Putting Patients Back in the Center of their
By all appearances, the waiting room in the Joan Karnell Cancer Center
at Pennsylvania Hospital is no different than any other, until you
notice several patients viewing what look like electronic clipboards.
Even before they meet with their doctor or receive therapy, patients
at the Karnell Cancer Center are documenting how they feel physically,
emotionally and mentally via a revolutionary selfassessment tool called
The e/tablet is part of a new program called AIM Higher. AIM stands
for Assessment, Information and Management of cancer related symptoms.
Developed and sponsored by Supportive Oncology Services in Memphis,
TN, the Joan Karnell Cancer Center is among a select group around
the country utilizing the e/table as part of a pilot program.
The e/tablet combines interactive computer technology with a patientcentered,
proactive approach toward improving care for patients who are experiencing
one or more chemotherapy-related symptoms.
This program has been designed to help doctors and their patients
together better assess and manage the side effects
of chemotherapy. The Joan Karnell Cancer Center
was selected to participate because of its reputation
not only for treating cancers, but for providing
the highest care possible in managing symptoms
and treatmentrelated side effects.
How It Works
Each time a patient comes to the Cancer Center,
they are asked to complete the e/tablet questionnaire.
The questionnaire elicits information regarding common chemotherapy-related
symptoms: anemia, depression or anxiety, diarrhea or constipation, nausea
and vomiting or neutropenia, low white blood cell counts which
can lead to infection. In place of a keyboard,
patients simply touch the response on the screen that most closely
matches their impressions. For example, patients are asked to select
the level of fatigue or weakness they are experiencing from a rating
meaning “not a problem” to “10,” which
indicates it has been “as bad as possible.”
Information from the questionnaire is sent wirelessly to a database,
where it is analyzed and highlights any moderate or severe symptoms
for the doctor's review. A report, which becomes part of the
patient's confidential medical record, is immediately printed
and provided to the doctor even before he or she meets with the patient.
The printout not only tells the doctor how the patient is feeling
that day, but it tracks a patient's progress before, during
and after any treatments they may have received over the course of
their Cancer Center visits.
If patients' answers register a certain level of severity having
to do with nutrition, anxiety or depression,
for example, those responses automatically trigger an e-mail to the
relevant health care professional – in
those cases, a dietician, social worker or psychologist – who
then is able to follow-up with the patient.
“The nurses, doctors and other health care professionals are
all receiving the same information from the patient, so they all know
if anything about a patient's health has changed,” explains
Cathy Fortenbaugh, RN, MSN, AOCN, a clinical nurse specialist, who
is coordinating the AIM Higher program at the Cancer Center. “Being
able to measure the progress and level of severity of our patients' symptoms
based on their perspective helps us to offer them the best care possible.”
Since introducing the e/tablet to their patients, the Cancer Center
staff has seen a significant increase in patient referrals to the
Cancer Center's nutritionists, psychologists and social workers.
“This increase in referrals was a signal to us that some of
our patients were experiencing symptoms that they weren't conveying
to their doctor,” says David
Henry, MD, a medical oncologist at the Karnell Cancer Center.
The e/tablet is also an effective educational tool. As part of the
AIM Higher program, patients and their families have access to an
extensive collection of information on cancer through the e/tablet
and The Patient Companion, a binder containing brochures and other
printed materials corresponding to information on the e/tablet.
Developed by nurses and physicians around the country from AIM Higher
sites, topics range from the diagnosis and treatment of cancer to
dealing with side effects, descriptions of the Center's supportive
care services and the latest cancer research, all of which can be
provided to the patient in printed form as well. In addition to text-based
information, the e/tablet includes short videos featuring real patients.
Linda*, who was one of the first cancer patients at the Karnell Center
to participate in AIM Higher, says that the e/tablet has been particularly
helpful in keeping track of changes in her symptoms.
“I don't have to rely on my memory when describing whether
my symptomshave deteriorated or improved to any
degree since prior visits,” she said. “Arecord from my
e/tablet responses is always available and immediately noted by both
my doctor and the nurse.
“And,” she adds, “it's a record of my impressions,
not someone else's interpretation of how I might
“This device is a very effective way to begin to gather
information from our patients, so that we can
zero in on what's bothering them at that particular
time and provide better symptom management.”
*Name changed to protect patient privacy.