LAUSR

Routine use of home-based symptom monitoring and management using electronic patient-reported outcomes (ePRO) to improve care delivery is on the horizon. Randomized clinical trials demonstrate that use of patient-reported symptoms can have marked impact on patient outcomes, including minimizing symptom burden, enhancing quality of life, reducing hospitalizations, increasing time receiving cancer treatments, and, in some studies, improving survival. 1-4 As a result, these powerful tools are now recommended as part of value-based health care initiatives, including the proposed Oncology Care First Model by the Center for Medicare and Medicaid Innovation and the American Society of Clinical Oncology’s Oncology Medical Home Model. 5 One might think that with this evidence, as well as the pressure from professional organizations and payers, that health care systems across the country would rapidly adopt this approach to patient care. However, this is not the case, and few health systems have successfully, fully integrated ePRO. 6 While the lack of adoption of this practice is multifactorial, one key component of the implementation gap is the lack of knowledge about how the intervention itself should be delivered as part of routine care. In the study by Daly and colleagues, 7 the authors begin to tackle an important question of frequency of assessment administration in ePRO. This study used daily symptom assessment in contrast to the weekly schedule that has been used in many of the prior studies. With the daily assessments, patients completed a mean (SD) of 3.9 (2.5) assessments per week in the initial 6 months, but this tapered off over time, falling to 2.7 (2.1) assessments being completed per week after 1 year of enrollment. While Daly et al 7 did not report a goal for completion, this falls well below the 80% to 85% completion rates observed in studies of weekly symptom monitoring and raises questions about the distribution of assessment responses. 8 Additionally, frequent assessments have thepotentialtoleadtosurveyfatigue.Furtherworkisneededtounderstandoptimalfrequencyover the course of illness. For example, the frequency of assessment may be higher initially and taper as