In Episode 4 of our Colorectal Cutting Edge series, Miguel Cunha interviews Christos Kontovounisios about PROMs.

Christos Kontovounisios is a colorectal surgeon and clinical senior lecturer at the Imperial College Department of Surgery and Cancer. He is based at Chelsea and Westminster Campus and the Royal Marsden Hospital.

He is fully committed to academic surgery, and is particularly interested in minimally invasive colorectal, pelvic floor and pelvic exenteration surgery. His research focuses on:

  • Validation of diagnostic, prognostic, and surveillance biomarkers for early and advanced colorectal cancer
  • Validation of biomarkers for anal canal cancer
  • 3D modelling of the gastrointestinal tract: surgical planning, surgical training, patient education
  • Datasets and registries for colorectal and anal canal cancer
  • Simulation for surgical training in colorectal pathologies

Miguel Cunha: Thank you for sharing with us your expert view on digital PROMs for colorectal surgery. Surgeons are known for their appetite for new technology. We are also aware of the growing importance of PROMs in colorectal surgery. To introduce the topic to our readers, can you briefly explain the basics of your digital PROMs tool - how does it work and what is its main aim?

Christos Kontovounisios: As part of Chelsea and Westminster's Innovation Programme (run jointly with its charity) the Colorectal Department has been working together with My Clinical Outcomes (MCO) and Imperial College London, to use a digital platform to capture patient reported outcome measures (PROMs).

The study will improve our understanding of patient reported outcomes, expectations, experiences and quality of services, enabling for an unprecedented level of patient-led continuous improvement. This will unify colorectal PROM collection and analysis, in order to create a colorectal PROM and patient-reported experience measures (PREM) tool. It is our aspiration that this work will provide a useful base for wider digital PROMs and PREMs application.

MC: We were very impressed and interest in the potential of this new tool. Can you explain us its main advantages, and how it can make the difference?

CK: The tool will enable us to increase PROMs/PREMs systematic collection within a colorectal department based on a digital platform. It will also enable:

  • Patient participation involvement
  • Improved quality of services and patients' experiences
  • Monitor patient through PROM data, and re-referral requests to prevent avoidable complications
  • Generate a general practice tool that can be used in the community to advise for colorectal pathologies referral, decreasing mis-referrals and/or unnecessary hospital demands
  • To estimate the average cost per quality adjusted life year (QALY) gained from different colorectal procedures

MC: One of the main goals of PROMs is to put back the 'power to the patients'. From your experience, do you think this tool will fit the majority of colorectal patients? How are you planning to deal with the ones that are not familiar with digital tools?

CK: Recent advances in technology, policies, and increasing amounts of data are rapidly changing the status quo of digital healthcare transformation.

Also, the pandemic has shifted patients' preferences as they are largely embracing new digital tools. Virtual and digital care is here to stay.

Technology companies, hospitals and clinicians need to invest people, time and money to build on this momentum to expand and enhance the tools and platforms they use to communicate with, and provide care for, patients. But technology is not enough, as all the stakeholders must continue to engage with patients directly.

MC: One of the main discussions on new technology is always its cost-effectiveness. Do you think this can be a problem for the global implementation of the tool?

CK: The cost is dependent on the needs of each colorectal unit and how they would like to use the digital PROMS. The digital platform can be cost effective for each colorectal unit by monitoring patients, and preventing avoidable complications. Moreover it can also provide data to estimate QALY gained from different colorectal procedures.

MC: What about outcomes and patient care? Do you think this approach adds meaningful value on these matters?

CK: This new digital way of collecting data actually allows the patient to become a true partner with the clinician. So far, the process of collecting information from patients has been very fragmented. With this new digital approach, patients will have the opportunity to report their outcomes and their experiences and improve our ability to care for them and to help improve the services for patients. The platform is designed in a way where not only disease specific, but also general QoL questions can capture most of patients’ outcomes. We have also developed a novel 'Decision Regret Scale' questionnaire, which will reflect patients’ satisfaction on their decisions during treatments.

MC: That brings us towards the end of the interview and some final questions... Do you picture a global implementation of digital PROMs worldwide? Besides patients, do you think that health systems would also benefit? In which way would they?

CK: Currently there is heterogeneity on the PROM and PREM tools used for colorectal pathologies. In order to achieve wider implementation, further studies are necessary to achieve standardisation. I believe our platform can make data collection easier and analysis more accurate.

'We can only be sure to improve what we can actually measure' - then there are tremendous opportunities for health care systems: monitor key aspects of the quality of care delivered, analyse clinical teams/clinicians performance, identify and share best practices guidelines, and elaborate on costs evaluations.

MC: Thank you so much for sharing with us your insight and expertise in this area.

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