ONS Connect - July 2008 - (Page 21)

sessments; a sample of four oncologists and four oncology nurses also was surveyed to determine healthcare providers’ opinions of the system. At each time point, patients used a stylus on a touch-screen tablet computer to answer questions about their symptoms. Questions were taken from standardized symptom assessment instruments and asked patients about pain; fatigue; depression, anxiety, and emotional distress; and sleep quality. After a patient completed the assessment, two summary printouts were generated: one for the patient and the second for the patient’s chart. Ease of Use and Satisfaction with the System The researchers observed patients as they completed the computer assessment and used a checklist to record the number and type of patients’ requests for help with the system. The computer system recorded the time it took patients to complete it. The most frequent problems patients requested help with were understanding how to use the stylus and learning how to advance to the next screen of questions. Patients’ requests for help and session completion times decreased significantly over the three time periods as they became more familiar with the system. Patients also were surveyed after completing the assessment at times 1 and 3. Satisfaction increased slightly from time 1 to time 3; at both points, more than 80% indicated that they liked using the computer, it was easy to use, and they would recommend the system to other patients with cancer. About half of the respondents said that the system made it easier for them to discuss their symptoms with their doctors. Providers responded to a questionnaire asking how the system fit into clinic flow, patient visits, and discussion of various symptoms. They also participated in focus groups, where they could offer general feedback and suggestions for improving the system. All of the providers said that the system was positively received by patients and that patients had about the same number of symptom-related questions. Sixty-two percent said that the system did not disrupt clinic flow or increase the length of patient visits. Providers believed that symptom management was improved because of the system, ranging from 37% for pain management to 87% for depression. Chart documentation either improved or stayed the same after use of the system, depending on the symptom recorded. See Figure 1 for the providers’ other comments about the system. implications for Nursing Carpenter et al. (2008) listed factors for nurses to keep in mind when considering the implementation of a computerized symptom assessment system. Although the system facilitates the reporting and documentation of patient symptoms, only half of the respondents said that it eased discussion of the symptoms with their healthcare providers. Therefore, oncology nurses may need to promote communication between patients and providers or offer education on communicating symptoms to providers. For complete information on the computerized symptom assessment system, refer to the full article by Carpenter et al. (2008). ✱ Carpenter, J.S., Rawl, S., Porter, J., Schmidt, K., Tornatta, J., Ojewole, F., et al. (2008). Oncology outpatient and provider responses to a computerized symptom assessment system. Oncology Nursing Forum, 35(4), 661–669. Figure 1. Provider comments About the computerized symptom Assessment system Usability • Pros: Computer-savvy patients are able to use it, clinic flow is not disrupted, and patients feel that their providers are more aware of their symptoms. • Cons: The printout is difficult to use or interpret, it is not a substitute for patient history or physical, it replicated other assessments the clinic already completed, and the system may not make a difference in patients who do not verbally report symptoms. • Suggested changes: Include additional symptoms, ask patients whether they want or need an intervention for a particular symptom, and allow more time in the clinic schedule for patients to complete the system. Impact • Positive: Providers are more aware of symptoms, particularly ones they do not assess regularly; patients begin thinking about their symptoms before they meet with providers; and providers are able to focus on symptoms that are particularly important or troublesome to a patient. • Negative: Some of the providers reported that they are more comfortable using other paperbased systems that are already in place. Note. Based on information from Carpenter et al., 2008. July 2008 ONS CONNECT 21

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ONS Connect - July 2008 Contents Editor's Note Just In Technologic Advancements in Cancer Care A Year in the Life - Month Seven Web Connect Capitol Connection Notice Nursing Now Caregiver Care Computerized System Standardizes Symptom Assessment and Management Nanotechnology Treats Cancer at the Atomic Level Rise in Mastectomies May Be Linked to Increased Use of MRI Detection Working for You Calendar of Events Staying on Top

ONS Connect - July 2008

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