Implementing Remote Symptom Monitoring in U.S. Cancer Care: A Precision, Context-Informed Approach - Remote symptom monitoring (RSM) using electronic patient-reported outcomes (ePROs) during active cancer treatment improves symptom control, quality of life, time on treatment, and hospitalization rates in clinical trials and real-world settings. This prompted the Centers for Medicare and Medicaid Services (CMS) to mandate RSM use in their national value-based care initiative and to recommend implementation nationwide. To support this effort, the Patient-Centered Outcomes Research Institute (PCORI) funded the OncoPRO Initiative (DI-2023C1-31283) to expand RSM to 15+ health systems, guide implementation through a structured learning collaborative, and develop a generalizable toolkit to support future adopters. However, OncoPRO does not currently address how differences across sites, such as in patient populations served, infrastructure, and resource availability, influence RSM implementation and impact. This is a missed opportunity to generate insights that can guide more tailored strategies and support more efficient, effective scale-up. Early evidence shows wide variation in engagement, reporting, and barriers across settings, creating inconsistent outcomes and underscoring the need for context-sensitive guidance. This proposal leverages the national OncoPRO dataset to identify site- and patient-level variation in engagement, barrier experience, and implementation strategy use, and translate that knowledge into actionable guidance for novice clinical teams. In Aim 1, we will use latent class analysis and geospatial methods to derive patient engagement profiles and assess their geographic and contextual distribution. In Aim 2, we will use methods from cognitive anthropology (cultural consensus and residual agreement analysis) to model site-level variation in barriers and strategies and assess their relationship to implementation outcomes such as reach, adoption, and effectiveness. These findings will be used to develop an excel-based Precision Implementation Module (PIM) in Aim 3, consisting of a Practice- Context Mapping Tool and a Barrier Forecast and Strategy Menu that will support more tailored, site-led implementation planning using information that teams already know or can easily obtain. We will then refine the PIM through iterative interviews and focus groups with OncoPRO participants and prospectively pilot test it with 3-5 novice OncoPRO sites to evaluate its feasibility, acceptability, and appropriateness. This project builds on my foundation in anthropology and qualitative methods while supporting new training in large database analysis, implementation science, and pragmatic trial design. It will generate a scalable, context-sensitive resource to support tailored RSM implementation and lay the foundation for a future R01 evaluating the added value of precision implementation to traditional facilitation. This award will launch a rigorous, stakeholder- informed research program focused on improving how innovations are adapted and delivered across diverse cancer care settings. By bridging real-world needs with methodological precision, this work will help ensure that interventions like RSM are not only effective but feasible and impactful wherever patients receive care.
