“More feet on the ground”: When non-clinical staff are needed for ePRO-enabled remote symptom monitoring implementation.

Abstract

437 Background: Remote symptom monitoring (RSM) using electronic patient-reported outcomes (ePROs) improves clinical outcomes and saves costs, but successful implementation also depends on patient understanding, enrollment, and sustained engagement. Practices must determine who will introduce ePROs to patients, support enrollment, troubleshoot access barriers, and reinforce survey completion. We assessed non-clinical staffing needs during RSM implementation across 12 practices participating in OncoPRO, a national learning collaborative facilitated by ASCO. Methods: We conducted semi-structured interviews with 78 clinicians and staff across 12 OncoPRO academic and community practices nationwide. Transcripts were coded in Dedoose using grounded theory with constant comparison, organized using the framework method and matrix displays, and analyzed with monthly meeting transcripts. Learning collaborative meeting transcripts were coded for implementation barriers using Consolidated Framework for Implementation Research (CFIR) and strategies using Expert Recommendations for Implementing Change (ERIC). Results: Interviewees included medical oncologists, advanced practice providers, nurses, navigators, patient-facing non-clinical navigators or outreach staff, pharmacists, quality staff, and operational leaders. Across practices, clinicians and staff anticipated that ePRO implementation would require patient-facing work beyond clinical alert response, including education, enrollment, technology support, outreach, and survey reinforcement. After implementation, sites found that the intensity of patient-facing support they could provide depended on baseline assets, including established navigation programs, available outreach personnel, and existing patient education infrastructure. Sites with these assets more easily assigned ePRO education, enrollment, and follow-up to navigators or outreach coordinators with protected time. Other sites made implementation manageable by starting small, using passive education or existing patient touchpoints, and using early implementation experience to refine responsibilities or justify additional support. As one participant explained, adding a navigator produced “a big jump” in enrollment and helped show hospital administration, “this is worthwhile...to hire someone for this to be their job.” Sites also described needing “more feet on the ground” as programs expanded across clinics and satellite locations. Conclusions: Non-clinical staffing concerns for RSM implementation can be addressed by aligning patient-facing work with existing navigation, outreach, and education infrastructure. Starting small and using early implementation metrics can help practices refine responsibilities, demonstrate value, and right-size personnel support as ePRO programs scale.