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Integrating real-time patient-reported outcomes in colorectal cancer care: development and evaluation of a concise clinical scorecard.

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Title: Integrating real-time patient-reported outcomes in colorectal cancer care: development and evaluation of a concise clinical scorecard.
Authors: Kanata, Despoina (AUTHOR), Chen, Ling Y. (AUTHOR), Foglia, Ashley (AUTHOR), Bober, Sarah (AUTHOR), Lee, Christina (AUTHOR), Abbass, Mohammad Ali (AUTHOR), Karagkounis, Georgios (AUTHOR), Widmar, Maria (AUTHOR), Wei, Iris H. (AUTHOR), Smith, J. Joshua (AUTHOR), Nash, Garrett M. (AUTHOR), Weiser, Martin R. (AUTHOR), Paty, Philip B. (AUTHOR), Vickers, Andrew J. (AUTHOR), Garcia-Aguilar, Julio (AUTHOR), Pappou, Emmanouil (AUTHOR)
Source: Quality of Life Research. Jun2026, Vol. 35 Issue 6, p1-15. 15p.
Subjects: Patient reported outcome measures, Colorectal cancer, Quality of life, Electronic health records, Cancer treatment, Patient-centered care, Feasibility studies, Functional status
Abstract: Purpose: Patient-reported outcomes (PROs), initially developed for research, are increasingly recognized as valuable in clinical practice to monitor health status, quality of life, and symptoms from the patient perspective. However, few practical, clinician-friendly PRO tools exist for routine oncology care. We aimed to develop a brief electronic "Colorectal Scorecard" grounded in validated PROM content and evaluate its implementation in a high-volume colorectal surgery practice. Methods: A multidisciplinary team co-designed a reduced-item electronic PRO questionnaire covering seven key quality-of-life domains plus a patient-designated priority concern, presented as a one-page color-coded report integrated into the electronic health record (EHR). Included PROM content was drawn from validated instruments (e.g., LARS, CIS, IIEF-5/FSFI domains, ICIQ-UI SF items, EQ-5D-5L/EQ-VAS, EORTC QLQ-CIPN20 items, and a FACT-C work-ability item), with wording simplification guided by patient input. The Scorecard rollout included staff training, patient portal distribution with automated reminders, and in-clinic tablet options. We tracked survey completion rates, drop-off rates, completion times, setting of completion (home portal vs. in-clinic tablet when available), and clinician access/printing when loggable from 2019–2024. Provider and patient feedback were collected through structured informal feedback channels to guide iterative refinements. We compared these data to the prior colorectal PRO report system used from 2013–2019. Results: From 2019 to 2024, approximately 13,400 colorectal patients completed > 19,000 Scorecard surveys as part of routine care. Overall PRO completion more than doubled (from ~ 33% pre-implementation to > 70% post-implementation), with a median survey completion time of 4 min (IQR ~ 3–6) and < 4% in-clinic drop-off. Clinician uptake varied by provider; early adoption was supported by a surgeon "champion" and recurring staff reinforcement. Patient "priority concern" responses changed significantly before vs. after surgery. Preoperatively, patients most commonly prioritized treatment planning (38%) and cancer status (29%), whereas postoperatively priorities more often included cancer status (19%), bowel function (18%), and recovery (17%). Postoperative priorities differed by cancer type: rectal cancer patients were nearly twice as likely as colon cancer patients to prioritize bowel function (21.8% vs. 11.8%) and more frequently selected urinary or sexual function, whereas colon cancer patients more often prioritized cancer status and results/surveillance concerns. Conclusion: Incorporating electronic PROs into a busy colorectal surgery clinic was feasible and sustained over five years. The Colorectal Scorecard's concise format and real-time reporting supported more focused, patient-centered discussions during appointments. Because we evaluated feasibility and implementation process outcomes rather than downstream clinical outcomes, conclusions regarding patient health impact should be reserved for future studies. Ongoing efforts—such as refining the user interface, clearly defining team responsibilities for acting on PROM results, and continuous staff training—are recommended to maintain high clinician uptake. Plain English summary: This study was needed because traditional patient-reported outcome questionnaires are often too long and impractical for use in busy colorectal cancer clinics, even though understanding patients' quality of life and function during and after treatment is essential. The key problem we addressed was how to design and implement a brief, user-friendly tool that could reliably capture patients' quality of life and functional outcomes and their key priorities, and be seamlessly integrated into routine colorectal surgery practice without adding burden to patients or clinicians. We developed a concise electronic "Colorectal Scorecard," covering key quality-of-life and functional domains and including questions about patient priorities, displayed in a one-page, color-coded report integrated into the electronic health record. The Scorecard was implemented with training, automated reminders, and both at-home and in-clinic completion options. Our main results show that approximately 13,400 patients used the Scorecard between 2019 and 2024, with completion rates rising from about 33% to over 70%. The median time to finish was only 4 min, and fewer than 4% of patients who started failed to complete it. We also found that patients' priorities evolve over the treatment journey: before surgery, patients most often emphasized cancer control and treatment planning, while after surgery their priorities shifted toward recovery and functional concerns, particularly bowel function. Postoperative priorities differed by cancer type—rectal cancer patients were nearly twice as likely as colon cancer patients to prioritize bowel function and more often highlighted urinary and sexual function—underscoring the need to align supportive care with patients' changing quality-of-life priorities. Because this project evaluated feasibility and workflow integration, further research is needed to determine whether Scorecard use improves clinical outcomes (e.g., symptom control, satisfaction, utilization). [ABSTRACT FROM AUTHOR]
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Database: Psychology and Behavioral Sciences Collection
Description
Abstract:Purpose: Patient-reported outcomes (PROs), initially developed for research, are increasingly recognized as valuable in clinical practice to monitor health status, quality of life, and symptoms from the patient perspective. However, few practical, clinician-friendly PRO tools exist for routine oncology care. We aimed to develop a brief electronic "Colorectal Scorecard" grounded in validated PROM content and evaluate its implementation in a high-volume colorectal surgery practice. Methods: A multidisciplinary team co-designed a reduced-item electronic PRO questionnaire covering seven key quality-of-life domains plus a patient-designated priority concern, presented as a one-page color-coded report integrated into the electronic health record (EHR). Included PROM content was drawn from validated instruments (e.g., LARS, CIS, IIEF-5/FSFI domains, ICIQ-UI SF items, EQ-5D-5L/EQ-VAS, EORTC QLQ-CIPN20 items, and a FACT-C work-ability item), with wording simplification guided by patient input. The Scorecard rollout included staff training, patient portal distribution with automated reminders, and in-clinic tablet options. We tracked survey completion rates, drop-off rates, completion times, setting of completion (home portal vs. in-clinic tablet when available), and clinician access/printing when loggable from 2019–2024. Provider and patient feedback were collected through structured informal feedback channels to guide iterative refinements. We compared these data to the prior colorectal PRO report system used from 2013–2019. Results: From 2019 to 2024, approximately 13,400 colorectal patients completed > 19,000 Scorecard surveys as part of routine care. Overall PRO completion more than doubled (from ~ 33% pre-implementation to > 70% post-implementation), with a median survey completion time of 4 min (IQR ~ 3–6) and < 4% in-clinic drop-off. Clinician uptake varied by provider; early adoption was supported by a surgeon "champion" and recurring staff reinforcement. Patient "priority concern" responses changed significantly before vs. after surgery. Preoperatively, patients most commonly prioritized treatment planning (38%) and cancer status (29%), whereas postoperatively priorities more often included cancer status (19%), bowel function (18%), and recovery (17%). Postoperative priorities differed by cancer type: rectal cancer patients were nearly twice as likely as colon cancer patients to prioritize bowel function (21.8% vs. 11.8%) and more frequently selected urinary or sexual function, whereas colon cancer patients more often prioritized cancer status and results/surveillance concerns. Conclusion: Incorporating electronic PROs into a busy colorectal surgery clinic was feasible and sustained over five years. The Colorectal Scorecard's concise format and real-time reporting supported more focused, patient-centered discussions during appointments. Because we evaluated feasibility and implementation process outcomes rather than downstream clinical outcomes, conclusions regarding patient health impact should be reserved for future studies. Ongoing efforts—such as refining the user interface, clearly defining team responsibilities for acting on PROM results, and continuous staff training—are recommended to maintain high clinician uptake. Plain English summary: This study was needed because traditional patient-reported outcome questionnaires are often too long and impractical for use in busy colorectal cancer clinics, even though understanding patients' quality of life and function during and after treatment is essential. The key problem we addressed was how to design and implement a brief, user-friendly tool that could reliably capture patients' quality of life and functional outcomes and their key priorities, and be seamlessly integrated into routine colorectal surgery practice without adding burden to patients or clinicians. We developed a concise electronic "Colorectal Scorecard," covering key quality-of-life and functional domains and including questions about patient priorities, displayed in a one-page, color-coded report integrated into the electronic health record. The Scorecard was implemented with training, automated reminders, and both at-home and in-clinic completion options. Our main results show that approximately 13,400 patients used the Scorecard between 2019 and 2024, with completion rates rising from about 33% to over 70%. The median time to finish was only 4 min, and fewer than 4% of patients who started failed to complete it. We also found that patients' priorities evolve over the treatment journey: before surgery, patients most often emphasized cancer control and treatment planning, while after surgery their priorities shifted toward recovery and functional concerns, particularly bowel function. Postoperative priorities differed by cancer type—rectal cancer patients were nearly twice as likely as colon cancer patients to prioritize bowel function and more often highlighted urinary and sexual function—underscoring the need to align supportive care with patients' changing quality-of-life priorities. Because this project evaluated feasibility and workflow integration, further research is needed to determine whether Scorecard use improves clinical outcomes (e.g., symptom control, satisfaction, utilization). [ABSTRACT FROM AUTHOR]
ISSN:09629343
DOI:10.1007/s11136-026-04224-w