How remote symptom monitoring works in routine oncology care: process mapping with a cultural-models lens

Remote symptom monitoring (RSM) improves outcomes during cancer treatment, but sustained program functioning requires coordination across clinical roles to optimize patient experience. Existing implementation tools provide building blocks for patient-reported data systems, but detailed approaches for clinical operation of RSM are lacking in oncology. We conducted a multi-method study at an NCI-designated comprehensive cancer center implementing RSM. Using ethnographic observation, process mapping, and semi-structured interviews with 25 healthcare professionals and 20 patients, we examined RSM workflows and experiences. A process map anchored interviews to elicit descriptions of who does what, when, how, and why. Applying a cultural-models lens, we analyzed responses using freelist logic and constant comparison across four subprocesses: screening, enrollment, survey, and intervention. Five cultural components of the RSM process emerged: ownership, mechanism, timing, auditing, and challenges. Screening placed ownership with non-clinical navigators and exposed communication gaps related to eligible patient identification. Enrollment depended on clinician endorsement, navigator-led logistics, and outreach near treatment start. Survey completion relied on brief weekly instruments aligned to treatment rhythms with navigator oversight. Symptom intervention centered on nurse-led triage and clear alert closure expectations. Multi-disciplinary team discussion yielded 12 suggestions anchored in these components. Pairing process mapping with a cultural-models approach clarifies the shared expectations that sustain RSM in routine care. This helps diagnose coordination needs, guide role-specific training, support local adaptation, and ensure patient experience is optimized.