Quality of life during electronic patient-reported outcome (ePRO) monitoring in thoracic surgery patients: a pilot randomized controlled trial

PURPOSE: Patients undergoing thoracic surgery experience high symptom burden and negative impacts on postoperative health-related quality of life (HRQOL). Remote symptom monitoring using electronic patient-reported outcomes (ePROs) in other patient populations improves HRQOL but may increase workload for surgical providers. We evaluated the feasibility of ePRO use by thoracic surgery patients and providers as well as its impact on HRQOL. METHODS: In this single center randomized controlled trial, thoracic surgery patients were assigned to either ePROs with alerts to their providers for severe symptoms or ePROs for measurement only, for 90 days after hospital discharge. Primary outcomes were feasibility (measured by patient survey completion) and change in postoperative HRQOL, assessed using the EORTC QLQ-C30 and LC-13 instruments. We also assessed symptom burden, health care utilization during ePRO use, and provider management of alerts. RESULTS: A total of 113 patients planned for thoracic surgery were randomized to ePROs with alerts (n = 56) vs. ePRO measurement (n = 57) only. Of these, 99 participants were discharged from the hospital using postoperative ePROs. More surveys were completed in the alerting arm (61.9% vs. 52.8%, p<0.001, h=0.18). HRQOL at 2 months (social and role function, summary score) was improved in the ePRO with alerts arm, and emotional function at 12 months was improved in the ePRO measurement only arm. CONCLUSION: Remote symptom monitoring using ePROs with alerts is feasible for thoracic surgery patients and providers. Short-term HRQOL may be improved with ePROs with alerts. The downstream impact of ePRO use on long-term HRQOL and other outcomes requires further study. TRIAL REGISTRATION: https://Clinicaltrials.gov NCT04342260.