Adapting the Exercise in Cancer Evaluation Decision Support (EXCEEDS) Algorithm into an Electronic Medical Record Compatible Tool

Research Objectives: The EXCEEDS algorithm is designed to be adapted to clinical and non-clinical platforms to enable appropriate triage recommendations for rehabilitation and exercise oncology programs. We adapted the EXCEEDS algorithm into an EMR-compatible tool that can be used to guide oncology referral decision-making, then examined agreement in triage recommendations between the new EMR tool (EXCEEDS-EMR) and the existing patient-reported outcome measure (EXCEEDS-PRO).

Design: Quality improvement study

Setting: Chemotherapy infusion suite at a large cancer center

Participants: Adults receiving chemotherapy infusion, N=167

Interventions: Participants completed EXCEEDS-PRO and EXCEEDS-EMR electronically during their second chemotherapy infusion session. Both forms include the following domains: activities of daily living (ADL) ability, recent fall(s), symptoms, fatigue, and treatment status. The EXCEEDS-PRO also includes pain that limits ADL, exercise level/confidence, and the presence of a port, catheter, or ostomy. EXCEEDS-PRO items are multi- and single-select (yes/no). EXCEEDS-EMR items are only single-select to simplify data entry and management in the EMR. Both measures were scored in REDCap. Triage recommendations were provided to patients in real time. Triage options were cancer rehabilitation (i.e., rehab), clinically supervised exercise (i.e., clinical), exercise oncology, or independent exercise.

Main Outcome Measures: Agreement in EXCEEDS-PRO and EXCEEDS-EMR triage recommendations were examined using descriptive and chi-squared goodness of fit tests.

Results: When using EXCEEDS-PRO, triage recommendations were: 61.7% rehab, 35.9% clinical, and 2.4% exercise oncology. When using EXCEEDS-EMR, triage recommendations were 49.7% rehab, 47.9% clinical, and 2.4%. Agreement was 79.6% (X2=58.54, p<.001). Disagreement only occurred at the rehab and clinical levels. Two items, the ability to eat or drink and pain that limits ADL, accounted for 79.4% of all disagreements.

Conclusions: In this initial evaluation, agreement between EXCEEDS-PRO and EXCEEDS-EMR was high. Key areas of disagreement were identified and used to revise EXCEEDS-EMR before implementation. Future research will evaluate EXCEEDD-EMR implementation and its impact on rehabilitation and exercise referrals from oncology.

Author(s) Disclosures: Dr. Wood receives a salary from Select Medical.