Integrating real-time patient-reported outcomes in colorectal cancer care: development and evaluation of a concise clinical scorecard.

purposePatient-reported outcomes (PROs), initially developed for research, are increasingly recognized as valuable in clinical practice to monitor health status, quality of life, and symptoms from the patient perspective. However, few practical, clinician-friendly PRO tools exist for routine oncology care. We aimed to develop a brief electronic “Colorectal Scorecard” grounded in validated PROM content and evaluate its implementation in a high-volume colorectal surgery practice.

methodsA multidisciplinary team co-designed a reduced-item electronic PRO questionnaire covering seven key quality-of-life domains plus a patient-designated priority concern, presented as a one-page color-coded report integrated into the electronic health record (EHR). Included PROM content was drawn from validated instruments (e.g., LARS, CIS, IIEF-5/FSFI domains, ICIQ-UI SF items, EQ-5D-5L/EQ-VAS, EORTC QLQ-CIPN20 items, and a FACT-C work-ability item), with wording simplification guided by patient input. The Scorecard rollout included staff training, patient portal distribution with automated reminders, and in-clinic tablet options. We tracked survey completion rates, drop-off rates, completion times, setting of completion (home portal vs. in-clinic tablet when available), and clinician access/printing when loggable from 2019–2024. Provider and patient feedback were collected through structured informal feedback channels to guide iterative refinements. We compared these data to the prior colorectal PRO report system used from 2013–2019.

resultsFrom 2019 to 2024, approximately 13,400 colorectal patients completed > 19,000 Scorecard surveys as part of routine care. Overall PRO completion more than doubled (from ~ 33% pre-implementation to > 70% post-implementation), with a median survey completion time of 4 min (IQR ~ 3–6) and < 4% in-clinic drop-off. Clinician uptake varied by provider; early adoption was supported by a surgeon “champion” and recurring staff reinforcement. Patient “priority concern” responses changed significantly before vs. after surgery. Preoperatively, patients most commonly prioritized treatment planning (38%) and cancer status (29%), whereas postoperatively priorities more often included cancer status (19%), bowel function (18%), and recovery (17%). Postoperative priorities differed by cancer type: rectal cancer patients were nearly twice as likely as colon cancer patients to prioritize bowel function (21.8% vs. 11.8%) and more frequently selected urinary or sexual function, whereas colon cancer patients more often prioritized cancer status and results/surveillance concerns.

conclusionIncorporating electronic PROs into a busy colorectal surgery clinic was feasible and sustained over five years. The Colorectal Scorecard’s concise format and real-time reporting supported more focused, patient-centered discussions during appointments. Because we evaluated feasibility and implementation process outcomes rather than downstream clinical outcomes, conclusions regarding patient health impact should be reserved for future studies. Ongoing efforts—such as refining the user interface, clearly defining team responsibilities for acting on PROM results, and continuous staff training—are recommended to maintain high clinician uptake.