DART is an electronic patient self-assessment tool including the Edmonton Symptom Assessment Survey (ESAS), and is linked to inter-professional supportive care pathways. DART has been created for the assessment of the physical, practical, and psychosocial health of patients.

DART has been rolled out in a step wise manner clinic by clinic since 2009. During this process we have gained tremendous experience working with provincial and federal organizations, including Cancer Care Ontario and the Canadian Partnership Against Cancer to develop a screening for distress body of knowledge.

Intelligent Programming and Two Step Approach

Successful distress screen tools must be thorough, providing clinicians with meaningful results, yet selective in order to minimize length and patient burden. A two-step approach to screening implements intelligent programming to automatically allow for a shorter survey in cases of low distress and a more comprehensive assessment when distress present is high. The two-step screening processhas beeen validated against the gold standard of a clinical diagnosis of a depressive or anxiety disorder based on psychiatric assessment to improve the positive predictive value (PPV) of emotional distress screening by DART (manuscript in preparation). The two-step algorithm approach to screening proposed will enhance patient buy in by tailoring the length of the assessment to the level of distress, reduce staff burden by minimizing false positives, increase automated screening rates to ensure completeness and accuracy of patient records, and enhance expandability and sustainability of DART.

Current PMCC DART Scales

Current implementation of DART at Princess Margaret Cancer Centre uses the following distress assessment scales:

- ESAS (Edmonton Symptom Assessment System)
- Edmonton General Hospital, Alberta, Canada
- SDI (Social Difficulties Inventory)
- Cookridge Hospital, Leeds, UK
- PHQ-9 and GAD-7
- Pfizer Inc. and Columbia U, NY, Indiana U, IN, U of Heidelberg, Germany
- PRFS (Patient Reported Functional Status)

Additional Questions:

- Spiritual and Informational Domains of the Canadian Problem Checklist
- Distress risk factors
- Current use of psychosocial supports
- Desire for psychosocial support
- Research consent screen

DART Data Flow and Context Diagram

Once the patient provides their identification number by manual entry or via card swiper, DART authenticates the patient by validating with the Hospital’s electronic medical record. Upon authentication the patient completes the survey, a print-out is generated, results are logged in their medical record, and pre-selected assessment scores are sent to assigned external entities

Database Compatibility

DART is compatible with Oracle and MySQL. Oracle is an object-relational database management system. MySQL is a multithreaded, multi-user, SQL (Structured Query Language) database management system. MySQL is available as free software under the GNU General Public License (GPL).
For more details, please refer to: Oracle web site or MySQL web site

Multi-User Accounts

Different permission levels for Admin, Managers, Physicians, and Technical Staff, based on the level of desired access. Admins can allow a user to customize DART, create user accounts, edit permissions, modify / update patient survey scores, and manage personnel, institutions, kiosks / iPADs.

Admin Features

Depending on the level of access granted, the Admin account can enable one to:

- Customize DART
- Create user accounts
- Edit permissions
- Modify / update patient survey scores
- Manage personnel, institutions, kiosks / iPADs

Site Based Customizations

DART has been designed to accommodate for site-based customizations. A governance structure is developed and processes put in place to support site-based customizations.

At UHN, the Head and Neck group was the first site to proceed with site-based customizations, and so we launched the DART- Head and Neck Inter-professional Collaborative. Since 2011 the Head and Neck Site has integrated the M.D. Anderson Symptom Inventory for Head and Neck Patients within DART linked with intelligent programming. UHN’s experience with this site has provided a structure for us to facilitate customizations. We have learned a tremendous amount about the key success factors required for site based customizations including: goal setting, identification of site-based champions/leads, development of a clear governance process, and identification of defined parameters for customizations.

With appropriate login credentials admin personnel can make the desired DART customizations.

Implementation and Change-Management Strategies

UHN has learned a tremendous amount about the key success factors required for site based customizations including: goal setting, identification of site-based champions/leads, development of a clear governance process, and identification of defined parameters for customizations.

With appropriate login credentials admin personnel can make the desired DART customizations.

One can enable specific clinics which will use DART.

CLINIC SELECTION

One can enable specific clinics which will use DART.

DART REASSESSMENT PERIOD

You can also choose your own thresholds for how often DART reassessment needs to be triggered. In this setting feature, one can also choose the type of survey should be deployed for a given visit for each clinic.

SCALES

Each facility using DART is required to have permission rights to use the scales they would like to incorporate into their customized DART.

ADD SCALES

Additional scales and questions can be added if the interested facility has permission rights to use them. The screenshot below illustrates this concept.

TeleForm Import

Patients who are not able to complete DART electronically are given the option to fill out ESAS portion of DART on paper. Through the scan and verification interface, data from the forms is transferred into the DART database.