane Library, Embase, Scopus, Web of Science, and PsycINFO, as well as three Chinese databases, including CNKI, WanFang, and SinoMed. Data were independently screened and extracted by two reviewers, with any discrepancy being resolved by a third reviewer. A content analysis was performed in order to analyze the qualitative data. The quantitative data were extracted using a standardized form and synthesised descriptively.

Results:

Thirty-six studies were included. Most studies employed a non-theory-driven approach to rSMS development and implementation. Electronic patient-reported outcome measures (ePROMs) were most frequently integrated as core components within various rSMS interventions or as study outcomes. Four functional modules of rSMS applications were identified: data collection, data analysis, response systems (care team responses), and patient education (personalized recommendations). A limited number of qualitative interviews indicated that health care providers (HCPs) and lung cancer patients recognize the effectiveness of rSMS in enhancing symptom monitoring and promoting patient-centered care. However, some HCPs express concerns about its implementation, particularly regarding the reliability of over-dependence on rSMS and its feasibility in populations with limited digital literacy. Similarly, patients also reported burdens such as overly frequent data collection or being too ill to respond to questionnaires. Most studies demonstrated improved symptom outcomes and HRQL in lung cancer patients, although some reported no statistically or clinically significant effects.

Conclusions:

The findings elucidate the clinical insights and common structural components of rSMS in lung cancer symptom monitoring. Despite some studies reporting limitations in rSMS application, its overall use in lung cancer patient populations is highly promising. However, limitations in rSMS research warrant attention, including insufficient qualitative studies exploring user experiences of lung cancer patients and HCPs, as well as a lack of theory-driven research designs and intervention implementation. Future research should address these gaps to enhance the development and implementation of rSMS. Clinical Trial: NA