My Wellness Check, an electronic health record integrated symptom and practical-needs screening and referral system developed at Sylvester Comprehensive Cancer Center, part of UHealth – University of Miami Health System, went live for all Sylvester outpatients and providers on June 1.
Sylvester researchers have been using and studying the My Wellness Check tool in preparation for the system-wide rollout, which will now include not only Sylvester’s ambulatory oncology clinics but also the central Sylvester campus. Ambulatory, or outpatient, clinics are where patients receive care, treatment, and follow-up visits post cancer diagnosis. The cancer center has these satellite offices across South Florida, including specialty clinics for breast oncology, gynecology, hematologic oncology, general oncology, radiation oncology, surgical oncology, surgical reconstruction, survivorship, and supportive care.
My Wellness Check is available in English and Spanish and was developed to assess a broad range of cancer patients’ physical and emotional symptoms, such as pain, fatigue, anxiety, and depression, as well as practical needs including transportation, child care, and financial concerns. The assessment is scored in “real time” within the electronic health record, and patients are triaged to supportive services and/or the medical teams during their visits.
“UHealth is the first health system to incorporate (National Institutes of Health-) NIH-developed and well-validated Patient-Reported Outcomes Measurement Information System (PROMIS) measures in Spanish to evaluate and monitor physical, emotional, and social well-being,” said Frank J. Penedo, Ph.D., Sylvester associate director for cancer survivorship and translational behavioral sciences.
The rollout comes on the heels of research recently published in JCO Oncology Practice, which documented the feasibility of using the screening measures in English and Spanish among racially and ethnically diverse patients.
Feasibility Study Included Spanish Speakers
“Ours was the first large-scale study to evaluate the use of a patient-reported screening system embedded within the electronic health record among Spanish speakers, which have historically been excluded from such initiatives,” Dr. Penedo said.
Dr. Penedo and co-authors at Sylvester implemented the pilot at the UHealth gynecology-oncology ambulatory clinic. Of the more than 1,200 assessments offered to patients from October 2019 to January 2021, 60% were initiated, including more than 65% of the English and about 50% of the Spanish My Wellness Check screenings. Among the 506 completed screenings, more than 50% were Hispanic or Latino. All were women, which the authors wrote may limit the generalizability of these findings to other patient populations.
Responding to Patients’ Needs and Concerns
Most patients completed the 8- to 10-minute screening at home via the patient portal. Patients were most likely to voice nutritional concerns or needs, followed by emotional symptoms, practical needs, and physical symptoms. The appropriate oncology health professional addressed physical symptoms in more than 77% of cases; social work staff responded to emotional symptoms in nearly 100% of cases; and a dietician followed up with patients with nutritional needs in nearly 79% of cases.
These findings are in line with emerging evidence that patient-reported outcomes assessing the spectrum of health and wellness concerns among cancer patients and survivors may facilitate responsive, patient-centered care and improve patient-provider communication, according to Dr. Penedo.
Enhancing Care for Cancer Patients, Survivors
This type of screening is beginning to impact the lives of cancer patients and survivors at cancer centers nationwide. It will inform future efforts about how to improve care with adequate representation from racial and ethnic minorities, and, in the case of Sylvester, among Spanish speakers, according to Dr. Penedo.
“We are currently looking at long-term clinical outcomes, such as emergency room visits, hospitalizations, and how My Wellness Check impacts those outcomes. Those results should be ready for publication soon,” Dr. Penedo said.
Co-authors on the JCO Oncology Practice paper include: Heidy N. Medina M.P.H., a Ph.D. candidate in epidemiology at the Miller School’s Department of Public Health Sciences; Patricia I. Moreno, Ph.D., lead of evidence-based survivorship supportive care at Sylvester; Vandana Sookdeo, M.D., M.B.A., administrative director of survivorship clinical programs at Sylvester; Akina Natori, M.D.; Cody Boland, M.S., psychology graduate student; Matthew P. Schlumbrecht, M.D., medical co-director, survivorship clinical research programs at Sylvester; Carmen Calfa, M.D., medical co-director, survivorship clinical programs at Sylvester; Jessica MacIntyre, APRN, NP-C, AOCNP, director of clinical operations at Sylvester; and Tracy E. Crane, Ph.D., director of lifestyle medicine and digital health at Sylvester.
Published research reveals that participation in ongoing monitoring of physical and emotional symptoms as well as practical needs through Sylvester’s My Wellness Check dramatically improves the care team’s ability to refer the patient to available services. Our research team, who worked with a racially and ethnically diverse group of study participants, showed that these interventions are also associated with fewer emergency room visits and hospitalizations.