Monitoring electronic patient reported outcomes (ePROs) during cancer treatment: protocol for a phased implementation of an ePRO system across seventeen cancer care sites within an integrated healthcare system

Advances in cancer treatment have improved patient survival, but treatment-related toxicities commonly impair patient quality of life and contribute to emergency department visits and hospitalizations. Electronic patient-reported outcomes (ePRO) systems have demonstrated benefits for symptom control, quality of life, and reduced acute healthcare utilization. However, evidence of large-scale implementation within routine oncology care remains limited. We describe a protocol to implement, track adaptations, and evaluate a system-wide ePRO program across 17 diverse oncology settings. This single-arm, phased implementation initiative, supported through the Patient-Centered Outcomes Research Institute (PCORI) Health Systems Implementation Initiative, aims to implement an ePRO program across 17 oncology sites, including an academic medical center and community oncology practices. The project includes a one-year planning phase, two-year implementation period, and a maintenance phase. All adults age 21 + initiating a new non-hormonal systemic cancer treatment will receive weekly symptom surveys via text message and/or email for six months, with a pivot to interactive voice response if three consecutive weeks are not completed. Symptoms identified as warranting clinical attention will be sent to oncology care teams, who will respond within two business days. Evaluation is framed by the Reach, Effectiveness (healthcare utilization with propensity-score-matched controls), Adoption, Implementation, and Maintenance (RE-AIM) Framework. Implementation strategies and adaptations will be documented in a modified FRAME-IS tracker. We will track adaptations in implementation of an Evidence-Based ePRO intervention within a large, mid-Atlantic healthcare system. Anticipated challenges include a pending electronic health record transition, workforce turnover, and sustained engagement among clinical teams. We will give special consideration to implementation strategies to track our implementation decisions and outcomes. Findings will contribute to implementation science by identifying pragmatic strategies for scaling and sustaining ePRO programs in cancer care and may contribute to the broader adoption of symptom monitoring interventions in clinical practice.