Cleeland 2011.

Study characteristics
Methods	Randomised trial, USA
Participants	100 adult patients receiving thoracotomy for lung cancer or lung metastasis Mean age intervention group: 59.2 years (SD 13.6) and 44.7% female. Mean age control group: 60.9 years (SD 11.8) and 48.8% female.
Interventions	This study examines whether at‐home symptom monitoring plus feedback to clinicians about severe symptoms contributes to more effective postoperative symptom control. After hospital discharge, patients rated symptoms twice weekly for 4 weeks via automated telephone calls. For intervention group patients, an e‐mail alert was forwarded to the patient’s clinical team for response if any of a subset of symptoms (pain, disturbed sleep, distress, shortness of breath, or constipation) reached a predetermined severity threshold using the M.D. Anderson Symptom Inventory (MDASI).   Intervention features Multiple simple feedback (one PROM at multiple times) PROM(s) used as intervention: M.D. Anderson Symptom Inventory (MDASI) Constructs measured: Symptoms, Functioning Instrument categories/domains: Domain/Disease specific (cancer)   Administration features Where PROMs administered: Non‐clinical setting How administered: Self‐administered by telephone Format of PROMs questionnaire(s): Electronic   Feedback features Format of PROMs feedback: Electronic How often information fed back: Patients rated symptoms twice weekly for 4 weeks via automated telephone calls Who information fed back to: Clinicians Information fed back: Scores
Outcomes	Main outcomes: number of symptom threshold events (MDASI); mean symptom severity between discharge and follow‐up(MDASI) Other outcomes: mean symptom interference (MDASI), patient satisfaction (AD HOC)
Notes	American Cancer Society, Atlanta, GA (grant# RSGPB‐03‐244‐01‐BBP); National Cancer Institute, Bethesda, MD (grant# R01CA026582). The study period was not reported. The authors indicated no potential conflicts of interest.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Paper only states randomisation was performed electronically using the medical centre's 'protocol management system'.
Allocation concealment (selection bias)	Unclear risk	Not clear whether allocation concealed
Blinding of participants and personnel (performance bias) All outcomes	High risk	Clinicians knew about intervention patients due to their email alert system
Blinding of outcome assessment (detection bias) All outcomes	High risk	Clinicians and surgical nurses were informed of symptoms through the IVR‐alerts which was an outcome
Baseline outcome measurements similar	Low risk	None apparent
Baseline characteristics similar	Low risk	No significant differences (patient demographics provided)
Incomplete outcome data (attrition bias) All outcomes	Low risk	None apparent
Was study protected against contamination	High risk	In the discussion the authors highlighted the possibility of the intervention patients knowing their symptoms were being monitored possibly affecting their results
Selective reporting (reporting bias)	Low risk	All the outcomes were reported in the results section