251
|
Patient-reported quality-of-life outcomes in relation to provider-assessed adverse events during head and neck radiotherapy. J Patient Rep Outcomes 2020; 4:60. [PMID: 32677021 PMCID: PMC7364694 DOI: 10.1186/s41687-020-00227-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/05/2020] [Indexed: 01/20/2023] Open
Abstract
Purpose To assess the relationship between patient-reported quality-of-life (QOL) outcomes and provider-assessed adverse events (AEs) during head-and-neck (H&N) radiotherapy (RT). Methods Sixty-five patients undergoing H&N RT prospectively completed 12-domain linear analogue self-assessments (LASA) at baseline, before biweekly appointments, and at last week of RT. At the same time points, provider-assessed AEs were graded using Common Terminology Criteria for Adverse Events v4.0. LASA scores were stratified by maximum-grade AE and analyzed using Kruskal-Wallis methodology. Agreement between LASA scores and maximum-grade AE was assessed using Bland-Altman analysis. Results Patient-reported QOL outcomes showed clinically meaningful decreases in most domains, predominantly fatigue (77.8% of patients), social activity (75.4%), and overall QOL (74.2%). Provider-assessed AEs showed 100% grade 2 AE, 35.4% grade 3 AE, and 3.1% grade 4 AE. At baseline, patients with higher grade AEs reported worse physical well-being (WB) (P = .04). At week 1, the following QOL domains were worse for patients with higher grade AEs: overall QOL (P = .03), mental WB (P = .02), and physical WB (P = .03). Bland-Altman analysis showed that QOL scores were relatively worse than AE burden at baseline and relatively better at RT completion. Conclusions Worse QOL was associated with higher-grade AEs at baseline and early in RT. The impact of AEs on QOL appears to lessen with time. Patient-reported QOL outcomes and provider-assessed AEs provide complementary information.
Collapse
|
252
|
Rubio A, Mendiburo A, Oyanedel JC, Benavente L, Paez D. [Relationship between the evaluation of the health system personnel by their users and their subjective well-being: A cross-sectional study]. Medwave 2020; 20:e7958. [PMID: 32678813 DOI: 10.5867/medwave.2020.06.7958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/26/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction This cross-sectional study sought to examine the relationships between the perception of efficiency and quality of the service provided by the staff of the health system with users well-being (satisfaction with life), in the Chilean context. Based on the literature review, we hypothesized that satisfaction with the services provided by the health system would be associated with the well-being of its users. Objective To determine the relationship between the evaluation of the health system, medical staff, and perceived efficiency, with users subjective well-being. Methods On a sample of 1,201 respondents (52.4% women, mean age 42.82 years), descriptive analysis, bivariate analysis, and a structural equation model were performed between the evaluation of the health system, medical staff, and perceived efficiency with users subjective well-being. Results These three variables are positively related to each other and have effects on subjective well-being. Discussion Health systems also influence the subjective well-being of their users and can be associated with indicators of quality of life. Some implications and considerations related to the Chilean health system are discussed. Also, some of the possible limitations of the study are mentioned. Lastly, the importance of the health systems as part of the state and government functions is discussed.
Collapse
Affiliation(s)
- Andrés Rubio
- Facultad de Enfermería, Universidad Andres Bello, Santiago, Chile. Adress: Sazié 2212, Santiago. Santiago, Chile. Código postal: 8320000.. ORCID: 0000-0001-8806-0697
| | - Andrés Mendiburo
- Facultad de Educación y Ciencias Sociales, Universidad Andres Bello, Santiago, Chile. ORCID:0000-0001-8486-6597
| | - Juan Carlos Oyanedel
- Facultad de Educación y Ciencias Sociales, Universidad Andres Bello, Santiago, Chile. ORCID:0000-0003-4023-6926
| | - Luna Benavente
- Centro de Investigación para la Educación Inclusiva, Viña del Mar, Chile. ORCID: 0000-0001-6143-7212
| | - Dario Paez
- Faculty of Psychology, University of the Basque Country, San Sebastian, Spain. ORCID: 0000-0002-8459-6037
| |
Collapse
|
253
|
Taarnhøj GA, Lindberg H, Dohn LH, Omland LH, Hjøllund NH, Johansen C, Pappot H. Electronic reporting of patient-reported outcomes in a fragile and comorbid population during cancer therapy - a feasibility study. Health Qual Life Outcomes 2020; 18:225. [PMID: 32653005 PMCID: PMC7353726 DOI: 10.1186/s12955-020-01480-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/07/2020] [Indexed: 02/05/2023] Open
Abstract
Background Electronic collection of patient-reported outcomes (ePROs) is becoming widespread in health care, but the implementation into routine cancer care during therapy remains to be seen. Especially, little is known of the use and success of electronic reporting during active cancer treatment in fragile and comorbid patients. The aim of this study was to test the feasibility of ePRO and its incorporation into routine cancer care, measured by physician compliance, for a fragile and comorbid bladder cancer (BC) population receiving chemo- or immunotherapy. Methods All BC patients initiating treatment for locally advanced or metastatic bladder cancer at Rigshospitalet or Herlev Hospital, Denmark, were approached during an 8 month period. Exclusion criteria were patients not speaking Danish or not being signed up for electronic communication with health authorities. Enrolled patients were prompted to complete weekly ePROs from home. Patients completed the European Organisation for Research and Treatment of Cancer’s general quality of life questionnaire, QLQ-C30, and the module for muscle-invasive bladder cancer QLQ-BLM30, the Hospital Anxiety and Depression Scale, HADS, and selected items from the Patient Reported-Outcomes version of the Common Terminology Criteria of Adverse Events (PRO-CTCAE), in total 158 questions weekly. If failing to report when prompted, patients were sent two e-mail reminders. Patients were informed that the physician would have an overview of the reported ePROs at their following clinical visits. Physicians were at all clinical visits informed to look at the ePROs in a software solution separate from the medical records. Physicians were logged to check their compliance to the task. No continuous surveillance of ePROs was established. Results Of 91 patients screened for enrolment, 19 patients (21%) were not found eligible for standard treatment, eight patients (9%) were not signed up for electronic communication with the health authorities and nine patients (10%) declined participation. Another six patients did not meet other inclusion criteria. In total 49 BC patients were enrolled, 29 initiating chemotherapy and 20 initiating immunotherapy. A total of 466 electronic questionnaires were completed. The overall adherence of the patients to complete ePROs was at an expected level for an elderly cancer population (75%) and remained above 70% until the 6th cycle of treatment. The physician’ compliance was in contrast low (0–52%) throughout the course of treatment. Conclusions Electronic reporting of PROs is feasible in a fragile and comorbid population of patients during routine active cancer treatment. Despite clear implementation strategies the physician compliance remained low throughout the study proving the need for further implementation strategies.
Collapse
Affiliation(s)
- Gry Assam Taarnhøj
- Department of Oncology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Henriette Lindberg
- Department of Oncology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Line Hammer Dohn
- Department of Oncology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Lise Høj Omland
- Department of Oncology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Niels Henrik Hjøllund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Department of Oncology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Helle Pappot
- Department of Oncology, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| |
Collapse
|
254
|
Kyte D, Anderson N, Auti R, Aiyegbusi OL, Bishop J, Bissell A, Brettell E, Calvert M, Chadburn M, Cockwell P, Dutton M, Eddington H, Forster E, Hadley G, Ives NJ, Jackson L, O'Brien S, Price G, Sharpe K, Stringer S, Stephenson G, Verdi R, Waters J, Wilcockson A, Williams J. Development of an electronic patient-reported outcome measure (ePROM) system to aid the management of patients with advanced chronic kidney disease. J Patient Rep Outcomes 2020; 4:55. [PMID: 32642867 PMCID: PMC7343684 DOI: 10.1186/s41687-020-00223-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/28/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Effective management of patients with chronic kidney disease (CKD) relies on timely detection of clinical deterioration towards end stage kidney failure. We aimed to design an electronic Patient-Reported Outcome Measure (ePROM) system, which would allow patients with advanced CKD (pre-dialysis) to: (i) remotely self-report their symptoms using a simple and secure online platform; (ii) share the data with the clinical team in real-time via the electronic patient record to help optimise care. We adopted a staged development process which included: a systematic review of PROMs used in CKD; formation of a co-design team; prototype system design/development, user acceptance testing and refinement; finalisation of the system for testing in a pilot/feasibility trial. RESULTS A co-design team was convened, including patients with lived experience of CKD; clinical team members; IT/Informatics experts; academics; and Birmingham Clinical Trials Unit representatives. A prototype system was developed and iterative changes made before finalisation during a series of operational meetings. The system allows patients to remotely self-report their symptoms; provides tailored self-management advice; allows monitoring of real-time patient ePROM data; sends automated notifications to the patient/clinical team in the advent of a severe symptom report; and incorporates longitudinal ePROM symptom data into the electronic patient record. Feasibility of the system will be evaluated as part of the National Institute for Health Research funded RePROM (Renal electronic Patient-Reported Outcome Measure) pilot trial (ISRCTN12669006). CONCLUSIONS Routine ePROM collection with real-time feedback has the potential to improve outcomes and reduce health service costs. We have successfully developed a trial-ready ePROM system for advanced CKD, the feasibility of which is currently being explored in a pilot trial. Assuming feasibility is demonstrated, formal evaluation of efficacy will take place in a future multi-centre randomised controlled trial.
Collapse
Affiliation(s)
- Derek Kyte
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK.
| | - Nicola Anderson
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ram Auti
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Andrew Bissell
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Marie Chadburn
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mary Dutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Eddington
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elliot Forster
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gabby Hadley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natalie J Ives
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sonja O'Brien
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keeley Sharpe
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Gael Stephenson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rav Verdi
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Judi Waters
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adrian Wilcockson
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Jim Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
255
|
Höfer S. Health-related quality of life in heart disease. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
256
|
van Nuenen FM, Donofrio SM, Tuinman MA, van de Wiel HBM, Hoekstra-Weebers JEHM. Effects on patient-reported outcomes of "Screening of Distress and Referral Need" implemented in Dutch oncology practice. Support Care Cancer 2020; 28:3391-3398. [PMID: 31781949 PMCID: PMC7256091 DOI: 10.1007/s00520-019-05140-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/17/2019] [Indexed: 11/12/2022]
Abstract
PURPOSE This study investigated the effect of the "Screening for Distress and Referral Need" (SDRN) process (completing a screening instrument; patient-caregiver discussion about the patient's responses, regardless of distress level, and possible referral to specialized care), implemented in Dutch oncology practice on patient-reported outcomes (PROs). METHODS A non-randomized time-sequential study was conducted to compare two cohorts. Cohort 1 respondents (C1) were recruited before and cohort 2 respondents (C2) after SDRN implementation in nine Dutch hospitals. Participants completed the EORTC-QLQ-C30, HADS, Patient Satisfaction Questionnaire-III, and the Distress Thermometer and Problem List (DT&PL). Descriptive analyses and univariate tests were conducted. RESULTS C2 respondents (N = 422, response = 54%) had significantly lower mean scores on the practical (t = 2.3; p = 0.02), social (t = 2.3; p = 0.03), and emotional PL domains (t = 2.9; p = 0.004) compared with C1 (N = 518, response = 53%). No significant differences were found on quality of life, anxiety, depression, satisfaction with care, distress level, the spiritual and physical PL domains, or on referral wish. CONCLUSIONS After implementation of SDRN, patients report significantly fewer psychosocial (practical, social, and emotional) problems on the DT/PL but responses on the other patient-reported outcomes were comparable. These results add to the mixed evidence on the beneficial effect of distress screening. More and better focused research is needed.
Collapse
Affiliation(s)
- Floor M van Nuenen
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stacey M Donofrio
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Marrit A Tuinman
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry B M van de Wiel
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josette E H M Hoekstra-Weebers
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
| |
Collapse
|
257
|
Höfer S. Health-related quality of life in heart disease. Rev Port Cardiol 2020; 39:375-376. [DOI: 10.1016/j.repc.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
258
|
Krogstad H, Loge JH, Grotmol KS, Kaasa S, Kiserud CE, Salvesen Ø, Hjermstad MJ. Symptoms in the general Norwegian adult population - prevalence and associated factors. BMC Public Health 2020; 20:988. [PMID: 32576168 PMCID: PMC7310321 DOI: 10.1186/s12889-020-09109-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients´ own perceptions and evaluations of symptoms, functioning and other health-related factors, i.e. Patient Reported Outcomes (PROs), are important elements for providing good patient care. Symptoms are subjective and best elicited by the patient orally or by using PRO measures (PROMs), be it on paper, or as electronic assessment tools. Reference values on frequently used PROMs facilitate the interpretation of scores for use in clinics and research settings, by comparing patient data with relevant samples from the general population. Study objectives were to (1) present reference values for the M.D. Anderson Symptom Inventory (MDASI) (2) examine the occurrence and intensity of symptoms assessed by the MDASI in a general Norwegian adult population sample, and (3) examine factors associated with higher symptom burden defined as the sum score of all symptoms, and factors associated with symptoms` interference on functions. METHODS In 2015, MDASI was sent by mail as part of a larger survey, to a representative sample of the general Norwegian adult population (N = 6165). Medical comorbidities were assessed by the Self-Administered Comorbidity Questionnaire. Depression was self-reported on the Patient Health Questionnaire 9 (PHQ-9). Linear multivariable regression analysis was used to examine for factors associated with MDASI sum score and factors associated with symptoms' interference on functions. RESULTS The response rate was 36%. More women (54%) than men (46%) responded. Mean age was 55 years (SD 14). The most frequent symptoms were fatigue (59.7%), drowsiness (56.2%) and pain (56.1%). Fatigue, pain and disturbed sleep had the highest mean scores. The presence of one or more comorbidities, increasing PHQ-9 score and lower level of education were associated with higher MDASI sum score (p < 0.001). The MDASI sum score and the PHQ-9 score were positively associated with all interference items (p < 0.001) except for walking (p = 0.22). CONCLUSION This study provides the first Norwegian reference values for MDASI. The presence of one or more comorbidities, higher level of depressive symptoms and lower level of education were significantly associated with higher MDASI sum score. These covariates must be controlled for when using the reference values.
Collapse
Affiliation(s)
- Hilde Krogstad
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway. .,Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Jon Håvard Loge
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kjersti S Grotmol
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cecilie E Kiserud
- National advisory unit for late effects after cancer treatment, Oslo University Hospital, and University of Oslo, Oslo, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
259
|
Bull KS, Hornsey S, Kennedy CR, Darlington ASE, Grootenhuis MA, Hargrave D, Liossi C, Shepherd JP, Walker DA, Morris C. Systematic review: measurement properties of patient-reported outcome measures evaluated with childhood brain tumor survivors or other acquired brain injury. Neurooncol Pract 2020; 7:277-287. [PMID: 32537177 DOI: 10.1093/nop/npz064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Survivors of childhood brain tumors or other acquired brain injury (ABI) are at risk of poor health-related quality of life (HRQoL); its valid and reliable assessment is essential to evaluate the effect of their illness on their lives. The aim of this review was to critically appraise psychometric properties of patient-reported outcome measures (PROMs) of HRQoL for these children, to be able to make informed decisions about the most suitable PROM for use in clinical practice. Methods We searched MEDLINE, EMBASE, and PsycINFO for studies evaluating measurement properties of HRQoL PROMs in children treated for brain tumors or other ABI. Methodological quality of relevant studies was evaluated using the consensus-based standards for the selection of health status measurement instruments checklist. Results Eight papers reported measurement properties of 4 questionnaires: Health Utilities Index (HUI), PedsQL Core and Brain Tumor Modules, and Child and Family Follow-up Survey (CFFS). Only the CFFS had evidence of content and structural validity. It also demonstrated good internal consistency, whereas both PedsQL modules had conflicting evidence regarding this. Conflicting evidence regarding test-retest reliability was reported for the HUI and PedsQL Core Module only. Evidence of measurement error/precision was favorable for HUI and CFFS and absent for both PedsQL modules. All 4 PROMs had some evidence of construct validity/hypothesis testing but no evidence of responsiveness to change. Conclusions Valid and reliable assessment is essential to evaluate impact of ABI on young lives. However, measurement properties of PROMs evaluating HRQoL appropriate for this population require further evaluation, specifically construct validity, internal consistency, and responsiveness to change.
Collapse
Affiliation(s)
- Kim S Bull
- Clinical and Experimental Sciences, University of Southampton, UK
| | - Samantha Hornsey
- Primary Care, Population Sciences, and Medical Education, University of Southampton, UK
| | - Colin R Kennedy
- Clinical and Experimental Sciences, University of Southampton, UK
| | | | - Martha A Grootenhuis
- Psychosocial Research and Healthcare Innovation, Princess Máxima Centre for Paediatric Oncology, Utrecht, NL
| | - Darren Hargrave
- UCL Great Ormond Street Institute of Child Health, University College London, UK.,Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London,UK
| | - Christina Liossi
- Psychology, University of Southampton, UK.,Pain Control Service, Great Ormond Street Hospital for Children NHS Trust, UK
| | - Jonathan P Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, UK
| | - David A Walker
- Children's Brain Tumour Research Centre, University of Nottingham, UK
| | - Christopher Morris
- The Peninsula Childhood Disability Research Unit, University of Exeter, UK
| |
Collapse
|
260
|
Mamguem Kamga A, Di Martino C, Anota A, Paget-Bailly S, Coutant C, Arveux P, Desmoulins I, Dabakuyo-Yonli TS. Impact of routine assessment of health-related quality of life coupled with therapeutic information on compliance with endocrine therapy in patients with non-metastatic breast cancer: protocol for a randomized controlled trial. Trials 2020; 21:527. [PMID: 32546198 PMCID: PMC7296931 DOI: 10.1186/s13063-020-04397-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/08/2020] [Indexed: 01/02/2023] Open
Abstract
Background Despite its proven efficacy in reducing recurrence and improving survival, adherence to endocrine therapy (ET) is suboptimal in women with breast cancer (BC). Health-related quality of life (HRQoL) in BC has been widely studied and many positive effects have been highlighted. Recently, a link between HRQoL and compliance with ET has been suggested, which would suggest a potential role for HRQoL assessment in improving compliance with ET. With the advent of digital technologies, electronic collection of HRQoL on a tablet is now possible. Thus, we hypothesize that systematic HRQoL assessment (using a tablet, prior to each consultation, with presentation of scores to clinicians) coupled with therapeutic information could have an impact on 12-month compliance with ET in patients with non-metastatic BC. Methods In this study, we will include 342 women with non-metastatic hormone receptor–positive BC with an indication for treatment with ET. Patients will be randomly assigned 1:1 by minimization and stratified by age, stage, type of ET prescribed, and presence of comorbidities (or not) in two arms. The intervention will consist of numerical HRQoL assessment using the CHES (Computer-based Health Evaluation System) software before each consultation (with delivery of scores to clinicians) coupled with therapeutic information. Therapeutic information will consist of three workshops related to understanding the prescription, nutrition, and fatigue. A reminder letter will be sent to patients every month. Patients in the control group will follow standard care. HRQoL will be assessed using a classic “paper-pencil” collection at baseline in both arms to ensure comparability between arms and at 12 months. The primary endpoint is 12-month compliance with ET. Patient satisfaction with care and the clinicians’ perception of the usefulness of routine HRQoL assessment will also be assessed. Discussion This study will allow clinicians to identify and better understand the areas in which patients who receive ET have difficulties and thus it will assist clinicians with patient management. Systematic evaluation of HRQoL could provide an additional endpoint for measuring patients’ health status and treatment-related symptoms, including ET. If the results of this study are positive, this intervention could be proposed as an integral part of daily clinical practice in patients who receive ET. Trial registration ClinicalTrials.govNCT04176809. Registered Nov. 25, 2019.
Collapse
Affiliation(s)
- Ariane Mamguem Kamga
- Epidemiology and Quality of Life Research Unit, INSERM U1231, Georges Francois Leclerc Centre - UNICANCER, 1 rue du Professeur Marion, Dijon Cedex, 21000, France
| | - Cyril Di Martino
- Georges François Leclerc Centre - UNICANCER, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Amelie Anota
- Methodological and Quality of Life Unit in Oncology, University Hospital Of Besançon, 3 Boulevard Alexandre Fleming, Besançon, 25000, France.,INSERM, EFS BFC, UMR1098, Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire ET Génique, University Bourgogne Franche-Comté, 32 Avenue de l'Observatoire, Besançon, 25000, France.,National Quality of Life and Cancer Platform, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Sophie Paget-Bailly
- Methodological and Quality of Life Unit in Oncology, University Hospital Of Besançon, 3 Boulevard Alexandre Fleming, Besançon, 25000, France.,INSERM, EFS BFC, UMR1098, Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire ET Génique, University Bourgogne Franche-Comté, 32 Avenue de l'Observatoire, Besançon, 25000, France
| | - Charles Coutant
- Surgery Department, Georges François Leclerc Centre - UNICANCER, 1 rue du Professeur Marion, Dijon, 21000, France.,Burgundy Franche-Comté University, 7 Boulevard Jeanne d'Arc, Dijon, 21000, France
| | - Patrick Arveux
- Epidemiology and Quality of Life Research Unit, INSERM U1231, Georges Francois Leclerc Centre - UNICANCER, 1 rue du Professeur Marion, Dijon Cedex, 21000, France.,Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, University Paris-Sud, UVSQ Gustave Roussy, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Isabelle Desmoulins
- Medical Oncology Unit, Centre Georges-François Leclerc Centre - UNICANCER, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Epidemiology and Quality of Life Research Unit, INSERM U1231, Georges Francois Leclerc Centre - UNICANCER, 1 rue du Professeur Marion, Dijon Cedex, 21000, France. .,National Quality of Life and Cancer Platform, 1 rue du Professeur Marion, Dijon, 21000, France.
| |
Collapse
|
261
|
Lugtenberg RT, Fischer MJ, de Jongh F, Kobayashi K, Inoue K, Matsuda A, Kubota K, Weijl N, Yamaoka K, Ramai SRS, Nortier JWR, Putter H, Gelderblom H, Kaptein AA, Kroep JR. Using a quality of life (QoL)-monitor: preliminary results of a randomized trial in Dutch patients with early breast cancer. Qual Life Res 2020; 29:2961-2975. [PMID: 32529343 PMCID: PMC7591431 DOI: 10.1007/s11136-020-02549-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Abstract
Purpose The diagnosis and treatment of cancer negatively affect patients’ physical, functional and psychological wellbeing. Patients’ needs for care cannot be addressed unless they are recognized by healthcare providers (HCPs). The use of quality of life (QoL) assessments with feedback to HCPs might facilitate the identification and discussion of QoL-topics. Methods 113 patients with stage I–IIIB breast cancer treated with chemotherapy were included in this randomized controlled trial. Patients were randomly allocated to receive either usual care, or usual care with an intervention consisting of a QoL-monitor assessing QoL, distress and care needs before every chemotherapy cycle visit. Patients completed questionnaires regarding QoL, illness perceptions, self-efficacy, and satisfaction with communication. From the 2nd visit onwards, patients in the intervention arm and their HCPs received a copy of the QoL overview and results were shown in patients’ medical files. Audio-recordings and patients’ self-reports were used to investigate effects on communication, patient management and patient-wellbeing. A composite score for communication was calculated by summing the number of QoL-topics discussed during each consultation. Results Use of the QoL-monitor resulted in a higher communication score (0.7 topics increase per visit, p = 0.04), especially regarding the disease-specific and psychosocial issues (p < 0.01). There were no differences in patient management, QoL, illness perceptions or distress. Patients in the experimental arm (n = 60) had higher scores on satisfaction with communication (p < 0.05). Conclusions Use of a QoL-monitor during chemotherapy in patients with early breast cancer might result in a more frequent discussion of QoL-topics, associated with high levels of patients’ satisfaction. Electronic supplementary material The online version of this article (10.1007/s11136-020-02549-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- R T Lugtenberg
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - M J Fischer
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - F de Jongh
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Kobayashi
- Department of Respiratory Medicine, Saitama International Medical Center, Saitama, Japan
| | - K Inoue
- Division of Breast Oncology, Saitama Cancer Center, Saitama, Japan
| | - A Matsuda
- Department of Hygiene and Public Health, Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - K Kubota
- Department of Pulmonary Medicine and Oncology, Nippon Medical School, Saitama, Japan
| | - N Weijl
- Department of Medical Oncology, HMC Bronovo Hospital, The Hague, The Netherlands
| | - K Yamaoka
- Department of Hygiene and Public Health, Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - S R S Ramai
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W R Nortier
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - A A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| |
Collapse
|
262
|
Richards HS, Blazeby JM, Portal A, Harding R, Reed T, Lander T, Chalmers KA, Carter R, Singhal R, Absolom K, Velikova G, Avery KNL. A real-time electronic symptom monitoring system for patients after discharge following surgery: a pilot study in cancer-related surgery. BMC Cancer 2020; 20:543. [PMID: 32522163 PMCID: PMC7285449 DOI: 10.1186/s12885-020-07027-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Advances in peri-operative care of surgical oncology patients result in shorter hospital stays. Earlier discharge may bring benefits, but complications can occur while patients are recovering at home. Electronic patient-reported outcome (ePRO) systems may enhance remote, real-time symptom monitoring and detection of complications after hospital discharge, thereby improving patient safety and outcomes. Evidence of the effectiveness of ePRO systems in surgical oncology is lacking. This pilot study evaluated the feasibility of a real-time electronic symptom monitoring system for patients after discharge following cancer-related upper gastrointestinal surgery. Methods A pilot study in two UK hospitals included patients who had undergone cancer-related upper gastrointestinal surgery. Participants completed the ePRO symptom-report at discharge, twice in the first week and weekly post-discharge. Symptom-report completeness, system actions, barriers to using the ePRO system and technical performance were examined. The ePRO surgery system is an online symptom-report that allows clinicians to view patient symptom-reports within hospital electronic health records and was developed as part of the eRAPID project. Clinically derived algorithms provide patients with tailored self-management advice, prompts to contact a clinician or automated clinician alerts depending on symptom severity. Interviews with participants and clinicians determined the acceptability of the ePRO system to support patients and their clinical management during recovery. Results Ninety-one patients were approached, of which 40 consented to participate (27 male, mean age 64 years). Symptom-report response rates were high (range 63–100%). Of 197 ePRO completions analysed, 76 (39%) triggered self-management advice, 72 (36%) trigged advice to contact a clinician, 9 (5%) triggered a clinician alert and 40 (20%) did not require advice. Participants found the ePRO system reassuring, providing timely information and advice relevant to supporting their recovery. Clinicians regarded the system as a useful adjunct to usual care, by signposting patients to seek appropriate help and enhancing their understanding of patients’ experiences during recovery. Conclusion Use of the ePRO system for the real-time, remote monitoring of symptoms in patients recovering from cancer-related upper gastrointestinal surgery is feasible and acceptable. A definitive randomised controlled trial is needed to evaluate the impact of the system on patients’ wellbeing after hospital discharge.
Collapse
Affiliation(s)
- H S Richards
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - J M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.,Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - A Portal
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - R Harding
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - T Reed
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - T Lander
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - K A Chalmers
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - R Carter
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, St James's Hospital, Leeds, LS9 7TF, UK
| | - R Singhal
- Queen Elizabeth Hospital Birmingham, Mindelson Way, Edgbaston, Birmingham, B15 2WB, UK
| | - K Absolom
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, St James's Hospital, Leeds, LS9 7TF, UK
| | - G Velikova
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research at St James's, University of Leeds, St James's Hospital, Leeds, LS9 7TF, UK
| | - K N L Avery
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| |
Collapse
|
263
|
Lindner OC, Boon IS, Joffe J, Stark D. Evaluation of the "Shared Community Follow-up" after a germ cell tumour-A novel initiative for remote cancer follow-up enhanced by online patient-reported outcome measures. Eur J Cancer Care (Engl) 2020; 29:e13264. [PMID: 32495464 DOI: 10.1111/ecc.13264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 03/11/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Replying to germ cell tumour patients' needs, we implemented "Shared Community Follow-up"-a collaborative initiative, enabling remote delivery of specialist cancer care across large geographical areas. Blood, radiological investigations and patient-reported outcome measures (PROMs) are completed remotely and integrated within the electronic patient records for specialist review without patients requiring appointments. We describe the service evaluation estimating the feasibility, safety and acceptability of this initiative versus traditional Standard Follow-up. METHODS This cross-sectional evaluation estimated feasibility (uptake, adherence) and safety (via missed appointments, timeliness, cancellations) using routinely collected service process data. An acceptability questionnaire, evaluating patient satisfaction, was administered to 91 patients. RESULTS The new service is feasible. Across 2 years (2014-2016), uptake increased 54% (N = 123 to N = 270) and only 4.8% (N = 13) of patients were non-adherent. Fewer missed/cancelled investigations (N = 39, 5.9% vs. N = 566, 85.5%), timelier investigations (seven vs. 14 timely investigations) and equal relapse detection suggest its safety. PROMs replaced 3 appointments/patient. Patients were as satisfied with both services (3.4/4 vs. 3.6/4). CONCLUSION New follow-up services, with investigations completed remotely and shared between community providers and cancer centres, offer an alternative to traditional appointments with advantages for patients and the National Health Service.
Collapse
Affiliation(s)
- Oana C Lindner
- Patient-Centred Outcomes Research Group, Leeds Institute of Medical Research at St. James's University Hospital, School of Medicine, University of Leeds, Leeds, UK
| | - Ian S Boon
- Leeds Institute for Medical Research at St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Johnathan Joffe
- Leeds Institute for Medical Research at St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dan Stark
- Patient-Centred Outcomes Research Group, Leeds Institute of Medical Research at St. James's University Hospital, School of Medicine, University of Leeds, Leeds, UK.,Leeds Institute for Medical Research at St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
264
|
Wiltink LM, White K, King MT, Rutherford C. Systematic review of clinical practice guidelines for colorectal and anal cancer: the extent of recommendations for managing long-term symptoms and functional impairments. Support Care Cancer 2020; 28:2523-2532. [PMID: 32025805 PMCID: PMC7181546 DOI: 10.1007/s00520-020-05301-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/09/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Due to increasing numbers of colorectal and anal cancer survivors, more individuals are living with long-term symptoms after treatment. A systematic review was undertaken to assess the extent to which practice guidelines for colorectal and anal cancer provide recommendations for managing long-term symptoms and functioning impairments. METHODS Four electronic databases and websites of 30 international cancer societies were searched for clinical practice guidelines, consensus statements, or best practice recommendations for colorectal or anal cancer. Quality of included guidelines was evaluated with the Appraisal of Guidelines for Research & Evaluation II tool. Results were narratively summarized. RESULTS We included 51 guidelines or consensus statements. Recommendations for managing long-term symptoms or functioning impairments were reported in 13 guidelines (25.4%). All 13 recommend a healthy lifestyle, diet, body weight, and physical activity. The ASCO Colorectal Cancer Survivorship Care Guideline is the most comprehensive, including interventions targeting sexual and bowel function to pain and cognitive issues, and also highlights limited evidence for informing management strategies. Other guidelines recommend treating incontinence, chronic diarrhea, and distress, and stress the need for greater awareness for sexual dysfunction, survivorship clinics, and referrals to specific supportive care interventions. CONCLUSIONS Few clinical practice guidelines include recommendations for managing long-term symptoms and functioning impairments. It is unclear if this is due to limited evidence or absence of management strategies and interventions. Clear recommendations for managing long-term symptoms and functioning to help health professionals in supporting colorectal and anal cancer survivors are needed.
Collapse
Affiliation(s)
- Lisette M Wiltink
- School of Psychology, Quality of Life Office, Faculty of Science, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, Sydney, NSW, 2006, Australia.
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands.
| | - K White
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - M T King
- School of Psychology, Quality of Life Office, Faculty of Science, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, Sydney, NSW, 2006, Australia
| | - C Rutherford
- School of Psychology, Quality of Life Office, Faculty of Science, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, Sydney, NSW, 2006, Australia
- Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
265
|
Ector GI, Westerweel PE, Hermens RP, Braspenning KA, Heeren BC, Vinck OM, de Jong JJ, Janssen JJ, Blijlevens NM. The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach. J Med Internet Res 2020; 22:e15895. [PMID: 32412424 PMCID: PMC7260663 DOI: 10.2196/15895] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/11/2020] [Accepted: 02/07/2020] [Indexed: 12/23/2022] Open
Abstract
Background With the global rise in chronic health conditions, health care is transforming, and patient empowerment is being emphasized to improve treatment outcomes and reduce health care costs. Patient-centered innovations are needed. We focused on patients with chronic myeloid leukemia (CML), a chronic disease with a generally good long-term prognosis because of the advent of tyrosine kinase inhibitors. However, both medication adherence by patients and guideline adherence by physicians are suboptimal, unnecessarily jeopardizing treatment outcomes. Objective The aim of this study was to develop a patient-centered innovation for patients with CML using a design thinking methodology. Methods The 5 phases of design thinking (ie, empathize, define, ideate, prototype, and test) were completed, and each phase started with the patient. Stakeholders and end users were identified and interviewed, and observations in the care system were made. Using tools in human-centered design, problems were defined and various prototypes of solutions were generated. These were evaluated by patients and stakeholders and then further refined. Results The patients desired (1) insights into their own disease; (2) insights into the symptoms experienced, both in terms of knowledge and comprehension; and (3) improvements in the organization of care delivery. A web-based platform, CMyLife, was developed and pilot-tested. It has multiple features, all targeting parts of the bigger solution, including a website with reliable information and a forum, a guideline app, personal medical records with logs of symptoms and laboratory results (including a molecular marker and linked to the guideline app), tailored feedback based on the patients’ symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home. Conclusions The multifeatured innovation, CMyLife, was developed in a multidisciplinary way and with active patient participation. The aim of developing CMyLife was to give patients the tools to monitor their results, interpret these results, and act on them. With this tool, they are provided with the know-how to consider their results in relation to their personal care process. Whether CMyLife achieves its goal and the evaluation of the added value will be the focus of future studies. CML could become the first malignancy for which patients are able to monitor and manage their disease by themselves.
Collapse
Affiliation(s)
- Geneviève Icg Ector
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter E Westerweel
- Department of Hematology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Rosella Pmg Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karin Ae Braspenning
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Barend Cm Heeren
- REshape Innovation Center, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Jan Jm de Jong
- Dutch Patient Advocacy Group 'Hematon', Utrecht, Netherlands
| | - Jeroen Jwm Janssen
- Department of Hematology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Nicole Ma Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
266
|
Diagnosing deficits in quality of life and providing tailored therapeutic options: Results of a randomised trial in 220 patients with colorectal cancer. Eur J Cancer 2020; 130:102-113. [DOI: 10.1016/j.ejca.2020.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/09/2020] [Accepted: 01/23/2020] [Indexed: 12/24/2022]
|
267
|
Jim HSL, Hoogland AI, Brownstein NC, Barata A, Dicker AP, Knoop H, Gonzalez BD, Perkins R, Rollison D, Gilbert SM, Nanda R, Berglund A, Mitchell R, Johnstone PAS. Innovations in research and clinical care using patient-generated health data. CA Cancer J Clin 2020; 70:182-199. [PMID: 32311776 PMCID: PMC7488179 DOI: 10.3322/caac.21608] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Patient-generated health data (PGHD), or health-related data gathered from patients to help address a health concern, are used increasingly in oncology to make regulatory decisions and evaluate quality of care. PGHD include self-reported health and treatment histories, patient-reported outcomes (PROs), and biometric sensor data. Advances in wireless technology, smartphones, and the Internet of Things have facilitated new ways to collect PGHD during clinic visits and in daily life. The goal of the current review was to provide an overview of the current clinical, regulatory, technological, and analytic landscape as it relates to PGHD in oncology research and care. The review begins with a rationale for PGHD as described by the US Food and Drug Administration, the Institute of Medicine, and other regulatory and scientific organizations. The evidence base for clinic-based and remote symptom monitoring using PGHD is described, with an emphasis on PROs. An overview is presented of current approaches to digital phenotyping or device-based, real-time assessment of biometric, behavioral, self-report, and performance data. Analytic opportunities regarding PGHD are envisioned in the context of big data and artificial intelligence in medicine. Finally, challenges and solutions for the integration of PGHD into clinical care are presented. The challenges include electronic medical record integration of PROs and biometric data, analysis of large and complex biometric data sets, and potential clinic workflow redesign. In addition, there is currently more limited evidence for the use of biometric data relative to PROs. Despite these challenges, the potential benefits of PGHD make them increasingly likely to be integrated into oncology research and clinical care.
Collapse
Affiliation(s)
- Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Anna Barata
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Randa Perkins
- Department of Clinical Informatics and Clinical Systems, Moffitt Cancer Center, Tampa, Florida
| | - Dana Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Scott M Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ronica Nanda
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
- BayCare Health Systems Inc, Morton Plant Hospital, Clearwater, Florida
| | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Ross Mitchell
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | | |
Collapse
|
268
|
DeWees TA, Mazza GL, Golafshar MA, Dueck AC. Investigation Into the Effects of Using Normal Distribution Theory Methodology for Likert Scale Patient-Reported Outcome Data From Varying Underlying Distributions Including Floor/Ceiling Effects. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:625-631. [PMID: 32389228 DOI: 10.1016/j.jval.2020.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/14/2019] [Accepted: 01/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Utilization of parametric or nonparametric methods for testing Likert scale data is often debated. This 2-part simulation study aims to investigate the sampling distribution of various Likert scale distributions (including floor/ceiling effects) and analyze the effectiveness of using parametric versus nonparametric tests with varying sample sizes. METHODS We simulated populations from parametric distributions binned into Likert scales. In study 1, replicates were sampled from each distribution with sizes ranging from 5 to 150 observations, calculating means with simulated 95% CIs at each sample size. In study 2, floor/ceiling effects were introduced such that the proportion of patients responding with the lowest rating varied from approximately 40% to 90%. Two-sample tests were then conducted for the 90% floor effect distribution against all other floor distributions to determine effectiveness of parametric versus nonparametric methods via 2-sided pooled t tests and Wilcoxon rank-sum tests. Coverage of the difference in means, realized P values, relative efficiency, measures of agreement in direction, and conclusion of tests were plotted by sample size. RESULTS The sampling distributions of the 1-sample means and SDs for most distributions converged quickly to Gaussian, with 95% coverage. One- and 2-sample t tests of the mean demonstrated acceptable coverage, type I error, and agreement. CONCLUSIONS Simulations confirm that the sampling distribution of the mean rapidly approaches normality and appropriate tests provide adequate coverage and type I error. Two-sample t tests demonstrate appropriateness and increased statistical power gained by using parametric over nonparametric approaches, suggesting t tests should be implemented with few restrictions.
Collapse
Affiliation(s)
- Todd A DeWees
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA.
| | - Gina L Mazza
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
269
|
Taarnhøj GA, Johansen C, Lindberg H, Basch E, Dueck A, Pappot H. Patient reported symptoms associated with quality of life during chemo- or immunotherapy for bladder cancer patients with advanced disease. Cancer Med 2020; 9:3078-3087. [PMID: 32154663 PMCID: PMC7196058 DOI: 10.1002/cam4.2958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Bladder cancer (BC) patients with advanced disease have poor outcomes. The use of patient-reported outcomes (PROs) could lead to improvements in symptom management and hence quality of life (QoL). The aim of this study is to report correlations between selected PROs and QoL and thus to present symptoms that influence QoL. Identification of these symptoms during treatment can lead to earlier symptom management and thus secure improvements in QoL. METHODS BC patients in chemo- or immunotherapy for locally advanced or metastatic disease reported weekly PROs for the duration of their treatment. The PROs included EORTC QLQ-C30 and QLQ-BLM30 and 45 selected PRO-CTCAE items. Spearman's correlation analysis was performed for all PRO-CTCAE items and QLQ-C30 global QoL and subdomains. RESULTS In this study, 78 BC patients reported 724 questionnaires. Spearman's analysis showed significant correlations between almost all PRO-CTCAE items and the expected domain of QoL. The PRO-CTCAE items with the strongest correlations with QoL were anxiety (F, frequency item) and emotional function (rs = -0.603, P < .0001), concentration (S, severity item) and cognitive function (rs = -0.704, P < .0001), discouraged (F) and emotional function (rs = -0.659, P < .0001), fatigue (S) and role function (rs = -0.659, P < .0001) and sad (F) and emotional function (rs = -0.711, P < .0001). The weakest correlations were found for the PRO-CTCAE items urinary frequency, incontinence and urge, all with variations in the direction and significance of the correlations. CONCLUSIONS This study delivers information on which PROs may influence QoL for patients in clinical trials or daily clinic. Psychological issues have a strong impact on QoL and should be dealt with during treatment to secure the best possible QoL for BC patients.
Collapse
Affiliation(s)
- Gry A. Taarnhøj
- Department of OncologyUniversity Hospital of CopenhagenRigshospitaletCopenhagenDenmark
| | - Christoffer Johansen
- Department of OncologyUniversity Hospital of CopenhagenRigshospitaletCopenhagenDenmark
| | - Henriette Lindberg
- Department of OncologyUniversity Hospital of CopenhagenHerlev HospitalHerlevDenmark
| | - Ethan Basch
- Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel HillNCUSA
| | - Amylou Dueck
- Section of BiostatisticsMayo ClinicScottsdaleAZUSA
| | - Helle Pappot
- Department of OncologyUniversity Hospital of CopenhagenRigshospitaletCopenhagenDenmark
| |
Collapse
|
270
|
Prevalence of unmet palliative care needs in adults with cystic fibrosis. J Cyst Fibros 2020; 19:394-401. [DOI: 10.1016/j.jcf.2019.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022]
|
271
|
Crivelli F, Perfetti E, Sartorello B, Cantele V, Ostano P, Ilardi F, Di Massimo DS, Clerico M. Survey on symptoms in patients receiving chemotherapy in an Italian department of oncology: a comparison between period prevalences. Support Care Cancer 2020; 29:255-261. [PMID: 32346798 DOI: 10.1007/s00520-020-05486-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 04/20/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the prevalence over time of the measured side effects using a self-assessment questionnaire in normal clinical practice. METHODS The prevalence of symptoms reported by patients on the questionnaire was evaluated over two 1-year periods: from 1 June 2006 to 31 May 2007 and from 1 July 2013 to 30 June 2014. Descriptive statistics were used to describe population. The 2006-2007 and 2013-2014 datasets were compared with each other using the chi-squared test for equality of proportion, Pearson's chi-squared test, and chi-squared test for trend in proportion. RESULTS We analyzed 1974 questionnaires from 283 patients in 2006-2007 and 2619 questionnaires from 403 patients in 2013-2014. The most frequently encountered symptom in both periods was fatigue; nausea and constipation decreased in 2013-2014 compared with 2006-2007, while alopecia increased. CONCLUSIONS Using the self-assessment questionnaire in normal clinical practice has allowed us to carry out an accurate prevalence survey on symptoms in patients receiving chemotherapy that takes into account not only reports of the presence of symptoms but also of their absence. Between 2006-2007 and 2013-2014, there was an increase in patients treated at the Oncological Day Hospital of the Biella Hospital, whose characteristics were comparable in the two periods, except for the type of therapies carried out. Some symptoms were in decline: fatigue, nausea, and constipation.
Collapse
Affiliation(s)
- Francesca Crivelli
- S.C. Oncologia ASL BI, Fondazione Edo ed Elvo Tempia, Via dei Ponderanesi 2, Ponderano, 13875, Biella, BI, Italy.
| | - Elisa Perfetti
- S.C.Oncologia ASL BI, Via dei Ponderanesi 2, Ponderano, 13875, Biella, BI, Italy
| | - Barbara Sartorello
- S.C.Oncologia ASL BI, Via dei Ponderanesi 2, Ponderano, 13875, Biella, BI, Italy
| | | | - Paola Ostano
- Fondazione Edo ed Elvo Tempia, Via Malta 3, 13900, Biella, BI, Italy
| | - Francesco Ilardi
- Fondazione Edo ed Elvo Tempia, Via Malta 3, 13900, Biella, BI, Italy
| | | | - Mario Clerico
- S.C.Oncologia ASL BI, Via dei Ponderanesi 2, Ponderano, 13875, Biella, BI, Italy
| |
Collapse
|
272
|
Symptom Care at Home: A Comprehensive and Pragmatic PRO System Approach to Improve Cancer Symptom Care. Med Care 2020; 57 Suppl 5 Suppl 1:S66-S72. [PMID: 30531525 DOI: 10.1097/mlr.0000000000001037] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is growing recognition that systematically obtaining the patient's perspective on their health experience, using patient-reported outcomes (PRO), can be used to improve patient care in real time. Few PRO systems are designed to monitor and provide symptom management support between visits. Patients are instructed to contact providers between visits with their concerns, but they rarely do, leaving patients to cope with symptoms alone at home. We developed and tested an automated system, Symptom Care at Home (SCH), to address this gap in tracking and responding to PRO data in-between clinic visits. The purpose of this paper is to describe SCH as an example of a comprehensive PRO system that addresses unmet need for symptom support outside the clinic. METHODS FOR PRO SCORE INTERPRETATION SCH uses pragmatic, single-item measures for assessing symptoms, which are commonly used and readily interpretable for both patients and providers. We established alerting values for PRO symptom data, which was particularly important for conserving oncology providers' time in responding to daily PRO data. METHODS FOR DEVELOPING RECOMMENDATIONS FOR ACTING ON PRO RESULTS The SCH system provides automated, just-in-time self-management coaching tailored to the specific symptom pattern and severity levels reported in the daily call. In addition, the SCH system includes a provider decision support system for follow-up symptom assessment and intervention strategies. DISCUSSION SCH provides PRO monitoring, tailored automated self-management coaching, and alerts the oncology team of poorly controlled symptoms with a provider dashboard that includes evidence-based decision support for follow-up to improve individual patients' symptom care. We particularly emphasize our process for PRO selection, rationale for determining alerting thresholds, and the design of the provider dashboard and decision support. Currently, we are in the process of updating the SCH system, developing both web-based and app versions in addition to interactive voice response phone access and integrating the SCH system in the electronic health record.
Collapse
|
273
|
Nyrop KA, Deal AM, Reeve BB, Basch E, Chen YT, Park JH, Shachar SS, Carey LA, Reeder-Hayes KE, Dees EC, Jolly TA, Kimmick GG, Karuturi MS, Reinbolt RE, Speca JC, Lee JT, Wood WA, Muss HB. Congruence of patient- and clinician-reported toxicity in women receiving chemotherapy for early breast cancer. Cancer 2020; 126:3084-3093. [PMID: 32315091 DOI: 10.1002/cncr.32898] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/14/2020] [Accepted: 03/15/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events, collected alongside the clinician-reported Common Terminology Criteria for Adverse Events, enables comparisons of patient and clinician reports on treatment toxicity. METHODS In a multisite study of women receiving chemotherapy for early-stage breast cancer, symptom reports were collected on the same day from patients and their clinicians for 17 symptoms; their data were not shared with each other. The proportions of moderate, severe, or very severe patient-reported symptom severity were compared with the proportions of clinician-rated grade 2, 3, or 4 toxicity. Patient-clinician agreement was assessed via κ statistics. Chi-square tests investigated whether patient characteristics were associated with patient-clinician agreement. RESULTS Among 267 women, the median age was 58 years (range, 24-83 years), and 26% were nonwhite. There was moderate scoring agreement (κ = 0.413-0.570) for 53% of symptoms, fair agreement for 41% (κ = 0.220-0.378), and slight agreement for 6% (κ = 0.188). For example, patient-reported and clinician-rated percentages were 22% and 8% for severe or very severe fatigue, 41% and 46% for moderate fatigue, 32% and 39% for mild fatigue, and 6% and 7% for none. Clinician severity scores were lower for nonwhite patients in comparison with white patients for peripheral neuropathy, nausea, arthralgia, and dyspnea. CONCLUSIONS Although clinician reporting of symptoms is common practice in oncology, there is suboptimal agreement with the gold standard of patient self-reporting. These data provide further evidence supporting the integration of patient-reported outcomes into oncological clinical research and clinical practice to improve monitoring of symptoms as well as timely interventions for symptoms.
Collapse
Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina
| | - Ethan Basch
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yi Tang Chen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ji Hye Park
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine E Reeder-Hayes
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth C Dees
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor A Jolly
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Meghan S Karuturi
- The University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas
| | | | - JoEllen C Speca
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jordan T Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William A Wood
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
274
|
Nelson TA, Anderson B, Bian J, Boyd AD, Burton SV, Davis K, Guo Y, Harris BA, Hynes K, Kochendorfer KM, Liebovitz D, Martin K, Modave F, Moses J, Soulakis ND, Weinbrenner D, White SH, Rothrock NE, Valenta AL, Starren JB. Planning for patient-reported outcome implementation: Development of decision tools and practical experience across four clinics. J Clin Transl Sci 2020; 4:498-507. [PMID: 33948226 PMCID: PMC8057386 DOI: 10.1017/cts.2020.37] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 03/28/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist. METHODS To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors. RESULTS Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders. CONCLUSIONS Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.
Collapse
Affiliation(s)
| | | | - Jiang Bian
- University of Florida, Gainesville, FL, USA
| | | | | | | | - Yi Guo
- University of Florida, Gainesville, FL, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
275
|
Radionova N, Becker G, Mayer-Steinacker R, Gencer D, Rieger MA, Preiser C. The views of physicians and nurses on the potentials of an electronic assessment system for recognizing the needs of patients in palliative care. BMC Palliat Care 2020; 19:45. [PMID: 32247316 PMCID: PMC7129326 DOI: 10.1186/s12904-020-00554-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives Patients in oncological and palliative care (PC) often have complex needs, which require a comprehensive treatment approach. The assessment of patient-reported outcomes (PROs) has been shown to improve identification of patient needs and foster adjustment of treatment. This study explores occupational routines, attitudes and expectations of physicians and nurses with regards to a planned electronic assessment system of PROs. Methods Ten physicians and nine nurses from various PC settings in Southern Germany were interviewed. The interviews were analysed with qualitative content analysis. Results The interviewees were sceptical about the quality of data generated through a patient self-assessment system. They criticised the rigidity of the electronic assessment questionnaire, which the interviewees noted may not fit the profile of all palliative patients. They feared the loss of personal contact between medical staff and patients and favoured in-person conversation and on-site observations on site over the potential system. Interviewees saw potential in being able to discover unseen needs from some patients. Interviewees evaluated the system positively in the case that the system served to broadly orient care plans without affecting or reducing the patient-caregiver relationship. Conclusions A significant portion of the results touch upon the symbolic acceptance of the suggested system, which stands for an increasing standardisation and technisation of medicine where interpersonal contact and the professional expertise are marginalized. The study results can provide insight for processes and communication in the run-up to and during the implementation of electronic assessment systems.
Collapse
Affiliation(s)
- Natalia Radionova
- Institute for Occupational Medicine, Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstraße 27, D-72074, Tuebingen, Germany.
| | - Gerhild Becker
- Clinic for Palliative Care, Faculty of Medicine, Medical Centre University of Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Deniz Gencer
- Department of Medicine III, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Monika A Rieger
- Institute for Occupational Medicine, Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstraße 27, D-72074, Tuebingen, Germany.,Core Facility Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Christine Preiser
- Institute for Occupational Medicine, Social Medicine and Health Services Research, University Hospital Tuebingen, Wilhelmstraße 27, D-72074, Tuebingen, Germany.,Core Facility Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| |
Collapse
|
276
|
Das D, Wilfong L, Enright K, Rocque G. How Do We Align Health Services Research and Quality Improvement? Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32239962 DOI: 10.1200/edbk_281093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Quality improvement (QI) initiatives and health services research (HSR) are commonly used to target health care quality. These disciplines are increasingly important because of the movement toward value-based health care as alternative payment and care delivery models drive institutions and investigators to focus on reducing unnecessary health care use and improving care coordination. QI efforts frequently target medical error and/or efficiency of care through the Plan-Do-Study-Act methodology. Within the QI framework, strategies for data display (e.g., Pareto charts, run charts, histograms, scatter plots) are leveraged to identify opportunities for intervention and improvement. HSR is a multidisciplinary field of study that seeks to identify the most effective way to organize, deliver, and finance health care to maximize the quality and value of care at both the individual and population levels. HSR uses a diverse set of quantitative and qualitative methodologies, such as case-control studies, cohort studies, randomized control trials, and semistructured interview/focus group evaluations. This manuscript provides examples of methodologic approaches for QI and HSR, discusses potential challenges associated with concurrent quality efforts, and identifies strategies to successfully leverage the strengths of each discipline in care delivery.
Collapse
Affiliation(s)
- Devika Das
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL.,UAB Division of Hematology and Oncology, Birmingham, AL.,Birmingham VA Medical Center, Birmingham, AL
| | | | - Katherine Enright
- Carlo Fidani Regional Cancer Centre, Trillium Health Partners, Mississauga, Ontario, Canada.,University of Toronto, Division of Medical Oncology, Toronto, Ontario, Canada
| | - Gabrielle Rocque
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL.,UAB Division of Hematology and Oncology, Birmingham, AL.,UAB Division of Gerontology/Geriatrics/Palliative Care, Birmingham, AL
| |
Collapse
|
277
|
Riis CL, Jensen PT, Bechmann T, Möller S, Coulter A, Steffensen KD. Satisfaction with care and adherence to treatment when using patient reported outcomes to individualize follow-up care for women with early breast cancer - a pilot randomized controlled trial. Acta Oncol 2020; 59:444-452. [PMID: 32000559 DOI: 10.1080/0284186x.2020.1717604] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: The population of breast cancer survivors is increasing as a positive consequence of early detection and enhanced treatment. The disease and treatment associated side-effects or late-effects often impact on quality of life and daily life functions during survivorship. This calls for optimization of follow-up care. We aimed to evaluate the patients' satisfaction with the care provided, when using electronic patient reported outcomes (ePROs) to individualize follow-up care in women with early breast cancer receiving adjuvant endocrine therapy.Material and methods: Postmenopausal women treated for hormone receptor positive early breast cancer were included in a pilot randomized controlled trial and randomized to receive standard follow-up care with prescheduled consultations every six months or individualized follow-up care with the active use of ePROs to screen for the need of consultations. ePROs were distributed every third month over a two-year period. Primary outcomes were satisfaction with the assigned follow-up care and unmet needs. Secondary outcomes were use of consultations, adherence to treatment and quality of life.Results: Of the 207 consecutive patients who were potentially eligible for the study, 134 women were enrolled (65%). In total 64 women in standard care and 60 women in individualized care were analyzed. No statistically significant differences were reported in relation to satisfaction, unmet needs, adherence to treatment or quality of life. Women in standard care attended twice as many consultations during the two year follow-up period as women in individualized care; 4.3 (95% CI 3.9-4.7) versus 2.1 (95% CI: 1.6-2.6), p < .001.Conclusion: A significant reduction in consultations was observed for the group attending individualized care without compromising the patients' satisfaction, quality of life or adherence to treatment. For the majority of postmenopausal women treated for early breast cancer, implementation of ePROs to individualize follow-up care was feasible.
Collapse
Affiliation(s)
- Cathrine L. Riis
- Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle Denmark
| | - Pernille T. Jensen
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Troels Bechmann
- Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital
| | - Angela Coulter
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle Denmark
| | - Karina D. Steffensen
- Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle Denmark
| |
Collapse
|
278
|
Ahmed S, Barbera L, Bartlett SJ, Bebb DG, Brundage M, Bryan S, Cheung WY, Coburn N, Crump T, Cuthbertson L, Howell D, Klassen AF, Leduc S, Li M, Mayo NE, McKinnon G, Olson R, Pink J, Robinson JW, Santana MJ, Sawatzky R, Moxam RS, Sinclair S, Servidio-Italiano F, Temple W. A catalyst for transforming health systems and person-centred care: Canadian national position statement on patient-reported outcomes. Curr Oncol 2020; 27:90-99. [PMID: 32489251 PMCID: PMC7253746 DOI: 10.3747/co.27.6399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting. Methods The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice. Results The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care. Conclusions Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer.
Collapse
Affiliation(s)
- S Ahmed
- Quebec: Department of Medicine School of Physical and Occupational Therapy, McGill University, Montreal (Ahmed, Mayo); Faculty of Medicine, McGill University, and McGill University Health Systems, Montreal (Bartlett)
| | - L Barbera
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - S J Bartlett
- Quebec: Department of Medicine School of Physical and Occupational Therapy, McGill University, Montreal (Ahmed, Mayo); Faculty of Medicine, McGill University, and McGill University Health Systems, Montreal (Bartlett)
| | - D G Bebb
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - M Brundage
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - S Bryan
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - W Y Cheung
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - N Coburn
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - T Crump
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - L Cuthbertson
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - D Howell
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - A F Klassen
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - S Leduc
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - M Li
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - N E Mayo
- Quebec: Department of Medicine School of Physical and Occupational Therapy, McGill University, Montreal (Ahmed, Mayo); Faculty of Medicine, McGill University, and McGill University Health Systems, Montreal (Bartlett)
| | - G McKinnon
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - R Olson
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - J Pink
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - J W Robinson
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - M J Santana
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - R Sawatzky
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - R S Moxam
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - S Sinclair
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - F Servidio-Italiano
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - W Temple
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| |
Collapse
|
279
|
Abstract
PURPOSE Diagnosing cancer early is an imperative, as help-seeking delays affect survival. Quality of life (QoL) deteriorates after diagnosis, but decline may start when cancer is suspected at the earliest stage of the pathway to treatment. This study examined whether offering guided feedback about personal QoL to adults with potential cancer symptoms, living in deprived communities, changes QoL and promotes help-seeking in primary care. METHODS Visitors to a CRUK mobile cancer roadshow were recruited in 43 sites. A prospective longitudinal (2 × 2) repeated-measures design was applied. Where they presented a potential cancer symptom, and were 'signposted' to a GP, they were allocated to a symptom condition, or a lifestyle condition, if seeking cancer risk advice. Randomisation was to an Intervention group, who received feedback about personal QoL results (WHOQOL-BREF and WHOQOL importance measures), or a Control group who assessed QoL without feedback. Depression was screened. RESULTS Of 107 participants, the mean age was 53; 50% were women, 57% were without tertiary education, 66% were unemployed and 45% were currently ill. Over 10 weeks, 54% of all those with symptoms sought help from a medical source and 42% specifically from a GP. Thirty-one completed all three assessments. With symptoms present, psychological, social and environmental QoL were poor, becoming poorer over time. When the symptoms group received feedback, psychological QoL increased, but GP visits were unaffected. However, feedback increased help-seeking from informal social contacts. Lifestyle groups reported consistently good psychological and social QoL. CONCLUSION This early cancer research offers practical and theoretical implications for QoL interventions in deprived communities.
Collapse
|
280
|
Henson LA, Maddocks M, Evans C, Davidson M, Hicks S, Higginson IJ. Palliative Care and the Management of Common Distressing Symptoms in Advanced Cancer: Pain, Breathlessness, Nausea and Vomiting, and Fatigue. J Clin Oncol 2020; 38:905-914. [PMID: 32023162 PMCID: PMC7082153 DOI: 10.1200/jco.19.00470] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 12/27/2022] Open
Abstract
Good symptom management in oncology is associated with improved patient and family quality of life, greater treatment compliance, and may even offer survival advantages. With population growth and aging, the proportion of patients with multiple symptoms-both related and unrelated to their cancer-is anticipated to increase, supporting calls for a more routine and integrated approach to symptom management. This article presents a summary of the literature for the use of symptom assessment tools and reviews the management of four common and distressing symptoms commonly experienced by people with advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. We also discuss the role of palliative care in supporting a holistic approach to symptom management throughout the cancer trajectory.
Collapse
Affiliation(s)
- Lesley A. Henson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Catherine Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Martin Davidson
- King’s College Hospital National Health Service Foundation Trust, Denmark Hill, London, United Kingdom
| | - Stephanie Hicks
- King’s College Hospital National Health Service Foundation Trust, Denmark Hill, London, United Kingdom
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| |
Collapse
|
281
|
Racial differences in user experiences and perceived value of electronic symptom monitoring in a cohort of black and white bladder and prostate cancer patients. Qual Life Res 2020; 30:3213-3227. [PMID: 32112276 DOI: 10.1007/s11136-020-02442-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Electronic patient-reported outcomes (ePROs) are increasingly being used for symptom monitoring during routine cancer care, but have rarely been evaluated in diverse patient populations. We assessed ePRO user experiences and perceived value among Black and White cancer patients. METHODS We recruited 30 Black and 49 White bladder and prostate cancer patients from a single institution. Participants reported symptoms using either a web-based or automated telephone interface over 3 months and completed satisfaction surveys and qualitative interviews focused on user experiences and value. Using a narrative mixed methods approach, we evaluated overall and race-specific differences in ePRO user experiences and perceived value. RESULTS Most participants selected the web-based system, but Blacks were more likely to use the automated telephone-based system than Whites. In satisfaction surveys, Whites more commonly reported ease in understanding and reporting symptoms compared with Blacks. Blacks more often reported that the ePRO system was helpful in facilitating symptom-related discussions with clinicians. During interviews, Blacks described how the ePRO helped them recognize symptoms, while Whites found value in better understanding and tracking symptoms longitudinally. Blacks also expressed preferences for paper-based ePRO options due to perceived ease in better understanding of symptom items. CONCLUSION Electronic patient-reported outcomes are perceived as valuable for variable reasons by Black and White cancer populations, with greater perceived value for communicating with clinicians reported among Blacks. To optimize equitable uptake of ePROs, oncology practices should offer several ePRO options (e.g., web-based, phone-based), as well as paper-based options, and consider the e-health literacy needs of patients during implementation.
Collapse
|
282
|
Brundage MD, Wu AW, Rivera YM, Snyder C. Promoting effective use of patient-reported outcomes in clinical practice: themes from a "Methods Tool kit" paper series. J Clin Epidemiol 2020; 122:153-159. [PMID: 32061828 DOI: 10.1016/j.jclinepi.2020.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/03/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES "PRO-cision Medicine," using patients' reports of their symptoms, functioning, and well-being to personalize their care, is becoming more prevalent. Patient-reported outcomes (PROs) are assessed using standardized, validated measures. Research shows that clinicians' and patients' understanding of what the PRO scores mean and how to act on them is often suboptimal. Methods to improve interpretation of PRO scores and action based on PRO results can promote more effective use of PROs in practice. STUDY DESIGN AND SETTING A recent supplement to Medical Care describes various approaches to address challenges in interpreting and acting on PROs in practice and therefore serves as a "PRO-cision Medicine Methods Tool kit." This commentary provides an overview of the supplement and identifies cross-cutting themes guided by a theoretical framework. RESULTS Six papers describe methods for interpreting PROs, and eight papers describe how different PRO systems address interpreting PRO scores and/or acting on PRO results. Based on the theoretical framework, cross-cutting themes are described in terms of (1) providing PRO information, (2) using PRO data, (3) screening for problems and monitoring for changes, and (4) changing management and behavior. CONCLUSIONS The PRO-cision Medicine Methods Tool kit provides a useful resource for interpreting and acting on PRO scores to personalize patient care.
Collapse
Affiliation(s)
- Michael D Brundage
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Cancer Center of Southeastern Ontario at Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health and School of Medicine, Baltimore, MD, USA
| | - Yonaira M Rivera
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| |
Collapse
|
283
|
Skovlund PC, Ravn S, Seibaek L, Thaysen HV, Lomborg K, Nielsen BK. The development of PROmunication: a training-tool for clinicians using patient-reported outcomes to promote patient-centred communication in clinical cancer settings. J Patient Rep Outcomes 2020; 4:10. [PMID: 32048085 PMCID: PMC7013008 DOI: 10.1186/s41687-020-0174-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/13/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The value of using real-time patient-reported outcome (PRO) measures in cancer communication has gained attention both in the clinic and in research. Despite this, no internationally accepted guidelines or training programs for clinicians on how to engage in patient-centred communication based on PROs exist. Lack of training may complicate implementation and systematic use of PROs in the clinic. We aimed to develop a short and feasible manual and training session in PRO-based dialogue rooted in patient-centred communication, coined PROmunication. METHODS PROmunication was implemented in two studies using PROs in different clinical cancer settings. We interviewed clinicians twice during the development phase. First, adopting a clinical perspective, they provided ideas for content, length and structure of the training session and the manual. Second, they approved the draft of the manual with minor adjustments on how to document clinician-patient communication. The final version of the PROmunication tool was built on clinicians' input, theory on patient-centred communication, a literature review, and didactic considerations. RESULTS The one-page manual gave clinicians a brief and clear overview of how to prepare for, undergo and document a PRO-based consultation. Illustrations and verbal phrases were offered to operationalize and facilitate patient-centred communication. The training session included elements like evidence-based knowledge about the rationale, benefits and challenges of using PROs and comprised theory, experimental training and instructions for the use of the manual in clinical practice. Ad hoc training and feedback in the clinic followed the training session. CONCLUSIONS This paper presents the development of a short, theory-driven manual and training session intended to support and engage clinicians in PRO-based dialogue leading to patient-centred communication. Further testing of the tool is necessary and adjustments may be required if the PROmunication tool should be applied in other clinical settings were patients are seen regularly. An evaluation of the tool is planned to be performed in future studies. Training in PROmunication may further systematic and consistent use of PRO data in the consultation, leading to patient-centred consultations and increased patient involvement.
Collapse
Affiliation(s)
- Pernille C. Skovlund
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Sissel Ravn
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Lene Seibaek
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 137, 8200 Aarhus N, Denmark
| | - Henriette Vind Thaysen
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Kirsten Lomborg
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Berit Kjærside Nielsen
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Olof Palmes Allé 15, 8200 Aarhus N, Denmark
| |
Collapse
|
284
|
Patient-Reported Outcomes in Myelodysplastic Syndromes: the Move from Life Span to Health Span. Curr Hematol Malig Rep 2020; 15:149-154. [DOI: 10.1007/s11899-020-00562-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
285
|
Cohen ML, Hula WD. Patient-Reported Outcomes and Evidence-Based Practice in Speech-Language Pathology. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:357-370. [PMID: 32011905 DOI: 10.1044/2019_ajslp-19-00076] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The patient's perspective of their health is a core component of evidence-based practice (EBP) and person-centered care. Patient-reported outcomes (PROs), captured with PRO measures (PROMs), are the main way of formally soliciting and measuring the patient's perspective. Currently, however, PROs play a relatively small role in mainstream speech-language pathology practice. The purpose of this article is to raise important questions about how PROs could be applied to EBP in speech-language pathology for individuals with communication disorders and to propose preliminary approaches to address some of these questions. Method Based on a narrative review of the literature, this article introduces relevant terminology and broadly describes PRO applications in other health care fields. The article also raises questions related to PRO-informed clinical practice in speech-language pathology. To address some of these questions, the article explores previous research to provide suggestions for clinical administration, interpretation, and future research. Conclusion More routine measurement of subjective health constructs via PROMs-for example, constructs such as effort, participation, self-efficacy, and psychosocial functioning-may improve EBP. More routine use of PROMs could significantly expand the information that is available to clinicians about individual clients and add to the evidence base for the profession of speech-language pathology. However, careful consideration and more research are needed on how to capture and interpret PROs from individuals with cognitive and language disorders.
Collapse
Affiliation(s)
- Matthew L Cohen
- Department of Communication Sciences and Disorders and Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - William D Hula
- Geriatric Research, Education, and Clinical Center, VA Health Care System, and Department of Communication Sciences and Disorders, University of Pittsburgh, PA
| |
Collapse
|
286
|
Macnair A, Sharkey A, Le Calvez K, Walters R, Smith L, Nelson A, Staffurth J, Williams M, Bloomfield D, Maher J. The Trigger Project: The Challenge of Introducing Electronic Patient-Reported Outcome Measures Into a Radiotherapy Service. Clin Oncol (R Coll Radiol) 2020; 32:e76-e79. [DOI: 10.1016/j.clon.2019.09.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 11/26/2022]
|
287
|
Stonbraker S, Porras T, Schnall R. Patient preferences for visualization of longitudinal patient-reported outcomes data. J Am Med Inform Assoc 2020; 27:212-224. [PMID: 31670816 PMCID: PMC7025335 DOI: 10.1093/jamia/ocz189] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The study sought to design symptom reports of longitudinal patient-reported outcomes data that are understandable and meaningful to end users. MATERIALS AND METHODS We completed a 2-phase iterative design and evaluation process. In phase I, we developed symptom reports and refined them according to expert input. End users then completed a survey containing demographics, a measure of health literacy, and items to assess visualization preferences and comprehension of reports. We then collected participants' perspectives on reports through semistructured interviews and modified them accordingly. In phase II, refined reports were evaluated in a survey that included demographics, validated measures of health and graph literacy, and items to assess preferences and comprehension of reports. Surveys were administered using a think-aloud protocol. RESULTS Fifty-five English- and Spanish-speaking end users, 89.1% of whom had limited health literacy, participated. In phase I, experts recommended improvements and 20 end users evaluated reports. From the feedback received, we added emojis, changed date and font formats, and simplified the y-axis scale of reports. In phase II, 35 end users evaluated refined designs, of whom 94.3% preferred reports with emojis, the favorite being a bar graph combined with emojis, which also promoted comprehension. In both phases, participants literally interpreted reports and provided suggestions for future visualizations. CONCLUSIONS A bar graph combined with emojis was participants' preferred format and the one that promoted comprehension. Target end users must be included in visualization design to identify literal interpretations of images and ensure final products are meaningful.
Collapse
Affiliation(s)
| | - Tiffany Porras
- Columbia University School of Nursing, New York, New York, USA
| | - Rebecca Schnall
- Columbia University School of Nursing, New York, New York, USA
| |
Collapse
|
288
|
Binotto M, Reinert T, Werutsky G, Zaffaroni F, Schwartsmann G. Health-related quality of life before and during chemotherapy in patients with early-stage breast cancer. Ecancermedicalscience 2020; 14:1007. [PMID: 32104209 PMCID: PMC7039692 DOI: 10.3332/ecancer.2020.1007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 12/19/2022] Open
Abstract
Objectives Identify the main changes in the health-related quality of life (HRQoL) of women diagnosed with breast cancer (BC) undergoing chemotherapy. Methods Prospective cohort study that included 33 women diagnosed with clinical stages I–III BC and who underwent adjuvant chemotherapy. HRQoL was assessed using the EORTC QLQ-C30 and EORTC QLQ-BR23 instruments 1 week before the start of chemotherapy and during the third month of chemotherapy. Results There was a decline in the HRQoL scores of patients during treatment. Therefore, chemotherapy alters the patient’s perceptions of their HRQoL since there is a decrease in global health status/quality of life (QoL) and functional scales such as physical functioning, role functioning, emotional functioning, social functioning, body image, sexual function and sexual enjoyment. We also observed an increase in side effects related to the systemic therapy, fatigue, nausea and vomiting, insomnia, appetite loss and diarrhoea, despite a decrease in breast symptoms and arm symptoms. Conclusions HRQoL was negatively affected during chemotherapy. Even though HRQoL assessment is a useful method for optimising patients’ care, its implementation into clinical practice remains a challenge. Since side effects are very often underestimated, we consider that the evaluation of HRQoL parameters should be done for BC patients treated with chemotherapy.
Collapse
Affiliation(s)
- Monique Binotto
- Postgraduate Program in Clinical Research, Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, RS 90035-007, Brazil.,Centro de Pesquisa da Serra Gaúcha, CEPESG, Caxias do Sul, RS 95020-450, Brazil.,https://orcid.org/0000-0002-5799-5390
| | - Tomás Reinert
- Centro de Pesquisa da Serra Gaúcha, CEPESG, Caxias do Sul, RS 95020-450, Brazil.,https://orcid.org/0000-0003-4715-1415
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group, LACOG, Porto Alegre, RS 90619-900, Brazil.,https://orcid.org/0000-0001-6271-105X
| | - Facundo Zaffaroni
- Latin American Cooperative Oncology Group, LACOG, Porto Alegre, RS 90619-900, Brazil
| | - Gilberto Schwartsmann
- Postgraduate Program in Clinical Research, Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, RS 90035-007, Brazil.,https://orcid.org/0000-0002-7850-1644
| |
Collapse
|
289
|
Esham KS, Rodday AM, Smith HP, Noubary F, Weidner RA, Buchsbaum RJ, Parsons SK. Assessment of health-related quality of life among adults hospitalized with sickle cell disease vaso-occlusive crisis. Blood Adv 2020; 4:19-27. [PMID: 31891655 PMCID: PMC6960476 DOI: 10.1182/bloodadvances.2019000128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/25/2019] [Indexed: 01/25/2023] Open
Abstract
Sickle cell disease (SCD) is characterized by painful vaso-occlusive crises (VOCs). Self-reported pain intensity is often assessed with the Numeric Rating Scale (NRS), whereas newer patient-reported outcome measures (PROMs) assess multidimensional pain in SCD. We describe pain experiences among hospitalized adults with VOCs, using 2 PROMs: the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health and the Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me). Adults with SCD hospitalized with VOCs at 2 academic centers in Boston, Massachusetts, from April 2016 to October 2017 were eligible. Participants completed the NRS and PROMs at admission and 7 days postdischarge. PROM scores were described and compared with population norms. Length of stay (LOS) and 30-day readmission rates were assessed. Forty-two (96%) of 44 eligible patients consented and completed admission assessments. Mean age was 30.2 years (standard deviation, 9.1), 60% were women, 76% were non-Hispanic black, and 64% had hemoglobin SS. Twenty-seven participants (64%) completed postdischarge assessments. Sixty percent had ≥4 VOCs in the last year. Nearly all PROMIS Global Health and ASCQ-Me scores were worse than population norms. NRS and PROMIS Global Physical Health scores improved after discharge, the latter driven principally by improvements in pain. Overall median LOS was 7 days, and 30-day readmission rate was 40.5%. Administration of PROMs among adults with SCD hospitalized for VOCs is feasible and demonstrates participants experienced recurrent, prolonged, and severe VOCs. PROMIS Global and ASCQ-Me scores indicated substantial suffering, and the striking 30-day readmission rate highlights the vulnerability of these patients.
Collapse
Affiliation(s)
- Kimberly S Esham
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Hedy P Smith
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Farzad Noubary
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Ruth Ann Weidner
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Rachel J Buchsbaum
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA
| |
Collapse
|
290
|
Kerrigan K, Patel SB, Haaland B, Ose D, Weinberg Chalmers A, Haydell T, Meropol NJ, Akerley W. Prognostic Significance of Patient-Reported Outcomes in Cancer. JCO Oncol Pract 2020; 16:e313-e323. [PMID: 32048943 DOI: 10.1200/jop.19.00329] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Performance status (PS), an established prognostic surrogate of cancer survival, is a physician-synthesized metric of patient symptoms and mobility that is prone to bias and subjectivity. The National Cancer Institute (NCI) Patient-Reported Outcomes Measurement Information System-Cancer (PROMIS-Ca) Bank, a patient-centric patient-reported outcome (PRO) evaluation of physical function (PF), fatigue, depression, anxiety, and pain, shares subject matter with PS and, therefore, may also be prognostic while eliminating physician interpretation. METHODS Patients at Huntsman Cancer Institute were assessed using the NCI PROMIS-Ca Bank. Using tablets at routine office visits, PF, fatigue, depression, anxiety, and pain scores were collected from patients with advanced melanoma, non-small-cell lung cancer, colorectal cancer, and breast cancer. A PRO score collected at a single time point within 6 months of metastatic diagnosis for each patient was merged with curated clinical outcome data. The association of PROs, overall survival (OS), and hospitalization-free survival (HFS) were assessed in multivariable analysis that included sex and cancer type. RESULTS Two hundred eighty-two complete sets of patient data were available for analysis. All 5 PRO domains were strongly prognostic of OS and HFS. While the PRO domains were interrelated with moderate to strong correlations (0.40-0.79), multivariable regression suggested that PF was most strongly associated with the clinical outcomes of OS (P < .001) and HFS (P < .001). CONCLUSION NCI PROMIS-Ca PROs may be prognostic of both cancer survival and likelihood of hospitalization. Future prospective studies are needed for all major prognostic factors to fully understand the independent prognostic value of PROs.
Collapse
Affiliation(s)
| | - Shiven B Patel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Dominik Ose
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | | | - Wallace Akerley
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| |
Collapse
|
291
|
Quality of life considerations for patients with anterior and central skull base malignancies. J Neurooncol 2020; 150:501-508. [DOI: 10.1007/s11060-019-03367-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
|
292
|
Ivatury SJ, Hazard-Jenkins HW, Brooks GA, McCleary NJ, Wong SL, Schrag D. Translation of Patient-Reported Outcomes in Oncology Clinical Trials to Everyday Practice. Ann Surg Oncol 2020; 27:65-72. [PMID: 31452053 PMCID: PMC6925618 DOI: 10.1245/s10434-019-07749-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Clinical trials in oncology evaluating the effects of patient-reported outcomes (PRO) collection have found that monitoring of symptoms with PROs is associated with improved clinical care through reduced acute care utilization and decreased patient symptom burden. This educational review will evaluate strategies for systematic PRO integration into everyday oncology clinical practice. METHODS We outline key considerations for using PROs in clinical practice, highlighting evidence from published studies. We also discuss the benefits and challenges of PRO implementation in oncology. RESULTS Implementing PRO collection in clinical practice can improve care delivery and facilitate patient-centered clinical research. Considerations for using PROs in clinical practice include choice of instrument, method of delivery, and frequency of query. Challenges with implementing systematic PRO collection include the costs and resources needed for implementation, impact on clinical workflow, and controlling/monitoring physician burnout. CONCLUSIONS While challenges exist in terms of financial resources and staff participation/burnout, patient-reported outcomes in clinical practice provide a number of benefits, including symptom monitoring, clinical research, and potential real-time personalized clinical-decision support.
Collapse
Affiliation(s)
- Srinivas Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
- Geisel School of Medicine, Lebanon, NH, USA.
| | | | - Gabriel A Brooks
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine, Lebanon, NH, USA
| | | | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine, Lebanon, NH, USA
| | | |
Collapse
|
293
|
Shin JJ, Carroll TL, Prince AA, Landman AB. The Utility and Feasibility of Extending Beyond Traditional Patient Descriptions in Daily Practice. Laryngoscope 2019; 130 Suppl 3:S1-S13. [PMID: 31876293 DOI: 10.1002/lary.28467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/20/2019] [Accepted: 10/27/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Institutional and national programs have endorsed the use of validated instruments in daily practice, but their utility for frontline clinicians is unknown. Our first objective was thus to determine if routinely obtained patient descriptions accurately predict disease-specific validated instrument results. Our second objective was to assess the feasibility of deploying an electronic system to obtain and document patient-reported descriptions of health status. STUDY DESIGN Prospective assessment of consecutive eligible ambulatory care patients. METHODS For the first objective, patients presenting with the same chief complaint at consecutive visits provided concurrent routine symptom descriptions and validated instrument responses. To determine whether patients' routine descriptions predicted scores from disease-specific instruments, receiver operator characteristic (ROC) curves, sensitivity/specificity, Spearman ρ correlation, and regression models were utilized. For the second objective, feasibility assessment focused on percent with successful response capture, time to questionnaire completion, and impact on physician time needed to obtain and document patient histories. RESULTS For the first objective, among patients with hearing loss, eustachian tube dysfunction, nasal obstruction, and chronic rhinosinusitis, the areas under the ROC curves were 0.38 to 0.83. Spearman ρ coefficients were 0.25 to 0.46. Sensitivity and specificity ranged from 15.9% to 87.8%, with correct classification in 42.3% to 55.2% of cases. For the second objective, there was a 91% completion rate. Completion times were 7:18 to 12:37 for new patients and 3:23 to 6:41 for established patients. Physician time savings were estimated at 11 minutes per patient. CONCLUSIONS Using validated instruments and electronic data collection systems in daily practice has practical and clinical implications. These topics warrant further study. LEVEL OF EVIDENCE 2c Laryngoscope, 130:S1-S13, 2020.
Collapse
Affiliation(s)
- Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Thomas L Carroll
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Anthony A Prince
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Adam B Landman
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, U.S.A
| |
Collapse
|
294
|
Lagendijk M, Mittendorf E, King TA, Gibbons C, Pusic A, Dominici LS. Incorporating Patient-Reported Outcome Measures into Breast Surgical Oncology: Advancing Toward Value-Based Care. Oncologist 2019; 25:384-390. [PMID: 31848315 DOI: 10.1634/theoncologist.2019-0355] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Value in health care is defined as the health outcome achieved per unit of cost. For health care systems, improving value means achieving better outcomes at lower costs. Improving outcomes, including patient-reported outcomes (PROs), as well as more established metrics such as mortality and complication rates, ensures high-quality care. This is particularly true in breast cancer surgery, where survival and recurrence rates are comparable across different surgical approaches. Outcomes reflecting survivorship quality may therefore better inform decision making regarding surgical approaches. PROs can be assessed using validated instruments known as patient-reported outcome measures (PROMs). They are obtained directly from patients reflecting their health-related quality of life (HRQOL). Ongoing initiatives strive to define PROMs that accurately reflect HRQOL and demonstrate value, with the goal of establishing benchmarks for quality of care. Clinicians caring for patients with breast cancer are well positioned to be involved in defining meaningful measures of value-based breast cancer care. This article reviews value-based breast cancer care in the context of locoregional therapy, with attention paid to the work done by the International Consortium of Health Outcome Measures in which a "standard set" of value-based patient-centered outcomes for breast cancer for international use is defined. In addition, an overview is provided of relevant PROMs and previously reported scores. Recommendations and future challenges for implementation of routine collection of PROs are also discussed. IMPLICATIONS FOR PRACTICE: Opportunity exists to act as early adopters of the routine collection of longitudinal patient-reported outcome data for breast cancer, allowing transition of current care to value-based cancer care.
Collapse
Affiliation(s)
- Mirelle Lagendijk
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Elizabeth Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Christopher Gibbons
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrea Pusic
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Laura S Dominici
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| |
Collapse
|
295
|
Lungu DA, Pennucci F, De Rosis S, Romano G, Melfi F. Implementing successful systematic Patient Reported Outcome and Experience Measures (PROMs and PREMs) in robotic oncological surgery-The role of physicians. Int J Health Plann Manage 2019; 35:773-787. [PMID: 31793689 DOI: 10.1002/hpm.2959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/04/2023] Open
Abstract
Patient Reported Outcome and Experience Measures (PROMs and PREMs) play an increasingly important role in monitoring the quality of the oncological pathway. The aim of this study is to describe the case of five hospitals a year after the adoption of PROMs and PREMs for robotic oncological colorectal surgery in Tuscany and to investigate how the clinicians can impact the process of implementation and the efficacy of such measures. We used 14 months of data from the five robotic centers in Tuscany. Above all, the physician's personal motivation to improve the treatment of patients, the teamwork, and the possibility to use data for research purposes proved to be the essential factors for their engagement and the successful implementation of patient reported measures. Physicians play a key role in the adoption of systematic PROMs and PREMs. The higher their level of engagement, the higher the collection success, both in terms of number of patients enrolled and response rates. Moreover, the collection of patient reported measures may become part of physicians' daily practice and may lead to a change in their relationship and communication with patients, as clinicians accept to have their job reviewed and are not afraid to be evaluated by their patients.
Collapse
Affiliation(s)
- Daniel Adrian Lungu
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Pennucci
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sabina De Rosis
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
296
|
|
297
|
Kall M, Marcellin F, Harding R, Lazarus JV, Carrieri P. Patient-reported outcomes to enhance person-centred HIV care. Lancet HIV 2019; 7:e59-e68. [PMID: 31776101 DOI: 10.1016/s2352-3018(19)30345-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/19/2022]
Abstract
Quality of life has been proposed as the fourth 90 to complement the UNAIDS 90-90-90 targets to monitor the global HIV response, highlighting a need to address the holistic needs of people living with HIV beyond viral suppression. This proposal has instigated a wider discussion about the use of patient-reported outcomes (PROs) to improve the treatment and care of an ageing HIV population with increasing comorbidities and a disproportionate burden of social problems. PROs can provide a first-hand assessment of the impact of HIV treatment and care on patients' quality of life, including symptoms. The field of PRO measures is rapidly expanding but still no gold standard exists, raising concerns about tool selection. Challenges also remain in the collection, interpretation, and use of PRO data to improve the performance of the health system. An emerging concern is how to adapt PROs to different sociocultural and geographical settings.
Collapse
Affiliation(s)
- Meaghan Kall
- HIV/STI Department, National Infection Service, Public Health England, London, UK.
| | - Fabienne Marcellin
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, Cicely Saunders Institute, Kings College London, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Patrizia Carrieri
- Aix Marseille University, Institut National de la Santé et de la Recherche Médicale, Institution Française Publique de Recherche, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| |
Collapse
|
298
|
Garcia SF, Wortman K, Cella D, Wagner LI, Bass M, Kircher S, Pearman T, Penedo FJ. Implementing electronic health record-integrated screening of patient-reported symptoms and supportive care needs in a comprehensive cancer center. Cancer 2019; 125:4059-4068. [PMID: 31373682 PMCID: PMC11345862 DOI: 10.1002/cncr.32172] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/19/2019] [Accepted: 03/20/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Oncology practice can be enhanced by the integration of the assessment of patient-reported symptoms and concerns into the electronic health record (EHR) and clinical workflows. METHODS Adult oncology outpatients (n = 6825) received 38,422 invitations to complete assessments through the EHR patient portal. Patient-Reported Outcomes Measurement Information System computer adaptive tests were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial, nutritional, and informational needs. In real time, assessment results were populated in the EHR, and clinicians were notified of elevated symptoms and needs. RESULTS In all, 3521 patients (51.6%) completed 8162 assessments; approximately 55% of the responding patients completed 2 or more within 32 months. Fatigue, pain, anxiety, and depression scores were comparable to those of the general population (approximately 5% of assessments triggered clinical alerts across those domains); mean scores indicated a lower level of physical function (with severe scores prompting alerts in nearly 5% of assessments). More than half of assessments triggered an alert based on patient endorsement of supportive care needs, with the majority of those being nutritional (41.82% of assessments). Patient endorsement of supportive care needs was associated with significantly higher anxiety, depression, fatigue, and pain interference scores and lower physical function scores. Patients who triggered clinical alerts tended to be younger and more recently diagnosed, to have greater comorbidities, and to be a racial/ethnic minority. Patients who triggered clinical alerts had more health care service encounters in the ensuing month. CONCLUSIONS EHR integration facilitated the assessment and reporting of patient-reported symptoms and needs within routine oncology outpatient care.
Collapse
Affiliation(s)
- Sofia F Garcia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Katy Wortman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David Cella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | | | - Michael Bass
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sheetal Kircher
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Timothy Pearman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Frank J Penedo
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| |
Collapse
|
299
|
Sandbergen L, Spriensma AS, de la Rosette JJ, Laguna MP. Health-related quality of life in localized renal masses: A matter of sparing nephrons or minimizing the incision? Urol Oncol 2019; 38:43.e1-43.e11. [PMID: 31711835 DOI: 10.1016/j.urolonc.2019.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/10/2019] [Accepted: 09/22/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Longitudinal assessment of health-related quality of life (HRQoL) differences in patients with localized renal masses according to treatment strategy. METHODS Consecutive patients ≥ 18 years with localized renal masses treated with different approaches (open [O], laparoscopic [L], and percutaneous [P]) and modalities (radical nephrectomy [RN], nephron sparing surgery [NSS] and cryoablation [CA]). The SF-36, Functional Assessment of Cancer Therapy-Kidney Symptom Index-15 questionnaires and pain visual analog scale were completed pretreatment and at 1, 3, and 12 months posttreatment. Questionnaire results were stratified according to approach and treatment modality using a longitudinal multilevel linear regression model. Clinical patient and tumor characteristics, complications, and histopathology results were tested as confounders. RESULTS Ninety eight patients completed baseline and at least one follow-up questionnaires; 27.5%, 16.3%, 22.5%, 9.2%, 13.3%, and 11.2% patients received LNSS, ONSS, LRN, ORN, LCA, and PCA, respectively. Higher baseline SF-36 (3 domains) and Functional Assessment of Cancer Therapy-Kidney Symptom Index-15 scores were reported in L group compared with the O approach. Overall, HRQoL decreased at 1 month and gradually normalized to baseline level or higher at 1 year. For treatment modality at baseline, higher mean visual analog scale was observed in CA than RN group. A trend to decreased HRQoL was observed at 1 month for RN and NSS; thereafter, scores normalized to baseline levels or higher. Approach or treatment modality HRQoL did not change substantially when corrected for confounders. CONCLUSION At short-term, HRQoL outcome favored minimally invasive treatment of RCC; at mid-term, these advantages were no longer apparent. This suggest that in selecting the best surgical treatment for the patient, oncological outcome should be the primary consideration as both approach and treatment modality result in similar HRQoL outcomes.
Collapse
Affiliation(s)
- Laura Sandbergen
- Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, the Netherlands
| | - Alette S Spriensma
- Amsterdam UMC, VU University Medical Center, Department of Epidemiology & Biostatistics, Amsterdam, the Netherlands
| | | | - M Pilar Laguna
- Istanbul Medipol University, Department of Urology, Istanbul, Turkey.
| |
Collapse
|
300
|
Health related quality of life in older patients with solid tumors and prognostic factors for decline. J Geriatr Oncol 2019; 10:895-903. [DOI: 10.1016/j.jgo.2019.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/18/2019] [Accepted: 03/25/2019] [Indexed: 02/07/2023]
|