3441 - Patient-Facing Electronic Medical Record Care Companion for Breast Cancer Patient-Reported Outcomes and Education during Radiation Therapy

S. Teckie^1,2, S. Ansari², S. Smith², Q. Spellen², A. N. Green², and E. C. Nwokedi^2,3; ¹New York University Grossman School of Medicine, New York, NY, ²Kings County Hospital, Brooklyn, NY, ³SUNY Downstate Medical Center, Brooklyn, NY

Purpose/Objective(s): Patient-reported outcome (PRO) collection and intervention improves disease outcomes. In our urban public hospital radiation oncology department, we created a digital “care companion” (CC) program embedded in the health system electronic medical record (EMR) to provide breast cancer (BC) radiation therapy (RT) patient education and collect PRO. We hypothesized that CC would be used by a majority of patients who had activated the mobile EMR app. Materials/

Methods: A multidisciplinary team (physicians, nurses, and information technology) oversaw CC. Because the EMR did not have an existing CC module for RT, we created a first-of-its-kind program using established and validated content. CC included weekly education, PROs at multiple timepoints during and after RT, reminder messages, and videos. Patients were eligible for the program if they had a diagnosis of BC undergoing RT, were English-literate, and had a smartphone. All patients received usual care consisting of paper-based educational materials before RT start. Patients were enrolled in CC through the EMR before the first RT fraction and instructed to download the mobile EMR app. PROs came from two source surveys: 1) National Cancer Institute PRO-CTCAE Custom Survey of 36 questions relevant to BC, and 2) EORTC-QLQ BR23 comprising 23 BC-related items. Patients completed skin reaction and pain scales weekly during RT. Educational materials were “tasked” to patients during and after RT. Reminder messages were sent by email. Nurses also verbally reminded patients about CC during clinic visits. CC ended 90 days after RT. We measured monthly patient Engagement and Task Compliance. “Engagement” is percentage of patients interacting with a task and either skipping or completing it within a specific time window (1 week for PRO surveys, 3 days for other tasks). “Task compliance” is the percentage of a specific assigned educational or PRO task that is completed each month.
Results: A total of 56 BC patients were enrolled in CC from 9/6/2023 to 2/28/2024; 40 completed the program and 16 remain enrolled. Median age was 58 years (range, 29-85). 89% of enrolled patients activated the EMR chart by app or web browser. Engagement was 21.6% on average per month (range, 6 to 38%). Average monthly task compliance ranged from 2% (for PRO-CTCAE) to 6% (for Skin and Pain scales), with monthly high of 19% in January (skin/pain scales). Throughout our hospitals, patient logins to the EMR chart after activating an account remain low at 10-11% monthly.
Conclusion: In our urban public hospital population, a novel patient-facing BC care companion EMR program had low engagement in its first six months, despite most patients activating their EMR chart. Digital interventions suffer from high dropout or disengagement. To improve usage, next steps include demonstrating CC task completion to patients in clinic, changing automatic reminders to be text-based, and surveys to understand patient reasons for disengagement. PROs will be reported after longer follow up.