When using patient-reported outcomes in clinical practice, the measure matters: a randomized controlled trial (original) (raw)
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A B S T R A C T Purpose The systematic use of patient-reported outcome measures (PROMs) has been advocated as an effective way to standardize cancer practice. Yet, the question of whether PROMs can lead to actual improvements in the quality of patient care remains under debate. This review examined whether inclusion of PROM in routine clinical practice is associated with improvements in patient outcomes, processes of care, and health service outcomes during active anticancer treatment. Methods A systematic review of five electronic databases (Medline, EMBASE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], PsycINFO, and Psychology and Behavioral Sciences Collection [PBSC]) was conducted from database inception to May 2012 to locate randomized and nonrandomized controlled trials of patients receiving active anticancer treatment or supportive care irrespective of type of cancer. Results Based on prespecified eligibility criteria, we included 26 articles that reported on 24 unique controlled trials. Wide variability in the design and use of interventions delivered, outcomes evaluated, and cancer-and modality-specific context was apparent. Health service outcomes were only scarcely included as end points. Overall, the number of statistically significant findings were limited and PROMs' intervention effect sizes were predominantly small-to-moderate. Conclusion The routine use of PROMs increases the frequency of discussion of patient outcomes during consultations. In some studies, PROMs are associated with improved symptom control, increased supportive care measures, and patient satisfaction. Additional effort is required to ensure patient adherence, as well as additional support to clinicians who will respond to patient concerns and issues, with clear system guidelines in place to guide their responses. More research is required to support PROM cost-benefit in terms of patient safety, clinician burden, and health services usage.
Quality of Life Research, 2010
Purpose To investigate relevant patient-reported outcome (PRO) domains for oncology clinical practice. Methods We conducted cross-sectional semi-structured telephone interviews with patients with breast and prostate cancer and clinicians. Using open-ended questions followed by structured prompts of PRO domains, subjects were asked what they currently discuss during visits and which topics are relevant for a clinical practice PRO. For each domain, we calculated the percentage of patients and clinicians who responded positively. A qualitative thematic content analysis identified barriers and benefits of using PROs in clinical practice. Results A total of 41 patients (21 breast cancer and 20 prostate cancer) and 15 clinicians (7 medical oncologists, 5 radiation oncologists, and 3 surgeons) completed the interviews. In general, clinicians and patients reported that the topics explored were relevant. Barriers to using PROs in clinical practice include (1) time constraints, (2) varying relevance of questions, (3) value of the conversational approach, (4) decreased usefulness in established relationships, and (5) respondent burden. Benefits of PROs in clinical practice include (1) identifying problems, (2) serving as a reminder of topics to discuss, and (3) tracking changes over time.
Patient reported outcome measure applicability in clinical oncology
2020
Received on: September 11, 2020| Accepted on: October 5, 2020 DOI: https://doi.org/10.5935/2526-8732.20200046 Patient Reported Outcomes (PROs) are a report that comes from patients on a specific subject, describing how they feel about a condition or therapy. The term includes a range of constructions and methodology and can cover concepts such as symptoms to physical assessment, well-being and social involvement. The process can be described as a measure of patient reported outcome (Patient Reported Outcome Measure PROM). In oncology, PROMs help healthcare professionals and systems to reduce the impact of treatment on patient’s quality of life. In recent years, several studies have shown improvement in the evaluated outcomes. In our country, there is still little information on this subject, especially when it comes to cancer patients. Hence, we think that it is of utmost importance to review the particularities of this tool, in order to stimulate further discussion of the subject i...
Patient-Reported Outcomes In Cancer: a Review of Recent Research and Policy Initiatives
CA: A Cancer Journal for …, 2007
There is growing recognition that patient-reported outcome (PRO) measures--encompassing, for example, health-related quality of life--can complement traditional biomedical outcome measures (eg, survival, disease-free survival) in conveying important information for cancer care decision making. This paper provides an integrated review and interpretation of how PROs have been defined, measured, and used in a range of recent cancer research and policy initiatives. We focus, in turn, on the role of PRO measurement in the evaluation and approval of cancer therapies, the assessment of cancer care in the community, patient-provider decision making in clinical oncology practice, and population surveillance of cancer patients and survivors. The paper concludes with a discussion of future challenges and opportunities in PRO measure development and application, given the advancing state of the science in cancer outcomes measurement and the evolving needs of cancer decision makers at all levels.
Patient-reported outcome performance measures in oncology
Journal of oncology practice / American Society of Clinical Oncology, 2014
Patient-reported outcomes (PROs) such as symptoms, quality of life, and functional status are commonly measured in cancer clinical trials, 1,2 increasingly in comparative effectiveness research, 3,4 and in routine clinical care for symptom screening and to enhance communication. 5,6 There is emerging interest in integrating PROs into the assessment of care quality. 7 Historically, patient-reported experience measures, also called satisfaction measures, have been included in performance measurement programs, for example, using the Consumer Assessment of Healthcare Providers and Systems assessment questionnaires. These measures ask patients about their experiences with providers and care delivery processes, but do not ask patients about their symptoms, functioning, or well-being. PROs reflect how people feel, but generally have not been part of performance evaluation. Last year, the National Quality Forum (NQF), the major US organization that reviews and endorses quality metrics, assembled an expert panel to develop standards around the development of patient-reported outcome performance measures (PRO-PMs). 8 A resulting white paper described a pathway for developing such measures toward NQF endorsement, 6 and was endorsed by the International Society for Quality of Life Research. 9 Recommended steps include:
Supportive Care in Cancer, 2020
Objective To systematically review the literature on how the Patient-Reported Outcomes Measurement Information System (PROMIS) measure system is used to assess patient-reported outcomes (PROs) in cancer patients. Methods We conducted a systematic review following the PRISMA guidelines. Articles were identified through searches of PubMed, EMBASE, and additional manual review of the publications listed on the PROMIS website. We included studies measuring outcomes, including physical function, fatigue, pain, anxiety, and depression in cancer patients. Eligible articles included interventional and observational studies published in English between 2009 and 2019. Results A total of 1789 records were identified and screened by three reviewers, 118 articles were reviewed in full text, and 42 articles met the inclusion criteria. The majority of studies used the PROMIS measure system to prospectively assess longitudinal changes in PROs; the number of measurements ranges from 2 to 4 with the time points of follow-up set at 3, 6, and 12 months after the baseline assessment. Depression and fatigue were the most frequently measured outcomes. Fixed-length short forms with four items were the most common measure types. A transition toward utilizing a web-or smartphone-based electronic tool was observed to limit the burden of the conventional paper-based survey to collect and store PROs. Conclusion The PROMIS measure system is increasingly popular to measure PROs in cancer patients with acceptance of its various short forms and electronic-based systems to administer data electronically. Findings from this review highlight various aspects of PROMIS and may help health professionals in their choice of PRO tools for optimizing care and support for cancer patients.
Annals of oncology : official journal of the European Society for Medical Oncology / ESMO, 2015
This review focused on the identification of patient-reported outcome measures (PROMs) used in routine cancer clinical practice, the impact on patient, provider and system outcomes and the implementation factors influencing uptake. A scoping review of the published health literature was conducted using empirical databases, namely, Ovid Medline (2003 to September 2013), CINAHL (2003-2013) and PsycINFO (2003-2013). Scoping reviews are systematic literature reviews in a broad topic area that provide relevant and quantified results about the knowledge available on a particular topic and aim to rapidly map and synthesize the evidence to highlight what is known. From a total of 2447 unique publications, 30 articles that met eligibility criteria were reviewed. PRO use appears to be acceptable to patients, enables earlier detection of symptoms and may improve communication between clinicians and patients. However, the impact of routine PROMs collection on health outcomes is less clear and h...
Monitoring of patients' physical and psychological problems during and after cancer treatment is essential in modern oncology practice. Traditional clinical methods can be supplemented by Patient-Reported Outcomes Measures (PROMs) measures. The potential role of PROMs is recognised and endorsed by national and international practice guidelines. The introduction of formal measurement of PROMs in clinical practice is a complex health care innovation requiring careful planning, design and successful implementation of a number of essential components, such as choosing the patient questionnaire(s), a convenient affordable electronic method for reporting and display in hospital records and engaging clinicians to use and act on the reports. There is mounting research evidence that using PROMs in individual patient care in oncology is beneficial to patients, but this approach has not found a place in routine clinical practice. A brief overview of this evidence will be provided. Following this, the presentation will focus on examples of incorporating PROMs and eHealth interventions into routine patient care during and after cancer treatment, drawing on 20 years' experience in Leeds of using electronic systems for capturing patient reported data in oncology settings. Examples will be given of: 1) Monitoring toxicity during systemic cancer treatment using online PROMs integrated with Electronic Patient Records (randomized trial part of NIHR eRAPID programme); 2) Service development project-Remote follow-up of testicular cancer patients using online PROMs plus community-based investigations. Examples of other online PROMs systems will be presented. The values and challenges of PROMs integration in routine oncology practice will be discussed.