Upper Digestive Disease App for Electronic Patient-Reported Outcomes: A Mixed Methods Pilot Study.

BACKGROUND: Patient-reported outcomes (PROs) can enable communication of symptoms, function, and quality of life. Mobile devices capture PROs electronically (ePRO). The purpose of this study was to determine the feasibility and acceptability of collecting ePROs in esophagectomy patients using the upper digestive disease application (UDD App). METHODS: A single-group, mixed methods design was used to address the study purposes. A convenience sample of esophagectomy patients was recruited after resumption of an oral diet from January 2020 to December 2020. Demographic characteristics (age, sex) and clinical data (surgical procedure) were obtained after informed consent. Participants used the UDD App for 1 year, followed by scripted telephone interviews. Descriptive statistics and thematic analyses of the interviews were the primary data analyses. RESULTS: Sixty-four patients were enrolled (80% male; 62.9 ± 12 years old). Of these, 50 patients initiated 108 evaluations through the UDD app, with 98% completing the questionnaire on the first attempt, indicating feasibility. A subset of 32 patients participated in the scripted telephone interview. Participants (74%) reported high computer literacy; all reported that using the UDD App was easier than or equivalent to a paper form. Interview themes revealed value of the app for identifying problems and enhanced communication with providers and caregivers, with an overall appreciation for the convenience of remote monitoring but concerns about data privacy. CONCLUSIONS: The UDD App is feasible and acceptable for collecting ePROs in esophagectomy patients. Future work will determine whether the UDD App improves symptoms, function, and quality of life.

Standard setting for a novel esophageal conduit questionnaire: CONDUIT Report Card.

BACKGROUND: The purpose of this study was to establish the clinical thresholds for five domains (dysphagia, reflux, dumping-hypoglycemia, dumping-GI symptoms, pain) to support the use of the CONDUIT questionnaire as a screening tool to identify patients who might benefit from an educational or clinical intervention. METHODS: A panel of 16 experts met to develop descriptions of "poor," "moderate," and "good" conduit performance. They were trained to use the modified and extended Angoff standard-setting method. Each judge provided item ratings that reflected borderline good and borderline moderate patients. The average item ratings were summed and transformed to a 0-100 scale to derive final cut scores. Panelist evaluation of the process and confidence with the rating tasks were collected. RESULTS: Panelists expressed that the training on the method gave them information they needed to complete their assignment. Among other factors, their experience with patients was most influential on their ratings. On the 0-100 score scale, good/moderate cuts ranged from 7.2 to 20.8, and moderate/poor cuts ranged from 37.9 to 64.3, depending on domains and weights. Standard errors of one or both cut scores increased for dysphagia and dumping-GI with weighting. CONCLUSIONS: We described the selection and training of panelists and panelists' evaluations of the processes they were asked to follow in detail to defend the cut scores. Further prospective validation studies are underway to compare cut scores from this study and clinicians' judgments and further refine the categorization.