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Open Access Highly Accessed Research article

The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial

Donna L Berry12*, Fangxin Hong3, Barbara Halpenny2, Anne Partridge4, Erica Fox2, Jesse R Fann56, Seth Wolpin1, William B Lober1, Nigel Bush7, Upendra Parvathaneni8, Dagmar Amtmann9 and Rosemary Ford6

Author Affiliations

1 Department of Biobehavioral Nursing and Health Systems, University of Washington, Box 357366, Seattle, WA 98195-7366, USA

2 Phyllis F. Cantor Center, Dana-Farber Cancer Institute, 450 Brookline Ave, LW 518, Boston, MA 02215, USA

3 Biostatistics & Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA

4 Dana-Farber Cancer Institute, Department of Medicine, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215, USA

5 Department of Psychiatry, University of Washington Medical Center, Seattle, WA 98195, USA

6 Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109, USA

7 U.S. Department of Defense, Joint Base Lewis-McChord, National Center for Telehealth and Technology, Tacoma, Washington, USA

8 Radiation Oncology, University of Washington Medical Center, Seattle, WA 98195, USA

9 Department of Rehabilitation Medicine, University of Washington Seattle, Box 354237, Seattle, WA 98195-4237, USA

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BMC Cancer 2014, 14:513  doi:10.1186/1471-2407-14-513

Published: 12 July 2014



The electronic self report assessment - cancer (ESRA-C), has been shown to reduce symptom distress during cancer therapy The purpose of this analysis was to evaluate aspects of how the ESRA-C intervention may have resulted in lower symptom distress (SD).


Patients at two cancer centers were randomized to ESRA-C assessment only (control) or the Web-based ESRA-C intervention delivered to patients’ homes or to a tablet in clinic. The intervention allowed patients to self-monitor symptom and quality of life (SxQOL) between visits, receive self-care education and coaching to report SxQOL to clinicians. Summaries of assessments were delivered to clinicians in both groups. Audio-recordings of clinic visits made 6 weeks after treatment initiation were coded for discussions of 26 SxQOL issues, focusing on patients’/caregivers’ coached verbal reports of SxQOL severity, pattern, alleviating/aggravating factors and requests for help. Among issues identified as problematic, two measures were defined for each patient: the percent SxQOL reported that included a coached statement, and an index of verbalized coached statements per SxQOL. The Wilcoxon rank test was used to compare measures between groups. Clinician responses to problematic SxQOL were compared. A mediation analysis was conducted, exploring the effect of verbal reports on SD outcomes.


517 (256 intervention) clinic visits were audio-recorded. General discussion of problematic SxQOL was similar in both groups. Control group patients reported a median 75% of problematic SxQOL using any specific coached statement compared to a median 85% in the intervention group (p = .0009). The median report index of coached statements was 0.25 for the control group and 0.31 for the intervention group (p = 0.008). Fatigue, pain and physical function issues were reported significantly more often in the intervention group (all p < .05). Clinicians' verbalized responses did not differ between groups. Patients' verbal reports did not mediate final SD outcomes (p = .41).


Adding electronically-delivered, self-care instructions and communication coaching to ESRA-C promoted specific patient descriptions of problematic SxQOL issues compared with ESRA-C assessment alone. However, clinician verbal responses were no different and subsequent symptom distress group differences were not mediated by the patients' reports.

Trial registration

NCT00852852; 26 Feb 2009

Patient-provider communication; Cancer; Symptoms; Coaching; Internet