Patient Perspectives on Technological Barriers and Implementation Strategies Leveraged During a Real-World Remote Symptom Monitoring Program.

Abstract

Remote symptom monitoring (RSM) using electronic patient-reported outcomes leverages digital technologies to gather real-time information on patient experiences for symptom management. This study reports a formative evaluation of technology-related barriers encountered by patients participating in RSM and implementation strategies used to address those barriers in real-world, large-scale RSM implementations. Purposive sampling was conducted to recruit patients diagnosed with cancer and participating in RSM at the University of Alabama at Birmingham and USA Health Mitchell Cancer Institute for semi-structured interviews. Interviews were coded to identify technology-related barriers using a constant comparative method. Expert Recommendations for Implementing Change list was used to address the barriers to optimize RSM implementation. Barrier-associated themes from the interviews were mapped to implementation strategies. Forty participants age 24-77 years, half of whom were 60 years or older, were interviewed from December 2021 to February 2024. Three barrier themes relevant to technology utilization in RSM were identified: (1) <i>accessibility concerns</i>, (2) <i>digital health literacy</i>, and (3) <i>user interface challenges</i>. Themes were mapped to the implementation strategies as identified by the implementation team. Eight total implementation strategies were used to address these technology barriers: (1) assess for readiness and identify barriers and facilitators, (2) obtain and use patients/consumers and family/caregiver feedback, (3) involve patients/consumers and family members/caregivers, (4) access new funding, (5) change physical structure and equipment, (6) centralize technical assistance, (7) prepare patients/consumers to be active participants, and (8) intervene with patients/consumers to enhance uptake and adherence. Technology-related barriers may limit the uptake of RSM by patients. Addressing these barriers through multimodel assessment and intervention strategies is crucial to ensuring successful implementation of RSM in real-world settings.