Table 4.

Summary description of studies on consultation support in the reviewed randomized controlled trials of electronic symptom reporting^a.

Patient group	Trial and countryb	Participant characteristicsc	Study characteristicsd	Health service innovation: consultation support	Main findings and research targetse
Cancer
	Berry et al [44]; (Wolpin et al [78]); USA	262 clinicians from 2 clinics; 660 cancer patients, 18–86 (mean 54) years; female % not reported	Design: P + 2; inside clinic Duration: 2 visits (before treatment and 4–6 weeks later)	Enhancing patient–provider communication with electronic self-report assessment for cancer Intervention: ESRA-C f: a color graphical summary of the participant’s self-reported symptoms and quality-of-life issues with predetermined thresholds flagged was printed and handed to the clinician immediately before the targeted clinic visit. No recommendations offered. Control: ESRA-C questionnaires were filled, but no summary was handed to the clinician.	Berry et al [44]: Primary: The likelihood of symptoms and quality-of-life issues being discussed between clinicians and patients differed by randomized group and depended on whether a symptoms and quality-of-life issue was first reported as problematic (P = .032). Secondary: Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful. Wolpin et al [78]: The ESRA-C was easy for patients to use and acceptable across a range of user characteristics. Research targets: Patient centeredness, duration, resource utilization
	Boyes et al [45]; Australia	80 cancer patients, 20–85 years (mean not reported); female 59.5%	Design: P + 2; inside clinic Duration: before visit, 4 times	Effect of giving oncologist a summary of the cancer patient’s self-reported psychosocial well-being Intervention: Touch-screen survey filled out before oncologist visit. Computer scored the answers and a printed summary report was placed in the patient’s file for consideration during consultation. Suggested strategies for managing identified issues were included. Control: Touch-screen survey filled out, but no results made available to oncologist.	Unclear primary outcome. Intervention patients who reported a debilitating physical symptom at visit 2 were significantly less likely to report a debilitating physical symptom at visit 3 compared with control patients (odds ratio 2.8, P = .04). Reductions in levels of anxiety, depression, and perceived needs among intervention patients were not significantly different from those among control patients. Research targets: Health benefits, patient centeredness
	Ruland et al [46]; USA	14 physicians, 14 nurse practitioners; 52 cancer patients; 23–77 (mean 56.3) years; female 59%	Design: P + 2; inside clinic Duration: 1 consultation	Supporting shared decision making All patients scheduled for an outpatient visit used the system on a tablet computer to report their symptoms and preferences prior to consultation. The system highlighted for clinicians what symptoms patients were experiencing, including severity, degree of bother, and importance to patients. This information was printed and provided to the patient and clinician in the experimental group but not in the control group.	Primary: Significantly greater congruence between patients’ reported symptoms and those addressed by their clinicians in the experimental group. Secondary: The system scored high on ease of use. There were no significant group differences in patient satisfaction. Research target: Patient centeredness
	Ruland et al [47]; Norway	145 cancer patients (leukemia or lymphoma); ≥18 (mean in intervention: 50, in control: 49) years; female 38%	Design: P + 2; inside clinic Duration: up to 1 year (once per encounter during treatment, once per week during hospital stay, once per outpatient visit in up to 4 visits)	Effects of a computer-supported interactive tailored patient assessment tool Both groups used Choice, an interactive tailored patient assessment, touchpad tablet PC, for symptom assessments prior to inpatient and outpatient visits. The assessment summary, which displayed the patient’s self-reported symptoms, problems, and distress in rank order of the patient’s need for support, was provided to physicians and nurses in the intervention group. Control group patients used exactly the same tool, but the clinicians were not given any information from the patient’s assessment.	Primary: Significantly more symptoms were addressed in the intervention group patient charts than in those of the control group. Secondary: Symptom distress in the intervention group decreased significantly over time in 11 (58%) of 19 symptom/problem categories versus 2 (10%) for the control group. Need for symptom management support over time also decreased significantly more for the intervention group than the control group in 13 (68%) symptom categories. Research targets: Patient centeredness, health benefits, resource utilization
	Velikova et al [48]; UK	28 physicians, 286 oncology patients; age range not reported; mean age 54.9 years; female 73%	Design: P + 3; inside clinic Duration: approximately 6 months	Improving communication and patient well-being Intervention group completed touch-screen HRQLg questionnaires in the waiting room before every encounter. A summary was presented to physicians. Attention-control group also completed HRQL questionnaires on touch-screen computer, but summary was not presented to physicians. Control group used no touch-screen measurement of HRQL before clinic encounters.	Several primary outcomes: Intervention and attention-control groups had better HRQL than the control group (P = .006, P = .01, respectively), but the intervention and attention-control groups were not significantly different (P = .80). A positive effect on emotional well-being was associated with data feedback (P = .008) but not with instrument completion (P = .12). A larger proportion of intervention patients showed clinically meaningful improvement in HRQL. More frequent discussion of chronic nonspecific symptoms (P = .03) was found in the intervention group, without prolonging encounters. The clinicians found the information useful. There was no detectable effect on patient management (P = .60). In the intervention patients, HRQL improvement was associated with explicit use of HRQL data (P = .016), discussion of pain, and role function (P = .046). Research targets: Health benefits, patient centeredness, duration, resource utilization
Psychiatry	Stevens et al [49]; USA	878 potential behavioral concern patients from 9 clinics; 11–20 (mean 13.9) years; female 54%	Design: C + 2; inside clinic Duration: 1 consultation	Does screening increase clinicians’ recognition of behavior concerns? The Health eTouch system collected self-report data from patients in the waiting rooms. At 5 sites, patients’ screening results were printed and given to the primary care provider just before the face-to-face encounter (immediate-results condition). At 4 sites, the 1-page summary was mailed to the primary care provider 2–3 business days later (delayed-results condition). Providers had immediate access to screening results for youth reporting thoughts about suicide, regardless of group assignment.	Primary: In intent-to-treat analysis, difference approached but did not reach statistical significance (P = .058). However, if all youths who endorsed suicidal ideation, regardless of original condition assignment, were included in the immediate-results condition, then 68% of youths in the immediate-results condition who screened positive were identified as having a problem by their pediatrician, which was significantly higher than the recognition rate of 52% in the delayed-results condition (P = .001). Research targets: Health benefits, patient centeredness
Mixed	Leveille et al [50]; (Allen et al [81]); USA	34 physicians, 241 patients (depression, chronic pain, and mobility difficulty); 22–86 years (mean not reported); female 57%	Design: P+ 2; outside, probably at home Duration: from 4 weeks until index visit (start unclear).	Nurse coaching to promote patient–primary care physician discussion Intervention: PatientSite was used to enhance patient–provider communication regarding 3 common conditions (chronic pain, depression, and impaired mobility) during upcoming visits. Delivered online by nurse e-coaches, the intervention involved a standardized set of emails and worksheets targeting self-efficacy, patient education, and motivation to improve health. Control: Patients received a general message through PatientSite containing URL links to US government websites with general health information.	Several primary outcomes: Detection and treatment of the target conditions (1-week postvisit survey) and symptom burden related to these conditions. Similar high percentages of intervention (85%) and control (80%) participants reported discussing their condition during their primary care physician visit. More intervention than control patients reported their primary care physician gave them specific advice about their health (94% vs 84%; P = .03) and referred them to a specialist (51% vs 28%; P = .002). Intervention participants reported somewhat higher satisfaction than controls (P = .07). Results showed no significant differences in detection or management of screened conditions, symptom ratings, and quality of life between groups. Research targets: Health benefits, patient centeredness

^a Articles were identified in a comprehensive search in Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore from 1990 to November 2011, and were published in the time period 2002–2011.

^b Main author, main reference. References in parentheses contributed relevant study information on the study in question.

^c Number of clinicians, number of patients with diagnosis, age range (mean) of patients, percentage female patients.

^d Design (P = parallel group design, CO = crossover, C = cluster, F = factorial, O = other, U = unclear; + number of study arms), where symptom reporting took place (outside or in the home; or inside a clinic), and duration of intervention.

^e Main findings are in general presented as in the original article and refer to primary outcome if clearly defined and secondary outcomes considered relevant for the scope of the study. Research targets refers to the six areas of health service quality defined by the Institute of Medicine [43].

^f Electronic Self-Report Assessment-Cancer.

^g Health-related quality of life.