# Can the CANKADO online application improve quality of life monitoring via the endometriosis health profile-30 in endometriosis patients: A randomized cohort study on acceptance, usability, and correlations with demographics and media usage

## TL;DR

This study evaluates if the online tool CANKADO improves quality of life monitoring for endometriosis patients using the EHP-30 questionnaire.

## Contribution

The study introduces a novel evaluation of electronic patient-reported outcome (ePRO) acceptance and usability in endometriosis patients via the CANKADO platform.

## Key findings

- More than 80% of patients positively responded to ePRO measurements, expecting faster diagnosis and treatment improvement.
- The online modality was rated more suitable, less complex, and less laborious compared to the paper-based version.
- Longer completion times correlated with low coping ability, lower clarity, and greater effort.

## Abstract

The global increase in interest in endometriosis highlights the importance of further investigations concerning this so-called benign gynecological disease. Owing to their severe presentation of symptoms, patients suffer from an enormous impact on their health-related quality of life (HRQoL). While the paper-based assessment of quality of life via, e.g., the “Endometriosis Health Profile-30 questionnaire (EHP-30)” seems to be largely accepted and implemented, the electronic measurement of this patient-reported outcome (ePRO) is still rarely applied. This study aimed to analyze the acceptance and usability of electronic assessments of HRQoL in endometriosis patients via the online platform CANKADO.

The study was conducted at the Department of Gynecology and Obstetrics of LMU Munich between January 2022 and February 2023. Sixty conservatively treated patients with endometriosis were recruited for the randomized cohort study, followed by randomization due to their planned interrogation modality (n paper-based = 23, n online-based = 17). Afterwards, a HRQoL assessment via the EHP-30 questionnaire was performed. An evaluation of the interrogation modalities was performed at 0, 6 and 12 months. The metric or categorical variables were compared via Fisher’s exact test or the Mann‒Whitney U test. Correlation analysis was performed by calculating the Kendall Tau coefficient or Eta coefficient.

Forty patients completed evaluation forms at T0 (0 months), with n = 23 evaluating the paper-based interrogation modality and n = 17 evaluating the online version. At all the time of assessment, more than 80% of the patients showed a positive response to routinely performed ePRO measurements in the clinical context, expecting simplified communication, faster diagnosis, and therapeutic improvement. The online modality was rated more suitably (T0: 72.7% vs. 76.5%; T3: 60.0% vs. 90.0%), less complex (T0: 59.1% vs. 76.5%; T3: 80.0% vs. 70.0%), and less laborious (T0: 72.7% vs. 70.6%; T3: 80% each). Completion time over ten minutes was significantly correlated with low coping ability (r = 0.530; p = 0.029), lower clarity (r = 0.530; p = 0.029) and greater effort (r = 0.593; p = 0.012).

The findings indicate high acceptance and usability of regularly performed ePRO assessments in patients with endometriosis via the online tool CANKADO.