Perceptions of nursing staffing needs for remote symptom monitoring with patient-reported outcomes before and after program implementation.

Abstract

380 Background: Remote symptom monitoring using electronic patient reported outcomes (ePRO) improves clinical outcomes and saves costs, but oncology clinicians and staff often worry that implementation will increase their workload and require new nursing staffing. We assessed how practices anticipated, experienced, and managed workload changes and staffing needs during ePRO implementation using in-depth interviews and ethnographic assessments among 12 oncology practices through OncoPRO, a national learning collaborative for ePRO implementation facilitated by ASCO. Methods: Semi-structured interviews were conducted with 78 clinicians and staff across 12 OncoPRO academic and community practices nationwide. Transcripts were coded in Dedoose using grounded theory with constant comparison, then organized using the framework method and matrix displays to compare patterns within and across sites. We analyzed recordings from monthly OncoPRO practice stakeholder meetings, which were transcribed and coded in parallel with interview data using the same codebook, with additional deductive coding to classify implementation barriers using Consolidated Framework for Implementation Research (CFIR) and implementation strategies using the Expert Recommendations for Implementing Change (ERIC). Results: Interviewees included medical oncologists, advanced practice providers, nurses (navigators/clinic/infusion/triage), non-clinical navigators, pharmacists, quality staff, and operational leaders. Before implementation, personnel anticipated that ePRO would increase workload, especially for nurses, with concerns focused on alert burden and workflow changes. After implementation, personnel largely reported that workload was “less burdensome than expected” and became “manageable after an early adjustment period.” Whether new staffing was needed depended on ePRO software and practice characteristics. Fewer or no new staff were needed if there was reasonable alert volume, good integration of ePRO software with the electronic medical record, sufficient triage capacity, and strong infrastructure for managing symptoms and side effects. Tactics to make ePRO implementation manageable for existing personnel included phased rollout, piggybacking on existing workflow and processes, clearly delineating roles, standardizing responses to common symptoms, and dynamically adjusting workflow and roles. Conclusions: ePRO implementation did not uniformly require new nursing staff. Clinical personnel concerns are common prior to ePRO implementation but are often mitigated by phased rollout, clear role delineation, and optimizing existing triage and technology infrastructure. Implementation monitoring data can support iterative workflow refinement and right-sizing of staffing during scale-up.