ABCpro - symptom management in advanced breast cancer
ABCpro is a nurse-led telehealth symptom management programme, integrating a PROMs survey with clinical decision support (CDS), to improve symptom management and quality of life for advanced breast cancer patients. The aim is also to reduce unscheduled hospital care for these patients.
The ABCpro tool / service was developed by Breast Cancer Foundation NZ and is currently being piloted at Waikato DHB. Using an automated data extract from the hospital patient management system, patients are sent a weekly survey link via email or text message. They are invited to answer validated PROMs questions about disease symptoms and treatment side effects. Symptom(s) that exceed thresholds for concern trigger an automated email alert to a clinical nurse specialist, along with real-time, guideline-based CDS recommendations. CDS recommendations are customised based on patient disease status, cancer medications, comorbidities and comorbidity meds. The nurse provides telehealth support to the patient; this can be self-management advice, referral to support services or oncology, etc.
Patients benefit from proactive, timely symptom management in between their three-monthly clinic visits, reducing inequities for those who struggle to access the healthcare system. When they do come to the clinic, the oncology team can view their symptom history on the ABCpro dashboard, helping to make appointments more effective. Aggregate data for all patients can be analysed using filters such as ethnicity, age, medication etc. This can be used to audit individual clinicians’ practice, to provide real-world evidence about side effects for a medication, and to compare symptom experience in different patient groups.
ABCpro uses two cloud-based platforms, Cemplicity patient surveys and Cambio electronic clinical decision support. While Breast Cancer Foundation funded the integration of these platforms, our IP is limited to our symptom survey and guidelines. The integrated technology platform is available for and suited to use in any cancer stream, or any chronic condition. This is a relatively low-cost service, and we encourage others to consider it when looking to integrate PROMs and/or telehealth into clinical practice. The integrated CDS helps reduce variation in care and potentially allows the service to be delivered in primary care, hauora, etc.
The effectiveness of ABCpro is currently being evaluated in a pre-post cohort study, which is underway at Waikato DHB and seeking to enrol three additional sites. The study principal investigator is Dr Marion Kuper.