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Kim M, Gilliland JL, Parnes MF, Bruce C, Stern CS, Allen RJ, Pusic AL, Tadros AB, Nelson JA. BREAST-Q REACT: Qualitative Assessment of the Design, Functionality, and Clinical Utility of a New Score Interpretation Tool. Ann Surg Oncol 2024; 31:4498-4511. [PMID: 38570377 DOI: 10.1245/s10434-024-15185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The BREAST-Q real-time engagement and communication tool (REACT) was developed to aid with BREAST-Q score interpretation and guide patient-centered care. OBJECTIVE The purpose of this qualitative study was to examine the perspectives of patients and providers on the design, functionality, and clinical utility of REACT and refine the REACT based on their recommendations. METHODS We conducted three patient focus groups with women who were at least 6 postoperative months from their postmastectomy breast reconstruction, and two provider focus groups with plastic surgeons, breast surgeons, and advanced practice providers. Focus groups were audio-taped, transcribed verbatim, and analyzed thematically. RESULTS A total of 18 breast reconstruction patients and 14 providers participated in the focus groups. Themes identified by thematic analysis were organized into two categories: (1) design and functionality, and (2) clinical utility. On the design and functionality of REACT, four major themes were identified: visual appeal and usefulness; contextualizing results; ability to normalize patients' experiences, noting participants' concerns; and suggested modifications. On the clinical utility of REACT, three major themes were identified: potential to empower patients to communicate with their providers; increase patient and provider motivation to engage with the BREAST-Q; and effective integration into clinical workflow. CONCLUSION Patients and providers in this qualitative study indicated that with some modifications, REACT has a great potential to elevate the clinical utility of the BREAST-Q by enhancing patient-provider communication that can lead to patient-centered, clinically relevant action recommendations based on longitudinal BREAST-Q scores.
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Affiliation(s)
- Minji Kim
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaime L Gilliland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mei-Fan Parnes
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cayla Bruce
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Eng L, Chan RJ, Chan A, Charalambous A, Darling HS, Grech L, van den Hurk CJG, Kirk D, Mitchell SA, Poprawski D, Rammant E, Ramsey I, Fitch MI, Cheung YT. Perceived Barriers Toward Patient-Reported Outcome Implementation in Cancer Care: An International Scoping Survey. JCO Oncol Pract 2024; 20:816-826. [PMID: 38457755 DOI: 10.1200/op.23.00715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/15/2023] [Accepted: 01/24/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE Implementation of patient-reported outcomes (PROs) collection is an important priority in cancer care. We examined perceived barriers toward implementing PRO collection between centers with and without PRO infrastructure and administrators and nonadministrators. PATIENTS AND METHODS We performed a multinational survey of oncology practitioners on their perceived barriers to PRO implementations. Multivariable regression models evaluated for differences in perceived barriers to PRO implementation between groups, adjusted for demographic and institutional variables. RESULTS Among 358 oncology practitioners representing six geographic regions, 31% worked at centers that did not have PRO infrastructure and 26% self-reported as administrators. Administrators were more likely to perceive concerns with liability issues (aOR, 2.00 [95% CI, 1.12 to 3.57]; P = .02) while having nonsignificant trend toward less likely perceiving concerns with disruption of workflow (aOR, 0.58 [95% CI, 0.32 to 1.03]; P = .06) and nonadherence of PRO reporting (aOR, 0.53 [95% CI, 0.26 to 1.08]; P = .08) as barriers. Respondents from centers without PRO infrastructure were more likely to perceive that not having access to a local PRO expert (aOR, 6.59 [95% CI, 3.81 to 11.42]; P < .001), being unsure how to apply PROs in clinical decisions (aOR, 4.20 [95% CI, 2.32 to 7.63]; P < .001), and being unsure about selecting PRO measures (aOR, 3.36 [95% CI, 2.00 to 5.66]; P < .001) as barriers. Heat map analyses identified the largest differences between participants from centers with and without PRO infrastructure in agreed-upon barriers were (1) not having a local PRO expert, (2) being unsure about selecting PRO measures, and (3) not recognizing the role of PROs at the institutional level. CONCLUSION Perceived barriers toward PRO implementation differ between administrators and nonadministrators and practitioners at centers with and without PRO infrastructure. PRO implementation teams should consider as part of a comprehensive strategy including frontline clinicians and administrators and members with PRO experience within teams.
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Affiliation(s)
- Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, CA
| | - Andreas Charalambous
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
- Department of Nursing, University of Turku, Turku, Finland
| | - H S Darling
- Department of Medical Oncology, Command Hospital Air Force, Bangalore, India
| | - Lisa Grech
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Medicine Monash Health, Monash University, Melbourne, VIC, Australia
| | | | - Deborah Kirk
- School of Nursing and Midwifery, Edith Cowan University, Bunbury, WA, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Dagmara Poprawski
- Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Imogen Ramsey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
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Mourits BMP, den Hartog SJ, de Graaf JA, Roozenbeek B, Post MWM, Visser-Meily JMA, Scholten EWM. Exploring patients' experience using PROMs within routine post-discharge follow-up assessment after stroke: a mixed methods approach. J Patient Rep Outcomes 2024; 8:46. [PMID: 38668901 PMCID: PMC11052975 DOI: 10.1186/s41687-024-00724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Patient Reported Outcomes Measures (PROMs) are being used increasingly to measure health problems in stroke clinical practice. However, the implementation of these PROMs in routine stroke care is still in its infancy. To understand the value of PROMs used in ischemic stroke care, we explored the patients' experience with PROMs and with the consultation at routine post-discharge follow-up after stroke. METHODS In this prospective mixed methods study, patients with ischemic stroke completed an evaluation questionnaire about the use of PROMs and about their consultation in two Dutch hospitals. Additionally, telephone interviews were held to gain in-depth information about their experience with PROMs. RESULTS In total, 63 patients completed the evaluation questionnaire of which 10 patients were also interviewed. Most patients (82.2-96.6%) found completing the PROMs to be feasible and relevant. Half the patients (49.2-51.6%) considered the PROMs useful for the consultation and most patients (87.3-96.8%) reported the consultation as a positive experience. Completing the PROMs provided 51.6% of the patients with insight into their stroke-related problems. Almost 75% of the patients found the PROMs useful in giving the healthcare provider greater insight, and 60% reported discussing the PROM results during the consultation. Interviewed patients reported the added value of PROMs, particularly when arranging further care, in gaining a broader insight into the problems, and in ensuring all important topics were discussed during the consultation. CONCLUSIONS Completing PROMs appears to be feasible for patients with stroke attending post-discharge consultation; the vast majority of patients experienced added value for themselves or the healthcare provider. We recommend that healthcare providers discuss the PROM results with their patients to improve the value of PROMs for the patient. This could also improve the willingness to complete PROMs in the future.
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Affiliation(s)
- B M P Mourits
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - S J den Hartog
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J A de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - B Roozenbeek
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - J M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - E W M Scholten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Kamran R, Jackman L, Laws A, Stepney M, Harrison C, Jain A, Rodrigues J. Patient and healthcare professional perspectives on the Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC): analysis of open-ended responses from patients and healthcare professionals. BMJ Open Qual 2024; 13:e002721. [PMID: 38569665 PMCID: PMC11002366 DOI: 10.1136/bmjoq-2023-002721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
IMPORTANCE Several international calls have been made for evidence-based patient-reported outcome measure (PROM) implementation for gender-affirming care. The Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC) is a resource which can help guide PROM implementation efforts, developed using a three-phase participatory research approach with transgender and gender-diverse (TGD) patients and gender-affirming healthcare professionals. However, thoughts and perspectives from TGD patients and gender-affirming healthcare professionals on the PG-PROM-GAC need to be investigated. OBJECTIVE Investigate patient and healthcare professional perspectives on the PG-PROM-GAC through analysis of open-ended survey results. DESIGN Qualitative study analysing open-ended responses from TGD patients and gender-affirming healthcare professionals. SETTING Participants were recruited from a UK National Health System (NHS) gender clinic. PARTICIPANTS Patients receiving care at an NHS gender clinic and healthcare professionals working at an NHS gender clinic were eligible for participation. Eligible participants were invited to participate in this study via email. INTERVENTION Participants were sent an open-ended survey to collect responses on the PG-PROM-GAC. MAIN OUTCOMES AND MEASURES Data were thematically analysed by two independent researchers and interpreted following guidance from established methods in implementation science. RESULTS A total of 64 TGD patients and 9 gender-affirming healthcare professionals responded to the open-ended survey (mean (SD) age: 35 (16) and 48 (8), respectively). Four main themes emerged from the data: overall opinions and support for the PG-PROM-GAC, presentation of the PG-PROM-GAC, impact of gender clinic resources on PROM implementation and impact of PROM selection on implementation. Data were used to iterate the PG-PROM-GAC in response to participant feedback. CONCLUSIONS AND RELEVANCE The PG-PROM-GAC is an acceptable and feasible resource that can be used by clinicians, researchers and policymakers to guide PROM implementation for gender-affirming care settings, helping to align gender-affirming care with patient needs.
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Affiliation(s)
- Rakhshan Kamran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Liam Jackman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Laws
- Northern Region Gender Dysphoria Service, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Conrad Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jeremy Rodrigues
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, Amersham, UK
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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5
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Robinson OC, Pini S, Flemming K, Campling N, Fallon M, Richards SH, Mayland CR, Boland E, Swinson D, Hurlow A, Hartup S, Mulvey MR. Exploration of pain assessment and management processes in oncology outpatient services with healthcare professionals: a qualitative study. BMJ Open 2023; 13:e078619. [PMID: 38151273 PMCID: PMC10753735 DOI: 10.1136/bmjopen-2023-078619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/17/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES This study explored cancer pain management practices and clinical care pathways used by healthcare professionals (HCPs) to understand the barriers and facilitators for standardised pain management in oncology outpatient services (OS). DESIGN Data were collected using semistructured interviews that were audio-recorded and transcribed. The data were analysed using thematic analysis. SETTING Three NHS trusts with oncology OS in Northern England. PARTICIPANTS Twenty HCPs with varied roles (eg, oncologist and nurse) and experiences (eg, registrar and consultant) from different cancer site clinics (eg, breast and lung). Data were analysed using thematic analysis. RESULTS HCPs discussed cancer pain management practices during consultation and supporting continuity of care beyond consultation. Key findings included : (1) HCPs' level of clinical experience influenced pain assessments; (2) remote consulting impeded experienced HCPs to do detailed pain assessments; (3) diffusion of HCP responsibility to manage cancer pain; (4) nurses facilitated pain management support with patients and (5) continuity of care for pain management was constrained by the integration of multidisciplinary teams. CONCLUSIONS These data demonstrate HCP cancer pain management practices varied and were unstructured. Recommendations are made for a standardised cancer pain management intervention: (1) detailed evaluation of pain with a tailored self-management strategy; (2) implementation of a structured pain assessment that supports remote consultations, (3) pain assessment tool that can support both experienced and less experienced clinicians. These findings will inform the development of a cancer pain management tool to integrate within routine oncology OS.
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Affiliation(s)
| | - Simon Pini
- Psychological and Social Medicine, University of Leeds, Leeds, UK
| | | | - Natasha Campling
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Marie Fallon
- MRC Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Catriona R Mayland
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Divison of Clinical Medicine, University of Sheffield, Sheffield, UK
| | - Elaine Boland
- Palliative Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Daniel Swinson
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Adam Hurlow
- Palliative Care Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sue Hartup
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew R Mulvey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Oldenburger E, Isebaert S, Coolbrandt A, Van Audenhove C, Haustermans K. The use of electronic Patient Reported Outcomes in follow-up after palliative radiotherapy: A survey study in Belgium. PEC INNOVATION 2023; 3:100243. [PMID: 38169899 PMCID: PMC10758946 DOI: 10.1016/j.pecinn.2023.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
Objective Electronic Patient-Reported Outcome Measures (ePROMs) could be used to monitor patients' symptoms after treatment. However, ePROM implementation in clinical practice has been challenging, especially in (palliative) radiation oncology. The aim of this study was to explore the opinions of healthcare providers (HCP) active in radiation oncology in Belgium on the use of ePROMs for symptom follow-up after palliative radiotherapy. Methods An anonymous online survey was conducted with different HCP in radiation oncology in Belgium. Participants were recruited through several professional organizations with approximately 390 members actively working in the field of radiation oncology. The survey used was a self-developed questionnaire, based on existing literature on implementation of (e)PROMs in cancer care, our previous research on this topic as well as our personal experience in the field of oncology and palliative care. Results Of the 128 respondents, 26% had experience with ePROMs in clinical practice. Eighty-four percent considered ePROMs beneficial for patients' health and symptom knowledge, symptom self-management and active participation in care. ePROMs could help HCP to focus on detection of relevant symptoms and improve their management. Almost 75% were willing to implement and use ePROMs. Assigning ePROM introduction and follow-up to a dedicated person, such as a nurse navigator, was suggested to promote ePROM implementation and use in clinical practice. Conclusion Despite limited experience with ePROMs in clinical care for palliative radiotherapy patients, the majority of respondents is willing to implement and use ePROMs for this particular patient population. Innovation This is one of the first studies specifically focusing on experiences and opinions of HCP in radiation oncology on the use of ePROMs for symptom follow-up in palliative radiotherapy. HCP should be actively involved in implementation of ePROMs after palliative radiotherapy, to translate their vision of their ideals in practice.
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Affiliation(s)
- Eva Oldenburger
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Palliative Care, University Hospitals Leuven, Belgium
| | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Annemarie Coolbrandt
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | | | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
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Minteer SA, Cheville A, Tesch N, Griffin JM, Austin JD, Mitchell S, Leppin AL, Ridgeway JL. Implementing cancer symptom management interventions utilizing patient-reported outcomes: a pre-implementation evaluation of barriers and facilitators. Support Care Cancer 2023; 31:697. [PMID: 37962699 PMCID: PMC10645625 DOI: 10.1007/s00520-023-08114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Symptoms can negatively impact quality of life for patients with a history of cancer. Digital, electronic health record (EHR)-integrated approaches to routine symptom monitoring accompanied by evidence-based interventions for symptom management have been explored as a scalable way to improve symptom management, particularly between clinic visits. However, little research has evaluated barriers and facilitators to implementing these approaches in real-world settings, particularly during the pre-implementation phase. Pre-implementation assessment is critical for informing the selection and sequencing of implementation strategies and intervention adaptation. Thus, this study sought to understand pre-implementation perceptions of a remote cancer symptom monitoring and management intervention that uses electronic patient-reported outcome measures for symptom assessment. METHODS We interviewed 20 clinical and administrative stakeholders from 4 geographic regions within an academic medical center and its affiliated health system during the months prior to initiation of a stepped-wedge, cluster randomized pragmatic trial. Transcripts were coded using the Consolidated Framework for Implementation Research [CFIR] 2.0. Two study team members reviewed coded transcripts to understand how determinants were relevant in the pre-implementation phase of the trial and prepared analytic memos to identify themes. RESULTS Findings are summarized in four themes: (1) ability of the intervention to meet patient needs [recipient characteristics], (2) designing with care team needs in mind [innovation design and adaptability], (3) fit of the intervention with existing practice workflows [compatibility], and (4) engaging care teams early [engaging deliverers]. CONCLUSION Attention to these aspects when planning intervention protocols can promote intervention compatibility with patients, providers, and practices thereby increasing implementation success.
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Affiliation(s)
- Sarah A Minteer
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Nathan Tesch
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Jessica D Austin
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Sandra Mitchell
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Aaron L Leppin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
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Burner-Fritsch I, Kolmhuber S, Hodiamont F, Bausewein C, Hriskova K. Implementing ePROM in specialist palliative home care: the professionals' perspective - a mixed-methods study. Palliat Care Soc Pract 2023; 17:26323524231186827. [PMID: 37560175 PMCID: PMC10408331 DOI: 10.1177/26323524231186827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
Background Over the last decades, patient-reported outcome measures (PROM) have been developed for a better understanding of patient needs. The Integrated Palliative Care Outcome Scale (IPOS) is an internationally recommended PROM in palliative care. The validated electronic version of IPOS (eIPOS) was implemented in four German specialist palliative home care (SPHC) teams for use in everyday clinical practice. Patients reported symptoms and concerns via eIPOS, which were transmitted directly to the electronic patient record of the respective SPHC team. Objectives The aim of the study was to describe and explore the health care professionals' (HCPs') experiences regarding acceptance and use of eIPOS in clinical practice in SPHC. Design The mixed-methods sequential explanatory design comprised an anonymized quantitative online survey followed by qualitative focus groups. Methods The online survey asked in both closed and open questions for HCP's experience with eIPOS. Ambiguous results from the survey were discussed in two focus groups. Survey data were analysed with descriptive and univariable statistics, and the framework approach was used for qualitative data. In a further step, we conducted integrated analysis of quantitative and qualitative results using joint displays. Results All HCPs of the four SPHC teams (n = 52) were invited to participate. HCPs participating in the survey (n = 32) and the focus groups (n = 7) saw potentials for implementing ePROM in palliative home care - as far as it is technically easy to handle and can be easily integrated into clinical practice. Conclusion Successful use of ePROMs is affected by the possibility of easy integration into the teams' different structures and processes and the HCPs' perceptions of potentials regarding ePROM use in SPHC. Registration The study is registered on clinicaltrials.org (NCT03879668).
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Affiliation(s)
- Isabel Burner-Fritsch
- Department of Palliative Medicine, University Hospital, LMU Munich, Bahnhofstraße 20, 83673 Bichl, Germany
| | - Stefanie Kolmhuber
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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Consolo L, Colombo S, Basile I, Rusconi D, Campa T, Caraceni A, Lusignani M. Barriers and facilitators of electronic patient-reported outcome measures (e-PROMs) for patients in home palliative cancer care: a qualitative study of healthcare professionals' perceptions. BMC Palliat Care 2023; 22:111. [PMID: 37542264 PMCID: PMC10401773 DOI: 10.1186/s12904-023-01234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Patient-reported outcomes in palliative care enable early monitoring and management of symptoms that most impact patients' daily lives; however, there are several barriers to adopting electronic Patient-reported Outcome Measures (e-PROMs) in daily practice. This study explored the experiences of health care professionals (HCPs) regarding potential barriers and facilitators in implementing e-PROMs in palliative cancer care at home. METHODS This was a qualitative descriptive study. The data were collected from two focus groups structured according to the conceptual framework of Grol. HCPs involved in home palliative cancer care of Fondazione IRCCS Istituto Nazionale dei Tumori of Milan were enrolled. Data were analyzed using a reflexive thematic analysis. RESULTS A total of 245 codes were generated, 171 for the first focus group and 74 for the second focus group. The results were subdivided into subthemes according to Grol's themes: Innovation, Individual professional, Patient, Social context, Organizational context, except Economic Political context. Nine HCPs attended the first focus group, and ten attended the second. According to these participants, e-PROMs could be integrated into clinical practice after adequate training and support of HCPs at all stages of implementation. They identified barriers, especially in the social and organizational contexts, due to the uniqueness of the oncological end-of-life setting and the intangible care interventions, as well as many facilitators for the innovation that these tools bring and for improved communication with the patient and the healthcare team. CONCLUSIONS e-PROMs are perceived by HCPs as adding value to patient care and their work; however, barriers remain especially related to the fragility of these patients, the adequacy of technological systems, lack of education, and the risk of low humanization of care.
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Affiliation(s)
- Letteria Consolo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
- Bachelor School of Nursing, IRCCS, National Cancer Institute, Milan, Italy.
| | - Stella Colombo
- Intensive Care Unit, IRCCS, National Cancer Institute, Milan, Italy
| | - Ilaria Basile
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, IRCCS, National Cancer Institute, Milan, Italy
| | - Daniele Rusconi
- Urology Unit, IRCCS, National Cancer Institute, Milan, Italy
| | - Tiziana Campa
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, IRCCS, National Cancer Institute, Milan, Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, IRCCS, National Cancer Institute, Milan, Italy
- University of Milan, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Serna CDDLRDL, Drury A, Oldenmenger WH, Kelly D, Kotronoulas G. A Delphi Study of Core Patient-Reported Outcomes for Advanced Renal Cell Carcinoma and Advanced Hepatocellular Carcinoma. Semin Oncol Nurs 2023; 39:151409. [PMID: 37012164 DOI: 10.1016/j.soncn.2023.151409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/02/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES There is little research to help health care professionals understand what patient outcomes are considered a priority in advanced liver or kidney cancer. Knowing what is important to patients can help promote person-centered approaches to treatment and disease management. The aim of this study was to identify those patient-reported outcomes (PROs) that patients, carers, and health care professionals consider as "core" when providing care to those with advanced liver or kidney cancer. DATA SOURCES A three-round Delphi study was undertaken to ask experts by profession or experience to rank PROs identified from a previous literature review. Fifty-four experts, including people living with advanced liver or kidney cancer (44.4%), family members and caregivers (9.3%), and health care professionals (46.8%), reached consensus on 49 PROs including 12 new items (eg, palpitations, hopefulness, or social isolation). Items with the highest rate of consensus included quality of life, pain, mental health, and capacity to do daily activities. CONCLUSION People living with advanced liver or kidney cancer experience complex health care needs. Some important outcomes were not actually captured in practice in this population and were suggested as part of this study. There are discrepancies between the views of health care professionals, patients, and family in what is important, highlighting the need of using measures to facilitate communication. IMPLICATIONS FOR NURSING PRACTICE Identification of priority PROs reported here will be key to facilitate more focused patient assessments. The actual use of measures in cancer nursing practice to allow monitoring of PROs must be tested for feasibility and usability.
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Affiliation(s)
| | - Amanda Drury
- Associate Professor, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Wendy H Oldenmenger
- Assistant Professor, Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Daniel Kelly
- Professor, Cardiff University, School of Healthcare Sciences, Cardiff, United Kingdom
| | - Grigorios Kotronoulas
- Reader, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom.
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11
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Åsberg RE, Nilsen M, Hjermstad MJ, Reinertsen KV, Karlsen J, Giskeødegård GF, Reidunsdatter RJ. Norwegian general population normative data for the European Organization for Research and Treatment of Cancer questionnaires: the Quality of Life Questionnaire-Core 30, the Sexual Health Questionnaire QLQ-SHQ22 and the sexual domains of the QLQ-BR23/BR45. Eur J Cancer 2023; 190:112943. [PMID: 37515905 DOI: 10.1016/j.ejca.2023.112943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE The aim of this study was to provide sex-, age-, and morbidity-specific Norwegian general population normative values for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires QLQ-C30, the sexual health questionnaire QLQ-SHQ22 and the sexual domains of the breast modules QLQ-BR23 and QLQ-BR45. METHODS A random nationwide sample stratified by sex and age groups (18-29, 30-39, 40-49, 50-59, 60-69 and ≥70 years) was drawn from the Norwegian National Population Register. Participants were notified through national online health services (HelseNorge) and postal mail. The survey included sociodemographic background information, health-related quality of life assessed by the EORTC questionnaires, and morbidity assessed by the Self-Administered Comorbidity Questionnaire. Multivariable linear regression was carried out to estimate the associations of age, sex and morbidity with the EORTC scale and item scores. RESULTS Of the 15,627 eligible individuals, 5135 (33%) responded. Women and persons with morbidities reported lower functioning and higher symptom burden than men and persons without morbidities, respectively, on nearly all EORTC scales. Sex differences were most prominent for emotional functioning, pain, fatigue and insomnia (QLQ-C30), body image, sexual functioning (QLQ-BR23/45), importance of sexual activity, libido and fatigue (QLQ-SHQ22). The score differences between persons with and without morbidity were highly significant and largest in the youngest and middle-aged groups. CONCLUSION This is the first study to provide normative values for the EORTC sexual health questionnaire QLQ-SHQ22 and the sexual subscales of the QLQ-BR23 and QLQ-BR45 for all, separately in age groups by sex and morbidity.
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Affiliation(s)
- R E Åsberg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), The Fred Kavli Building, Olav Kyrres gate 9, 7030, Trondheim, Norway
| | - M Nilsen
- Department of Social Work, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - M J Hjermstad
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, European Palliative Care Research Centre (PRC) and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K V Reinertsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - J Karlsen
- Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - G F Giskeødegård
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Breast and Endocrine Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - R J Reidunsdatter
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), The Fred Kavli Building, Olav Kyrres gate 9, 7030, Trondheim, Norway.
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12
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Bennink C, de Mul M, van der Klift M, Broijl A, Tick L, de Jongh E, Garvelink M, Lobbezoo D, Sonneveld P, Hazelzet J. Improving Outcome-Driven Care in Multiple Myeloma Using Patient-Reported Outcomes: A Qualitative Evaluation Study. THE PATIENT 2023; 16:255-264. [PMID: 36790557 PMCID: PMC9930010 DOI: 10.1007/s40271-023-00616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Multiple myeloma is an incurable disease with a considerable illness and treatment burden, which negatively impacts patients' quality of life. This study aimed to evaluate the implementation of multiple myeloma care in five Dutch hospitals, related to the three objectives of outcome-driven care, which are defined as (1) providing information for shared decision making in individual patient care, (2) supporting the learning capacity of healthcare professionals and healthcare institutions through benchmarking and (3) developing outcome-driven and patient-centred contracting by health insurers. METHODS In this qualitative study, semi-structured interviews about experiences with patient-reported outcomes were conducted with patients, healthcare professionals and other stakeholders 2 years after implementation. Data were thematically analysed, and emerging topics were clustered around the three objectives of outcome-driven care. RESULTS A total of 46 interviews were held (15 with patients, 16 with professionals and 15 with other stakeholders) that showed patients with multiple myeloma were willing to complete patient-reported outcomes, although integration of patient-reported outcomes in shared decision making fell short in clinical practice. Aggregated patient-reported outcomes were considered important for improving quality of care; however, data collection and data exchange are hindered by privacy legislation, limitations of IT systems and a lack of data standards. Patient-reported outcomes were expected to contribute to cost-effective multiple myeloma treatment, yet outcome-driven reimbursement is still lacking. CONCLUSIONS Outcome-driven multiple myeloma care using patient-reported outcomes is feasible, provided that (1) patient-reported outcomes and shared decision making are integrated into clinical practice, (2) legal and technical obstacles hindering data collection are removed and (3) health insurers adjust their reimbursement plans to facilitate outcome-driven care.
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Affiliation(s)
- Christine Bennink
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Department of Haematology, Amphia, Breda, The Netherlands.
| | - Marleen de Mul
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | | | - Annemiek Broijl
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Lidwine Tick
- Department of Haematology, Maxima Medical Center, Veldhoven, Eindhoven, The Netherlands
| | - Eva de Jongh
- Department of Haematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mirjam Garvelink
- Department of Haematology, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Dorien Lobbezoo
- Department of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pieter Sonneveld
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jan Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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13
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Amplifying the Patient Voice: A Survey of Practitioners' Use of Patient-reported Outcome Measures Across Radiotherapy Providers in England. Clin Oncol (R Coll Radiol) 2023; 35:199-208. [PMID: 36443139 DOI: 10.1016/j.clon.2022.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/22/2022] [Accepted: 11/04/2022] [Indexed: 11/28/2022]
Abstract
AIMS The NHS England Radiotherapy Service Specification calls for routine use of patient-reported outcome measures (PROMs). However, barriers exist at patient, healthcare professional and service levels. The aim of the present study was to determine the current use of PROMs within radiotherapy services in England. The current attitudes, barriers and enablers to the implementation of PROMs in radiotherapy practice were evaluated and practical recommendations to inform future implementation were developed. MATERIALS AND METHODS A mixed-methods approach was adopted to obtain quantitative and qualitative data. An online questionnaire was developed and disseminated to all radiotherapy operational delivery network managers across England. The questionnaire consisted of 12 open and closed questions relating to PROMs use, with the option to provide free-text responses. Inductive thematic analysis was conducted on free-text comments, whereas descriptive statistics were used to analyse quantitative data. RESULTS In total, 182 responses were received from 40 of the 50 radiotherapy providers, resulting in a response rate of 84%. The current use of PROMs was analysed, including rationale for use, tools used, format of PROMs collection and timing within the radiotherapy pathway. Most respondents indicated that PROMs were used in the context of clinical trials only. Through thematic analysis, four identical key themes were identified relating to both barriers and enablers to PROMs use; these included IT infrastructure, time, human/financial resources and training/education. A fifth theme, standardisation, was identified as a key enabler to PROMs use. CONCLUSIONS Our findings show that outside of clinical trials, PROMs are not routinely used in radiotherapy services due to barriers identified at professional and service levels. Here we provide recommendations to mitigate the barriers identified and implement PROMs in radiotherapy, including training for healthcare professionals and standardisation of PROMs tools and storage. This study provides a key first step in driving PROMs implementation within radiotherapy services across England.
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14
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Lombi L, Alfieri S, Brunelli C. 'Why should I fill out this questionnaire?' A qualitative study of cancer patients' perspectives on the integration of e-PROMs in routine clinical care. Eur J Oncol Nurs 2023; 63:102283. [PMID: 36893578 DOI: 10.1016/j.ejon.2023.102283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE There is increasing interest in integrating electronic patient-reported outcomes (e-PROs) into clinical routines in cancer settings. However, little is known about patients' experiences with and perceptions of e-PRO measures (e-PROMs). This study examines patients' experiences with e-PROMS, particularly their perspectives about its usefulness and its implications for the clinical encounter with their doctors. METHOD A total of 19 individual in-person interviews with cancer patients at a Comprehensive Cancer Center in northern Italy conducted in 2021 inform this study. RESULTS The findings suggested that, overall, patients had positive attitudes towards data collection using e-PROMs. On the one hand, most patients found the integration of e-PROMs into routine clinical practice as beneficial in treating patients with cancer. The main benefits of e-PROMs according to this group of patients were that: they promoted patient-centred care; could be used to tailor and improve the quality of care through a holistic approach; supported early detection of problematic symptoms; increased patient self-awareness; and contributed to clinical research. On the other hand, many patients did not fully understand the purpose of e-PROMs and some patients were also sceptical about their usefulness in routine clinical practice. CONCLUSIONS These findings have several practical implications for ensuring the successful implementation of e-PROMs in routine clinical practice. These include the following preconditions: patients are informed about the purposes of data collection; physicians provide feedback to patients about the e-PROMs' results; and that hospital administrators allocate sufficient time for clinical interactions to integrate e-PROMs into routine clinical practice.
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Affiliation(s)
- Linda Lombi
- Department of Sociology, Università Cattolica del Sacro Cuore, Italy.
| | - Sara Alfieri
- Clinical psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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15
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Di Maio M, Basch E, Denis F, Fallowfield LJ, Ganz PA, Howell D, Kowalski C, Perrone F, Stover AM, Sundaresan P, Warrington L, Zhang L, Apostolidis K, Freeman-Daily J, Ripamonti CI, Santini D. The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline. Ann Oncol 2022; 33:878-892. [PMID: 35462007 DOI: 10.1016/j.annonc.2022.04.007] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/05/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- M Di Maio
- Department of Oncology, University of Turin, at A.O. Ordine Mauriziano Hospital, Turin, Italy
| | - E Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - F Denis
- Institut Inter-régional de Cancérologie Jean Bernard (ELSAN), Le Mans, France; Faculté de Santé, Université de Paris, Paris, France
| | - L J Fallowfield
- Sussex Health Outcomes Research & Education in Cancer, Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - P A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles (UCLA), USA
| | - D Howell
- Department of Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - C Kowalski
- Department of Certification - Health Services Research, German Cancer Society, Berlin, Germany
| | - F Perrone
- Clinical Trial Unit, National Cancer Institute IRCCS G. Pascale Foundation, Naples, Italy
| | - A M Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - P Sundaresan
- Sydney West Radiation Oncology Network, Westmead Hospital, Westmead, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - L Warrington
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - L Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - K Apostolidis
- European Cancer Patient Coalition, Brussels, Belgium
| | | | - C I Ripamonti
- Oncology - Supportive Care in Cancer Unit, Department Oncology-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Milan, Italy
| | - D Santini
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
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Lutz AT, Griza A, Machado GM, Loose U, Dahmer A, Herbert JS. ATIENT REPORTED OUTCOMES IN THE DAILY PRACTICE IN CLINICAL ONCOLOGY: A SYSTEMATIC REVIEW. Crit Rev Oncol Hematol 2022; 173:103658. [PMID: 35337971 DOI: 10.1016/j.critrevonc.2022.103658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
The use of patient-reported outcomes brings direct benefits to the daily practice in Clinical Oncology, providing information that allows the monitoring of patients between consultations, with an increase in the bond with the medical team and the patient's satisfaction with their treatment. This review seeks to identify electronic systems for collecting patient data, highlighting the possible benefits that motivated the use of these systems and identifying the population, instruments, way of handling alerts and possible limitations and barriers to implementation in clinical practice. Thus, 25 articles were selected and reviewed, following a previously established systematic literature review protocol. This review is useful for gathering information for the development of new patient-focused applications in Oncology.
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Affiliation(s)
- Andreas Timóteo Lutz
- Programa de Pós-Graduação em Tecnologias da Informação e Gestão em Saúde Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)Rua Sarmento Leite, 245 - CEP 90050-170 - Porto Alegre/RS, Brazil.
| | - Aline Griza
- Programa de Pós-Graduação em Tecnologias da Informação e Gestão em Saúde Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)Rua Sarmento Leite, 245 - CEP 90050-170 - Porto Alegre/RS, Brazil.
| | - Graziella Moraes Machado
- Programa de Pós-Graduação em Tecnologias da Informação e Gestão em Saúde Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)Rua Sarmento Leite, 245 - CEP 90050-170 - Porto Alegre/RS, Brazil.
| | - Uilian Loose
- Programa de Pós-Graduação em Tecnologias da Informação e Gestão em Saúde Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)Rua Sarmento Leite, 245 - CEP 90050-170 - Porto Alegre/RS, Brazil.
| | - Alessandra Dahmer
- Programa de Pós-Graduação em Tecnologias da Informação e Gestão em Saúde Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)Rua Sarmento Leite, 245 - CEP 90050-170 - Porto Alegre/RS, Brazil.
| | - Juliana Silva Herbert
- Programa de Pós-Graduação em Tecnologias da Informação e Gestão em Saúde Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)Rua Sarmento Leite, 245 - CEP 90050-170 - Porto Alegre/RS, Brazil.
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Karsten MM, Roehle R, Albers S, Pross T, Hage AM, Weiler K, Fischer F, Rose M, Kühn F, Blohmer JU. Real-world reference scores for EORTC QLQ-C30 and EORTC QLQ-BR23 in early breast cancer patients. Eur J Cancer 2022; 163:128-139. [DOI: 10.1016/j.ejca.2021.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 12/14/2022]
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Blanchard CL, Mmoledi K, Antoni MH, Demetriou G, Joffe M, Lopes G, Ruff P, O’Neil DS. Validating an Instrument for Direct Patient Reporting of Distress and Chemotherapy-Related Toxicity among South African Cancer Patients. Cancers (Basel) 2021; 14:95. [PMID: 35008258 PMCID: PMC8750185 DOI: 10.3390/cancers14010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022] Open
Abstract
Patient-reported outcome measures (PROM) for monitoring treatment toxicity improve quality of life (QoL) and clinical outcomes. However, no such PROMs exist for sub-Saharan African cancer patients. We aimed to validate the Patient Reported Symptoms-South Africa (PRS-SA) survey, a novel PROM for measuring distress and chemotherapy-related symptoms in South African cancer patients. We enrolled patients at the oncology clinic at Charlotte Maxeke Hospital, Johannesburg. At three separate visits, participants simultaneously completed the PRS-SA survey and several previously validated questionnaires. We constructed a receiver operator characteristics curve for distress levels predicting a Hospital Anxiety and Depression Scale (HADS) score ≥15. We evaluated construct validity for symptom items by comparing severity to the EORTC Core Quality of Life Questionnaire (QLQ-C30) summary score (Pearson correlation tests) and ECOG performance status (Mann-Whitney U tests). We assessed symptom item responsiveness by comparing change in severity to change in QLQ-C30 summary score and comparing standardized mean scores with negative, no, or positive change on the Global Impression of Change (GIC) questionnaire (Jockheere-Terpstra trend test). Overall, 196 participants with solid tumors completed instruments. A distress score of 4 had 82% sensitivity and 55% specificity for clinical depression/anxiety. All symptom items showed construct validity by association with either QLQ-C30 score or performance status (highest p = 0.03). All but cough showed responsiveness to change in QLQ-C30 score (highest p = 0.045). In South African cancer patients, the PRS-SA's stress scale behaves similarly to the distress thermometer in other populations, and the symptom items demonstrated construct validity and responsiveness. Of note, 46% and 74% of participants who completed the PRS-SA in English or isiZulu, respectively, required assistance reading half or more of the instrument.
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Affiliation(s)
- Charmaine L. Blanchard
- Centre for Palliative Care, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa;
- Non-Communicable Disease Research Division, Wits Health Consortium (PTY) Ltd., Johannesburg 2193, South Africa; (K.M.); (M.J.); (P.R.)
| | - Keletso Mmoledi
- Non-Communicable Disease Research Division, Wits Health Consortium (PTY) Ltd., Johannesburg 2193, South Africa; (K.M.); (M.J.); (P.R.)
| | - Michael H. Antoni
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL 33136, USA; (M.H.A.); (G.L.)
- Department of Psychology, University of Miami, Miami, FL 33136, USA
| | - Georgia Demetriou
- Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa;
| | - Maureen Joffe
- Non-Communicable Disease Research Division, Wits Health Consortium (PTY) Ltd., Johannesburg 2193, South Africa; (K.M.); (M.J.); (P.R.)
- MRC Developmental Pathways to Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL 33136, USA; (M.H.A.); (G.L.)
| | - Paul Ruff
- Non-Communicable Disease Research Division, Wits Health Consortium (PTY) Ltd., Johannesburg 2193, South Africa; (K.M.); (M.J.); (P.R.)
- Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa;
| | - Daniel S. O’Neil
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL 33136, USA; (M.H.A.); (G.L.)
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Long C, Beres LK, Wu AW, Giladi AM. Patient-level barriers and facilitators to completion of patient-reported outcomes measures. Qual Life Res 2021; 31:1711-1718. [PMID: 34533759 DOI: 10.1007/s11136-021-02999-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify patient-level barriers and facilitators to completion of patient-reported outcomes measures (PROMs) in a hand and upper extremity clinic in Baltimore, Maryland. METHODS We conducted 12 h of direct observation of PROM completion (October-November, 2020). Ethnographic observation memos were qualitatively analyzed for barriers and facilitators using rapid thematic analysis. Informed by observation findings, we conducted 17 semi-structured interviews with mixed-literacy patients, caregivers, and clinic staff to understand the patient experience when completing PROMs (November 2020-March 2021). We identified initial themes through inductive and deductive framework analysis and validated findings through subsequent interviews with member-checking. RESULTS We identified nine patient-level factors that influence PROM completion: platform design, print literacy, health literacy, technology literacy, language proficiency, physical functioning, vision, cognitive functioning, and time. CONCLUSIONS There are multiple distinct patient-level factors that affect PROM completion. Failure to consider these factors in PROM design and implementation may lower completion rates or prevent accurate completion, undermining PROM validity. Because certain factors affect minority populations at disproportionate rates, this may also contribute to existing health disparities.
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Affiliation(s)
- Chao Long
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA.,Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA.
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Cheung YT, Chan A, Charalambous A, Darling HS, Eng L, Grech L, van den Hurk CJG, Kirk D, Mitchell SA, Poprawski D, Rammant E, Ramsey I, Fitch MI, Chan RJ. The use of patient-reported outcomes in routine cancer care: preliminary insights from a multinational scoping survey of oncology practitioners. Support Care Cancer 2021; 30:1427-1439. [PMID: 34524527 PMCID: PMC8440726 DOI: 10.1007/s00520-021-06545-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
Background There exists scant evidence on the optimal approaches to integrating patient-reported outcomes (PROs) in clinical practice. This study gathered oncology practitioners’ experiences with implementing PROs in cancer care. Methods Between December 2019 and June 2020, we surveyed practitioners who reported spending > 5% of their time providing clinical care to cancer patients. Respondents completed an online survey describing their experiences with and barriers to using PROs in clinical settings. Results In total, 362 practitioners (physicians 38.7%, nurses 46.7%, allied health professionals 14.6%) completed the survey, representing 41 countries (Asia–Pacific 42.5%, North America 30.1%, Europe 24.0%, others 3.3%). One quarter (25.4%) identified themselves as “high frequency users” who conducted PRO assessments on > 80% of their patients. Practitioners commonly used PROs to facilitate communication (60.2%) and monitor treatment responses (52.6%). The most commonly reported implementation barriers were a lack of technological support (70.4%) and absence of a robust workflow to integrate PROs in clinical care (61.5%). Compared to practitioners from high-income countries, more practitioners in low-middle income countries reported not having access to a local PRO expert (P < .0001) and difficulty in identifying the appropriate PRO domains (P = .006). Compared with nurses and allied health professionals, physicians were more likely to perceive disruptions in clinical care during PRO collection (P = .001) as an implementation barrier. Conclusions Only a quarter of the surveyed practitioners reported capturing PROs in routine clinical practice. The implementation barriers to PRO use varied across respondents in different professions and levels of socioeconomic resources. Our findings can be applied to guide planning and implementation of PRO collection in cancer care. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06545-7.
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Affiliation(s)
- Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alexandre Chan
- School of Pharmacy & Pharmaceutical Sciences, Department of Clinical Pharmacy Practice, University of California, Irvine, LA, USA
| | - Andreas Charalambous
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.,Department of Nursing, University of Turku, Turku, Finland
| | - H S Darling
- Department of Medical Oncology, Command Hospital Air Force, Bangalore, India
| | - Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - Lisa Grech
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Medicine Monash Health, Monash University, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Health Sciences, Swinburne University, Melbourne, Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Deborah Kirk
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Dagmara Poprawski
- Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Imogen Ramsey
- Rosemary Bryant AO Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, 207 Chisholm Ave, Toronto, ON, Canada.
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.
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21
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Kuiper SZ, Kimman ML, Rørvik HD, Olaison G, Breukink SO. Making Use of Patient-Reported Outcome Measures for Haemorrhoidal Disease in Clinical Practice: A Perspective. Front Surg 2021; 8:728532. [PMID: 34513917 PMCID: PMC8424037 DOI: 10.3389/fsurg.2021.728532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/26/2021] [Indexed: 11/14/2022] Open
Abstract
Haemorrhoidal disease (HD) affects millions of people around the world and for most it is a recurring problem. Increasingly, clinicians broaden their focus on the patient's experiences with haemorrhoidal symptoms, including their impact on daily life. The patient's experience can be assessed using a patient-reported outcome measure (PROM). A PROM facilitates a deeper understanding of the disease-burden and allows a clinician to obtain information directly from the patients about their experiences with the ailment. Over the last years, PROMs have shown their additional role to traditional outcomes for several diseases and have earned their place in the daily consultation room. In order to improve and personalize the treatment of HD, we endorse the use of validated PROMs in clinical care.
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Affiliation(s)
- Sara Z Kuiper
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Håvard D Rørvik
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
| | | | - Stephanie O Breukink
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Surgery, School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, Netherlands
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