Impact of an Electronic Patient-Reported Outcome–Informed Clinical Decision Support Tool on Clinical Discussions With Head and Neck Cancer Survivors: Findings From the HN-STAR Randomized Controlled Trial (WF-1805CD)

PURPOSE Post-treatment head and neck cancer (HNC) survivors experience multiple symptoms and behavioral health issues. We developed Head and Neck Survivorship Tool: Assessments and Recommendation (HN-STAR), a clinical decision support tool using electronic patient-reported outcomes (ePROs) to improve follow-up of HNC survivors. METHODS We conducted a cluster-randomized controlled trial of oncology practices in the Wake Forest National Cancer Institute Community Oncology Research Program Research Base comparing HN-STAR to usual care (UC) during a routine clinic visit. Eligible survivors completed treatment for HNC < 2 years before. Before the visit, survivors completed ePROs rating the burden of 26 concerns (symptoms and health behaviors). During the visit, HN-STAR presented survivor's concerns and tailored clinician recommendations. After the visit, survivors reported which concerns were discussed. To evaluate differences in concerns discussed in clinic, concerns were characterized as absent or mild versus burdensome, with comparisons between arms for number of concerns discussed, number of burdensome concerns discussed, and proportion of burdensome concerns discussed, assessed by mixed models adjusted for within-practice correlation. RESULTS Three hundred forty-nine survivors at 28 practices reported a previsit mean of 7.5 burdensome concerns (standard deviation, 4.6), most commonly xerostomia (70%), taste changes (53%), and neck or shoulder stiffness (48%). In adjusted models, survivors in the HN-STAR arm had more burdensome concerns discussed (4.1 v 3.3 concerns, P = .042) and a greater proportion of burdensome concerns discussed (57% v 44%, P = .015) at the visit than survivors in the UC arm. CONCLUSION In a large, national, diverse, and symptomatic sample of HNC survivors at community oncology practices, using an ePRO-informed clinical decision support tool increased the likelihood that burdensome concerns were discussed in clinic. Alerting providers to burdensome concerns and presenting guideline-concordant management options at the point of care may improve provider-survivor interactions.