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McDool E, Powell P, Carlton J. Measuring health related quality of life (HRQoL) in Lysosomal Storage Disorders (LSDs): a rapid scoping review of available tools and domains. Orphanet J Rare Dis 2024; 19:252. [PMID: 38965628 PMCID: PMC11225496 DOI: 10.1186/s13023-024-03256-0] [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: 10/30/2023] [Accepted: 06/16/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Lysosomal storage diseases (LSDs) are a group of rare inherited metabolic disorders, consisting of over 70 diseases that are characterised by lysosomal dysfunction. Due to their varied and progressive symptoms, LSDs have a continual impact on patients' health-related quality of life (HRQoL). Several recently published studies have provided insight into the HRQoL of individuals with LSDs. However, it is challenging to meaningfully synthesise this evidence, since studies often focus upon a particular type of LSD and / or utilise different self-report questionnaires or patient-reported outcome measures (PROMs) to assess HRQoL. AIMS The aim of this study was to review the published literature in LSDs, to identify the PROMs which have been used to assess HRQoL and generate a conceptual map of HRQoL domains measured in individuals diagnosed with LSDs. METHODS Three electronic databases were searched in March 2022. Primary studies of any design which utilised multi-item PROMs to assess at least one aspect of HRQoL in individuals with LSDs since 2017 were identified. Data were extracted to assess both the characteristics of each study and of the PROMs utilised within each study. The extraction of HRQoL domains and synthesis were informed by an a priori framework, inductively modified to reflect data emerging from the identified literature. Selection and extraction was undertaken independently by two reviewers; discrepancies were ratified by a third reviewer. RESULTS Sixty nine studies were identified which were published 2017-2022, with a combined total of 52 PROMs (71 variants) used to assess HRQoL in individuals with LSDs. The final extracted HRQoL framework included 7 domains (Activities; Physical sensations; Autonomy; Cognition; Feelings and emotions; Self-identity; Relationships), characterised by 37 sub-domains. CONCLUSIONS This review highlights the breadth and variety of HRQoL domains assessed in individuals with LSDs, across three broad domains of physical, psychological and social functioning. The resultant framework and mapped PROMs will aid researchers and clinicians in the selection of PROMs to assess aspects of HRQoL in people living with LSDs, based on their conceptual coverage.
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Affiliation(s)
- Emily McDool
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, England
| | - Philip Powell
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, England
| | - Jill Carlton
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, England.
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Mercadal-Orfila G, Herrera-Pérez S, Piqué N, Mateu-Amengual F, Ventayol-Bosch P, Maestre-Fullana MA, Serrano-López de Las Hazas JI, Fernández-Cortés F, Barceló-Sansó F, Rios S. Implementing Systematic Patient-Reported Measures for Chronic Conditions Through the Naveta Value-Based Telemedicine Initiative: Observational Retrospective Multicenter Study. JMIR Mhealth Uhealth 2024; 12:e56196. [PMID: 38545697 PMCID: PMC11245666 DOI: 10.2196/56196] [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: 01/09/2024] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Patient-reported outcome and experience measures can play a critical role in providing patient-centered and value-based health care to a growing population of patients who are chronically ill. Value-based telemedicine platforms such as the Naveta initiative may facilitate the effective integration of these tools into health care systems. OBJECTIVE This study aims to evaluate the response rate to electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures (ePREMs) among patients participating in the Naveta telemedicine initiative and its correlations with sociodemographic and clinical characteristics, as well as the evolution of the response rates over time. METHODS Between January 1, 2021, and June 30, 2023, a total of 53,364 ePREMs and ePROMs for 20 chronic conditions were administered through the Naveta-Phemium platform. Descriptive statistics were used to summarize continuous and categorical variables. Differences in response rates within each sociodemographic variable were analyzed using logistic regression models, with significance assessed via chi-square and post hoc Tukey tests. Two-way ANOVA was used to examine the interaction between time interval and disease type on response rate evolution. RESULTS A total of 3372 patients with severe chronic diseases from 64 public hospitals in Spain participated in the Naveta health questionnaire project. The overall response rate to ePROMs and ePREMs during the first 2.5 years of the Naveta initiative was 46.12% (24,704/53,364), with a baseline rate of 53.33% (7198/13,496). Several sociodemographic factors correlated with lower response rates, including male gender, older age, lower education level, frequent alcohol use, being a student, and not being physically active. There were also significant variations in response rates among different types of chronic conditions (P<.001), with the highest rates being for respiratory (433/606, 71.5%), oncologic (200/319, 62.7%), digestive (2247/3601, 62.4%), and rheumatic diseases (7506/12,982, 57.82%) and the lowest being for HIV infection (7473/22,695, 32.93%). During the first 6 months of follow-up, the response rates decreased in all disease types, except in the case of the group of patients with oncologic disease, among whom the response rate increased up to 100% (6/6). Subsequently, the overall response rate approached baseline levels. CONCLUSIONS Recognizing the influence of sociodemographic factors on response rates is critical to identifying barriers to participation in telemonitoring programs and ensuring inclusiveness in patient-centered health care practices. The observed decline in response rates at follow-up may be due to survey fatigue, highlighting the need for strategies to mitigate this effect. In addition, the variation in response rates across chronic conditions emphasizes the importance of tailoring telemonitoring approaches to specific patient populations.
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Affiliation(s)
- Gabriel Mercadal-Orfila
- Pharmacy Department, Hospital Mateu Orfila, Mahó, Spain
- Department of Biochemistry and Molecular Biology, Universitat de les Illes Balears, Mallorca, Spain
| | - Salvador Herrera-Pérez
- Facultad de Ciencias de la Salud, Universidad Internacional de Valencia, Valencia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Núria Piqué
- Microbiology Section, Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Sciences, Universitat de Barcelona, Barcelona, Spain
- Research Institute of Nutrition and Food Safety (INSA-UB), Universitat de Barcelona, Barcelona, Spain
| | | | - Pedro Ventayol-Bosch
- Pharmacy Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | | | | | - Santiago Rios
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
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Goldstein SJ, Scaglione NM, Kan ML, Grimes KEL, Lane ME, Morgan JK, Martin SL. Accuracy, Acceptability, and Burden of an Integrated Screening Approach to Facilitate the Delivery of Tailored Sexual Assault Prevention in the U.S. Air Force. JOURNAL OF CHILD SEXUAL ABUSE 2024:1-21. [PMID: 38874411 DOI: 10.1080/10538712.2024.2364792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
This paper examines accuracy, acceptability, and respondent burden of integrated screening to facilitate tailored sexual assault (SA) prevention program delivery in a basic military training (BMT) environment. Trainees (n = 5,951) received tailored prevention content based on self-reported sex, sexual orientation, prior SA victimization and perpetration, and past-month post-traumatic stress symptoms. Bivariate analyses examined trainee-reported screener accuracy, acceptability, and burden, including differences by tailoring-targeted subgroups (e.g. men/women). Overall accuracy and acceptability were high (>90%) despite significant subgroup variability. Screening time averaged 10.55 (SD = 1.95) minutes; individuals with prior SA took longer. Missingness increased linearly throughout the screener. Integrated screening is an accurate, acceptable way to deploy tailored SA prevention in BMT. Findings inform data-driven screening improvements and novel applications.
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Affiliation(s)
| | | | - Marni L Kan
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | - Sandra L Martin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Steffens D, Solomon M, Young J, Beckenkamp PR, Bartyn J, Koh C, Hancock M. A review of patient recruitment in randomised controlled trials of preoperative exercise. Clin Trials 2024; 21:371-380. [PMID: 38149306 DOI: 10.1177/17407745231219270] [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] [Indexed: 12/28/2023]
Abstract
BACKGROUND Randomised controlled trials (RCTs) are considered the gold standard design to determine the effectiveness of an intervention, as the only method of decreasing section bias and minimising random error. However, participant recruitment to randomised controlled trials is a major challenge, with many trials failing to recruit the targeted sample size accordingly to the planned protocol. Thus, the aim of this review is to detail the recruitment challenges of preoperative exercise clinical trials. METHODS A comprehensive search was performed on MEDLINE, Embase, The Cochrane Library, CINAHL, AMED and PsycINFO from inception to July 2021. Randomised controlled trials investigating the effectiveness of preoperative exercise on postoperative complication and/or length of hospital stay in adult cancer patients were included. Main outcomes included recruitment rate, retention rate, number of days needed to screen and recruit one patient and trial recruitment duration. Descriptive statistics were used to summarise outcomes of interest. RESULTS A total of 27 trials were identified, including 3656 patients screened (N = 21) and 1414 randomised (median recruitment rate (interquartile range) = 53.6% (25.2%-67.6%), N = 21). The sample size of the included trials ranged from 19 to 270 (median = 48.0; interquartile range = 40.0-85.0) and the duration of trial recruitment ranged from 3 to 50 months (median = 19.0 months; interquartile range = 10.5-34.0). Overall, a median of 3.6 days was needed to screen one patient, whereas 13.7 days were needed to randomise one participant. Over the trials duration, the median dropout rate was 7.9%. Variations in recruitment outcomes were observed across trials of different cancer types but were not statistically significant. CONCLUSION The recruitment of participants to preoperative exercise randomised controlled trials is challenging, but patient retention appears to be less of a problem. Future trials investigating the effectiveness of a preoperative exercise programme following cancer surgery should consider the time taken to recruit patients. Strategies associated with improved recruitment should be investigated in future studies.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
| | - Jane Young
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, Sydney, NSW, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jenna Bartyn
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Nowojewski A, Bark E, Shih VH, Dearden R. Patient adherence and response time in electronic patient-reported outcomes: insights from three longitudinal clinical trials. Qual Life Res 2024; 33:1691-1706. [PMID: 38598132 DOI: 10.1007/s11136-024-03644-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] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are used to collect data on disease symptoms in support of clinical trial endpoints. Clinical studies can last a year or more, and the patients' adherence and response time to daily at-home questionnaires may vary significantly over time. The aim of this study was to understand patterns and changes in patients' completion of daily PROMs during longitudinal clinical studies. METHODS Data were collected from 1342 patients randomized into three respiratory clinical trials (NCT03401229, NCT03347279, and NCT03406078). PROMs were completed by patients using electronic handheld devices that collected the starting and completion times. A Bayesian generalized linear mixed-effects model was used to identify unbiased coefficients associated with PROM adherence and response time using patient, site, and calendar features as covariates. RESULTS Adherence decreased over time after randomization, and the rate of decrease was higher in younger patients. The 14-day pre-randomization adherence was correlated with adherence throughout the study. Patients were also more adherent during working days compared to non-working days. Oldest patients took twice as long to complete PROMs throughout the study; however, the response time for all patients decreased during the first month of the study regardless of age. Response time increased 7 days before and after the date of a scheduled clinic visit and when a patient-reported higher symptom burden. CONCLUSION Detailed analyses of adherence and response time for daily PROMs in clinical trials can provide significant insights about trends of patient behavior in longitudinal clinical studies with high baseline adherence.
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Affiliation(s)
- Andrzej Nowojewski
- Imaging & Data Analytics, Clinical Pharmacology & Safety Sciences, AstraZeneca, R&D BioPharmaceuticals, Cambridge, UK.
| | - Erik Bark
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Vivian H Shih
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Richard Dearden
- Imaging & Data Analytics, Clinical Pharmacology & Safety Sciences, AstraZeneca, R&D BioPharmaceuticals, Cambridge, UK
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Lyhne JD, Smith A'B, Jensen LH, Hansen TF, Frostholm L, Timm S. Missingness mechanisms and generalizability of patient reported outcome measures in colorectal cancer survivors - assessing the reasonableness of the "missing completely at random" assumption. BMC Med Res Methodol 2024; 24:104. [PMID: 38702599 PMCID: PMC11067079 DOI: 10.1186/s12874-024-02236-z] [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: 11/15/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Patient-Reported Outcome Measures (PROM) provide important information, however, missing PROM data threaten the interpretability and generalizability of findings by introducing potential bias. This study aims to provide insight into missingness mechanisms and inform future researchers on generalizability and possible methodological solutions to overcome missing PROM data problems during data collection and statistical analyses. METHODS We identified 10,236 colorectal cancer survivors (CRCs) above 18y, diagnosed between 2014 and 2018 through the Danish Clinical Registries. We invited a random 20% (2,097) to participate in a national survey in May 2023. We distributed reminder e-mails at day 10 and day 20, and compared Initial Responders (response day 0-9), Subsequent Responders (response day 10-28) and Non-responders (no response after 28 days) in demographic and cancer-related characteristics and PROM-scores using linear regression. RESULTS Of the 2,097 CRCs, 1,188 responded (57%). Of these, 142 (7%) were excluded leaving 1,955 eligible CRCs. 628 (32%) were categorized as initial responders, 418 (21%) as subsequent responders, and 909 (47%) as non-responders. Differences in demographic and cancer-related characteristics between the three groups were minor and PROM-scores only marginally differed between initial and subsequent responders. CONCLUSION In this study of long-term colorectal cancer survivors, we showed that initial responders, subsequent responders, and non-responders exhibit comparable demographic and cancer-related characteristics. Among respondents, Patient-Reported Outcome Measures were also similar, indicating generalizability. Assuming Patient-Reported Outcome Measures of subsequent responders represent answers by the non-responders (would they be available), it may be reasonable to judge the missingness mechanism as Missing Completely At Random.
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Affiliation(s)
- Johanne Dam Lyhne
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark.
| | - Allan 'Ben' Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Lars Henrik Jensen
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Signe Timm
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark
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Efficace F, Buckstein R, Abel GA, Giesinger JM, Fenaux P, Bewersdorf JP, Brunner AM, Bejar R, Borate U, DeZern AE, Greenberg P, Roboz GJ, Savona MR, Sparano F, Boultwood J, Komrokji R, Sallman DA, Xie Z, Sanz G, Carraway HE, Taylor J, Nimer SD, Della Porta MG, Santini V, Stahl M, Platzbecker U, Sekeres MA, Zeidan AM. Toward a more patient-centered drug development process in clinical trials for patients with myelodysplastic syndromes/neoplasms (MDS): Practical considerations from the International Consortium for MDS (icMDS). Hemasphere 2024; 8:e69. [PMID: 38774655 PMCID: PMC11106800 DOI: 10.1002/hem3.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 05/24/2024] Open
Abstract
Notable treatment advances have been made in recent years for patients with myelodysplastic syndromes/neoplasms (MDS), and several new drugs are under development. For example, the emerging availability of oral MDS therapies holds the promise of improving patients' health-related quality of life (HRQoL). Within this rapidly evolving landscape, the inclusion of HRQoL and other patient-reported outcomes (PROs) is critical to inform the benefit/risk assessment of new therapies or to assess whether patients live longer and better, for what will likely remain a largely incurable disease. We provide practical considerations to support investigators in generating high-quality PRO data in future MDS trials. We first describe several challenges that are to be thoughtfully considered when designing an MDS-focused clinical trial with a PRO endpoint. We then discuss aspects related to the design of the study, including PRO assessment strategies. We also discuss statistical approaches illustrating the potential value of time-to-event analyses and their implications within the estimand framework. Finally, based on a literature review of MDS randomized controlled trials with a PRO endpoint, we note the PRO items that deserve special attention when reporting future MDS trial results. We hope these practical considerations will facilitate the generation of rigorous PRO data that can robustly inform MDS patient care and support treatment decision-making for this patient population.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research UnitGIMEMA Data CenterRomeItaly
| | - Rena Buckstein
- Department of Medical Oncology/HematologySunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Gregory A. Abel
- Divisions of Population Sciences and Hematologic MalignanciesDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | - Pierre Fenaux
- Hôpital Saint LouisAssistance Publique Hôpitaux de Paris and Paris Cité UniversityParisFrance
| | - Jan Philipp Bewersdorf
- Leukemia Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Andrew M. Brunner
- Leukemia Program, Harvard Medical SchoolMassachusetts General Hospital Cancer CenterBostonMassachusettsUSA
| | - Rafael Bejar
- Division of Hematology and Oncology, Moores Cancer CenterUC San DiegoLa JollaCaliforniaUSA
| | - Uma Borate
- Ohio State University Comprehensive Cancer Center/James Cancer HospitalOhio State UniversityColumbusOhioUSA
| | - Amy E. DeZern
- Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins HospitalBaltimoreMarylandUSA
| | - Peter Greenberg
- Department of Medicine, Division of Hematology, Cancer InstituteStanford University School of MedicineStanfordCaliforniaUSA
| | - Gail J. Roboz
- Weill Cornell Medical College and New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Michael R. Savona
- Department of Medicine, Division of Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Francesco Sparano
- Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research UnitGIMEMA Data CenterRomeItaly
| | - Jacqueline Boultwood
- Blood Cancer UK Molecular Haematology Unit, Radcliffe Department of MedicineNuffield Division of Clinical Laboratory SciencesUniversity of OxfordOxfordUK
| | - Rami Komrokji
- Department of Malignant HematologyH. Lee Moffitt Cancer CenterTampaFloridaUSA
| | - David A. Sallman
- Department of Malignant HematologyH. Lee Moffitt Cancer CenterTampaFloridaUSA
| | - Zhuoer Xie
- Department of Malignant HematologyH. Lee Moffitt Cancer CenterTampaFloridaUSA
| | - Guillermo Sanz
- Health Research Institute La Fe, Valencia, SpainHospital Universitario y Politécnico La FeValenciaSpain
| | - Hetty E. Carraway
- Leukemia Program, Hematology and Medical OncologyTaussig Cancer Institute, Cleveland ClinicClevelandOhioUSA
| | - Justin Taylor
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Stephen D. Nimer
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Matteo Giovanni Della Porta
- Department of Biomedical SciencesIRCCS Humanitas Clinical and Research Center & Humanitas UniversityMilanItaly
| | - Valeria Santini
- Myelodysplastic Syndromes Unit, Department of Experimental and Clinical Medicine, Hematology, Azienda Ospedaliero Universitaria CareggiUniversity of FlorenceFlorenceItaly
| | - Maximilian Stahl
- Department of Medical OncologyDana‐Farber Cancer Institute and Harvard Medical SchoolBostonMassachusettsUSA
| | - Uwe Platzbecker
- Department of Hematology and Cellular TherapyUniversity Hospital LeipzigLeipzigGermany
| | - Mikkael A. Sekeres
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Amer M. Zeidan
- Section of Hematology, Department of Internal MedicineYale University School of Medicine and Yale Cancer CenterNew HavenConnecticutUSA
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Serrano D, Cella D, Husereau D, King-Kallimanis B, Mendoza T, Salmonson T, Stone A, Zaleta A, Dhanda D, Moshyk A, Liu F, Shields AL, Taylor F, Spite S, Shaw JW, Braverman J. Administering selected subscales of patient-reported outcome questionnaires to reduce patient burden and increase relevance: a position statement on a modular approach. Qual Life Res 2024; 33:1075-1084. [PMID: 38265747 PMCID: PMC10973071 DOI: 10.1007/s11136-023-03587-8] [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] [Accepted: 12/11/2023] [Indexed: 01/25/2024]
Abstract
Patient-reported outcome (PRO) questionnaires considered in this paper contain multiple subscales, although not all subscales are equally relevant for administration in all target patient populations. A group of measurement experts, developers, license holders, and other scientific-, regulatory-, payer-, and patient-focused stakeholders participated in a panel to discuss the benefits and challenges of a modular approach, defined here as administering a subset of subscales out of a multi-scaled PRO measure. This paper supports the position that it is acceptable, and sometimes preferable, to take a modular approach when administering PRO questionnaires, provided that certain conditions have been met and a rigorous selection process performed. Based on the experiences and perspectives of all stakeholders, using a modular approach can reduce patient burden and increase the relevancy of the items administered, and thereby improve measurement precision and eliminate wasted data without sacrificing the scientific validity and utility of the instrument. The panelists agreed that implementing a modular approach is not expected to have a meaningful impact on item responses, subscale scores, variability, reliability, validity, and effect size estimates; however, collecting additional evidence for the impact of context may be desirable. It is also important to recognize that adequate rationale and evidence (e.g., of fit-for-purpose status and relevance to patients) and a robust consensus process that includes patient perspectives are required to inform selection of subscales, as in any other measurement circumstance, is expected. We believe that the considerations discussed within (content validity, administration context, and psychometric factors) are relevant across multiple therapeutic areas.
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Affiliation(s)
- Daniel Serrano
- Pharmerit International, Bethesda, MD, USA.
- The Psychometrics Team, Sheridan, WY, USA.
| | | | | | | | - Tito Mendoza
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for Cancer Research, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | | | - Arthur Stone
- University of Southern California, Los Angeles, CA, USA
| | - Alexandra Zaleta
- Independent Consultant, Philadelphia, PA, USA
- CancerCare, New York, NY, USA
| | | | | | - Fei Liu
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Sasha Spite
- Adelphi Values, Boston, MA, USA
- Private Consultant, Escondido, CA, USA
| | | | - Julia Braverman
- Bristol Myers Squibb, Princeton, NJ, USA
- CSL Behring, King of Prussia, PA, USA
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Tang E, Yantsis A, Ho M, Hussain J, Dano S, Aiyegbusi OL, Peipert JD, Mucsi I. Patient-Reported Outcome Measures for Patients With CKD: The Case for Patient-Reported Outcomes Measurement Information System (PROMIS) Tools. Am J Kidney Dis 2024; 83:508-518. [PMID: 37924931 DOI: 10.1053/j.ajkd.2023.09.007] [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: 03/13/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 11/06/2023]
Abstract
Chronic kidney disease (CKD), kidney failure, and kidney replacement therapies are associated with high symptom burden and impaired health-related quality of life (HRQOL). Symptoms change with disease progression or transition between treatment modalities and frequently go unreported and unmanaged. Tools that reliably monitor symptoms may improve the management of patients with CKD. Patient-reported outcome measures (PROMs) assess symptom severity; physical, psychological, social, and cognitive functioning; treatment-related side effects; and HRQOL. Systematic use of PROMs can improve patient-provider communication, patient satisfaction, clinical outcomes, and HRQOL. Potential barriers to their use include a lack of engagement, response burden, and limited guidance about PROM collection, score interpretation, and workflow integration. Well-defined, acceptable, and effective clinical response pathways are essential for implementing PROMs. PROMs developed by the Patient-Reported Outcomes Measurement Information System (PROMIS) address some challenges and may be suitable for clinical use among patients with CKD. PROMIS tools assess multiple patient-valued, clinically actionable symptoms and functions. They can be administered as fixed-length, customized short forms or computer adaptive tests, offering precise measurement across a range of symptom severities or function levels, tailored questions to individuals, and reduced question burden. Here we provide an overview of the potential use of PROMs in CKD care, with a focus on PROMIS.
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Affiliation(s)
- Evan Tang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Alyssa Yantsis
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Matthew Ho
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Junayd Hussain
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Sumaya Dano
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Olalekan L Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham (OLA), Birmingham, United Kingdom; National Institute for Health Research Applied Research Centre West Midlands, Birmingham, United Kingdom
| | - John D Peipert
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Istvan Mucsi
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada.
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Gabel CP, Cuesta-Vargas A, Dibai-Filho AV, Mokhtarinia HR, Melloh M, Bejer A. Developing a shortened spine functional index (SFI-10) for patients with sub-acute/chronic spinal disorders: a cross-sectional study. BMC Musculoskelet Disord 2024; 25:236. [PMID: 38532353 PMCID: PMC10964542 DOI: 10.1186/s12891-024-07352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Brief whole-spine patient-reported outcome measures (PROMs) provide regional solutions and future directions for quantifying functional status, evidence, and effective interventions. The whole-spine regional Spine Functional Index (SFI-25) is used internationally in clinical and scientific contexts to assess general sub-acute/chronic spine populations. However, to improve structural validity and practicality a shortened version is recommended. This study developed a shortened-SFI from the determined optimal number of item questions that: correlated with criteria PROMs being highly with whole-spine, moderately with regional-spine, condition-specific and patient-specific, and moderately-low with general-health and pain; retained one-dimensional structural validity and high internal consistency; and improved practicality to reduce administrative burden. METHODS A cross-sectional study (n = 505, age = 18-87 yrs., average = 40.3 ± 10.1 yrs) of sub-acute/chronic spine physiotherapy outpatients from an international sample of convenience. Three shortened versions of the original SFI-25 were developed using 1) qualitative 'content-retention' methodology, 2) quantitative 'factorial' methodology, and 3) quantitative 'Rasch' methodology, with a fourth 'random' version produced as a comparative control. The clinimetric properties were established for structural validity with exploratory (EFA) and confirmatory (CFA) factorial analysis, and Rasch analysis. Criterion validity used the: whole-spine SFI-25 and Functional Rating Index (FRI); regional-spine Neck Disability Index (NDI), Oswestry Disability Index (ODI), and Roland Morris Questionnaire (RMQ), condition-specific Whiplash Disability Questionnaire (WDQ); and patient-specific functional scale (PSFS); and determined floor/ceiling effect. A post-hoc pooled international sub-acute/chronic spine sample (n = 1433, age = 18-91 yrs., average = 42.0 ± 15.7 yrs) clarified the findings and employed the general-health EuroQuol-Index (EQ-5D), and 11-point Pain Numerical Rating Scale (P-NRS) criteria. RESULTS A 10-item SFI retained structural validity with optimal practicality requiring no computational aid. The SFI-10 concept-retention-version demonstrated preferred criterion validity with whole-spine criteria (SFI-25 = 0.967, FRI = 0.810) and exceeded cut-off minimums with regional-spine, condition-specific, and patient-specific measures. An unequivocal one-dimensional structure was determined. Internal consistency was satisfactory (α = 0.80) with no floor/ceiling effect. Post-hoc analysis of the international sample confirmed these findings. CONCLUSION The SFI-10 qualitative concept-retention version was preferred to quantitative factorial and Rasch versions, demonstrated structural and criterion validity, and preferred correlation with criteria measures. Further longitudinal research is required for reliability, error, and responsiveness, plus an examination of the practical characteristics of readability and administrative burden.
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Affiliation(s)
| | - Antonio Cuesta-Vargas
- Department of Psychiatry and Physiotherapy, Faculty of Medicine, Malaga University, Malaga, Spain
| | | | - Hamid Reza Mokhtarinia
- Department of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Markus Melloh
- Queensland University of Technology, School of Public Health and Social Work, Brisbane, Australia
| | - Agnieszka Bejer
- Institute of Health Sciences, Medical College, Rzeszow University, Rzeszow, Poland
- The Holy Family Specialist Hospital, Rudna Mała 600, 36-060, Głogów Małopolski, Poland
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11
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Aiyegbusi OL, Cruz Rivera S, Roydhouse J, Kamudoni P, Alder Y, Anderson N, Baldwin RM, Bhatnagar V, Black J, Bottomley A, Brundage M, Cella D, Collis P, Davies EH, Denniston AK, Efficace F, Gardner A, Gnanasakthy A, Golub RM, Hughes SE, Jeyes F, Kern S, King-Kallimanis BL, Martin A, McMullan C, Mercieca-Bebber R, Monteiro J, Peipert JD, Quijano-Campos JC, Quinten C, Rantell KR, Regnault A, Sasseville M, Schougaard LMV, Sherafat-Kazemzadeh R, Snyder C, Stover AM, Verdi R, Wilson R, Calvert MJ. Recommendations to address respondent burden associated with patient-reported outcome assessment. Nat Med 2024; 30:650-659. [PMID: 38424214 DOI: 10.1038/s41591-024-02827-9] [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: 12/05/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
Patient-reported outcomes (PROs) are increasingly used in healthcare research to provide evidence of the benefits and risks of interventions from the patient perspective and to inform regulatory decisions and health policy. The use of PROs in clinical practice can facilitate symptom monitoring, tailor care to individual needs, aid clinical decision-making and inform value-based healthcare initiatives. Despite their benefits, there are concerns that the potential burden on respondents may reduce their willingness to complete PROs, with potential impact on the completeness and quality of the data for decision-making. We therefore conducted an initial literature review to generate a list of candidate recommendations aimed at reducing respondent burden. This was followed by a two-stage Delphi survey by an international multi-stakeholder group. A consensus meeting was held to finalize the recommendations. The final consensus statement includes 19 recommendations to address PRO respondent burden in healthcare research and clinical practice. If implemented, these recommendations may reduce PRO respondent burden.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK.
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
| | - Samantha Cruz Rivera
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | | | - Yvonne Alder
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Anderson
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Vishal Bhatnagar
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Philip Collis
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Alastair K Denniston
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Aston University, Birmingham, UK
| | | | - Robert M Golub
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Hughes
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Flic Jeyes
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Christel McMullan
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Rebecca Mercieca-Bebber
- The NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Juan Carlos Quijano-Campos
- William Harvey Research Institute, Queen Mary University of London, London, UK
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | | | | | - Claire Snyder
- Johns Hopkins Schools of Medicine and Public Health, Baltimore, MD, USA
| | - Angela M Stover
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Rav Verdi
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Cancer Research Advocacy Forum, London, UK
| | - Melanie J Calvert
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), University Hospital Birmingham and University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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12
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Lindegaard SF, Højen AA, Rolving N. Electronic adaptation and danish cross-cultural translation of PEmb-QoL and VEINES-QoL/Sym for patients with venous thromboembolism. J Patient Rep Outcomes 2024; 8:21. [PMID: 38407682 PMCID: PMC10897079 DOI: 10.1186/s41687-024-00698-9] [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: 06/13/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
PURPOSE Most patient-reported outcome (PROs) used in thrombosis research and clinical practice are delivered using technology like online questionnaires. However, only few have undergone formal electronic adaptation from paper to digital versions, threatening the validity and reliability of the PROs. The present study aimed to perform an electronic adaption and cross-cultural translation of two PROs measuring health-related quality of life in a Danish cohort of patients with venous thrombosis (VTE), specifically the VEINES-QoL/Sym questionnaire and the PEmb-QoL questionnaire. METHODS The electronic adaption and cross-cultural translation processes followed the international guidelines recommended by ISPOR. The migration of the questionnaires from paper to electronic versions was conducted in the Research Electronic Data Capture (REDCap). Following approval of the electronically adapted and translated versions, a pretest of the questionnaires was performed by cognitive interviewing patients with VTE recruited from a hospital setting. RESULTS Nine men and ten women between the age of 19 and 73 years participated in cognitive interviews. The questionnaires were successfully adapted from paper to electronic versions, and during the migration process only a few modifications to the content and format were made. Most comments were related to technicalities, e.g. touch functions and checkboxes. The cross-cultural translation of both questionnaires was satisfactory, as only minor rephrasing was required. CONCLUSIONS The original and Danish version of VEINES-QoL/Sym and PEmb-QoL were successfully adapted into electronic versions and are ready to share for REDCap users. Furthermore, the Danish versions of the two questionnaires have shown satisfactory face validity.
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Affiliation(s)
- Stine Foged Lindegaard
- Danish Center for Health Services Research, Aalborg University Hospital and Aalborg University , Aalborg, Denmark
| | - Anette Arbjerg Højen
- Danish Center for Health Services Research, Aalborg University Hospital and Aalborg University , Aalborg, Denmark
| | - Nanna Rolving
- Department of Physical and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
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13
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Peipert JD, Breslin M, Basch E, Calvert M, Cella D, Smith ML, Thanarajasingam G, Roydhouse J. [Special issue PRO] Considering endpoints for comparative tolerability of cancer treatments using patient report given the estimand framework. J Biopharm Stat 2024:1-19. [PMID: 38358291 DOI: 10.1080/10543406.2024.2313060] [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: 02/23/2023] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
Regulatory agencies are advancing the use of systematic approaches to collect patient experience data, including patient-reported outcomes (PROs), in cancer clinical trials to inform regulatory decision-making. Due in part to clinician under-reporting of symptomatic adverse events, there is a growing recognition that evaluation of cancer treatment tolerability should include the patient experience, both in terms of the overall side effect impact and symptomatic adverse events. Methodologies around implementation, analysis, and interpretation of "patient" reported tolerability are under development, and current approaches are largely descriptive. There is robust guidance for use of PROs as efficacy endpoints to compare cancer treatments, but it is unclear to what extent this can be relied-upon to develop tolerability endpoints. An important consideration when developing endpoints to compare tolerability between treatments is the linkage of trial design, objectives, and statistical analysis. Despite interest in and frequent collection of PRO data in oncology trials, heterogeneity in analyses and unclear PRO objectives mean that design, objectives, and analysis may not be aligned, posing substantial challenges for the interpretation of results. The recent ICH E9 (R1) estimand framework represents an opportunity to help address these challenges. Efforts to apply the estimand framework in the context of PROs have primarily focused on efficacy outcomes. In this paper, we discuss considerations for comparing the patient-reported tolerability of different treatments in an oncology trial context.
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Affiliation(s)
- John Devin Peipert
- Medical Sciences, Northwestern University Feinberg School of Medical Sciences, Chicago, Illinois, USA
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - David Cella
- Medical Sciences, Northwestern University Feinberg School of Medical Sciences, Chicago, Illinois, USA
| | - Mary Lou Smith
- Department of Medical Social Sciences, Research Advocacy Network, Chicago, Illinois, USA
| | | | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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14
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Singh H, Benn N, Fung A, Kokorelias KM, Martyniuk J, Nelson MLA, Colquhoun H, Cameron JI, Munce S, Saragosa M, Godhwani K, Khan A, Yoo PY, Kuluski K. Co-design for stroke intervention development: Results of a scoping review. PLoS One 2024; 19:e0297162. [PMID: 38354160 PMCID: PMC10866508 DOI: 10.1371/journal.pone.0297162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Co-design methodology seeks to actively engage end-users in developing interventions. It is increasingly used to design stroke interventions; however, limited guidance exists, particularly with/for individuals with stroke who have diverse cognitive, physical and functional abilities. Thus, we describe 1) the extent of existing research that has used co-design for stroke intervention development and 2) how co-design has been used to develop stroke interventions among studies that explicitly used co-design, including the rationale, types of co-designed stroke interventions, participants involved, research methodologies/approaches, methods of incorporating end-users in the research, co-design limitations, challenges and potential strategies reported by researchers. MATERIALS AND METHODS A scoping review informed by Joanna Briggs Institute and Arksey & O'Malley methodology was conducted by searching nine databases on December 21, 2022, to locate English-language literature that used co-design to develop a stroke intervention. Additional data sources were identified through a hand search. Data sources were de-duplicated, and two research team members reviewed their titles, abstracts and full text to ensure they met the inclusion criteria. Data relating to the research objectives were extracted, analyzed, and reported numerically and descriptively. RESULTS Data sources used co-design for stroke intervention development with (n = 89) and without (n = 139) explicitly using the term 'co-design.' Among studies explicitly using co-design, it was commonly used to understand end-user needs and generate new ideas. Many co-designed interventions were technology-based (65%), and 48% were for physical rehabilitation or activity-based. Co-design was commonly conducted with multiple participants (82%; e.g., individuals with stroke, family members/caregivers and clinicians) and used various methods to engage end-users, including focus groups and workshops. Limitations, challenges and potential strategies for recruitment, participant-engagement, contextual and logistical and ethics of co-designed interventions were described. CONCLUSIONS Given the increasing popularity of co-design as a methodology for developing stroke interventions internationally, these findings can inform future co-designed studies.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Natasha Benn
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Agnes Fung
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kristina M. Kokorelias
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Geriatrics Division, Sinai Health System, University Health Network, Toronto, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto Libraries, University of Toronto, Toronto, Canada
| | - Michelle L. A. Nelson
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jill I. Cameron
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah Munce
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Marianne Saragosa
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Kian Godhwani
- Department of Psychology, University of Toronto Scarborough, Toronto, Canada
| | - Aleena Khan
- Biological Sciences, University of Toronto, Toronto, Canada
| | - Paul Yejong Yoo
- Division of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Kerry Kuluski
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, Canada
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15
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Muñoz Amezcua AC, Jones JM, Griffith EH, Gruen ME. Pilot Study on the Efficacy and Safety of Long-Term Oral Imepitoin Treatment for Control of (Thunder)Storm-Associated Noise Phobia/Noise Aversion in Dogs Using an Individualized-Dose Titration Approach. Animals (Basel) 2024; 14:545. [PMID: 38396513 PMCID: PMC10886229 DOI: 10.3390/ani14040545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
Imepitoin is a low-affinity partial agonist for benzodiazepine binding sites of gamma-aminobutyric acid receptors with anxiolytic effects. It has been shown to reduce anxiety during noise-related events in dogs when given at 30 mg/kg PO BID, although this dose was associated with ataxia and increased appetite in some cases. The objective of this study was to assess its safety and efficacy for storm anxiety when started at 10 mg/kg PO BID and titrated to effect up to 30 mg/kg PO BID during storm season. Significant decreases in anxiety scores were seen in weekly surveys and storm logs (SLs) at 10, 20 and 30 mg/kg PO BID. Serious adverse events (AEs) were not reported in any subject. Ataxia was the most commonly reported non-serious AE (14/33), followed by increased hunger (13/33). The frequency of AEs was higher in the 20 mg/kg PO BID group than in the 10 mg/kg group PO BID. No clinically significant changes were seen in lab work pre- and post-study. In conclusion, Imepitoin given during storm season at doses ranging from 10 to 30 mg/kg PO BID reduced clinical signs of fear and anxiety during storms for the dogs in this study. These findings support the use of an individually titrated dose.
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Affiliation(s)
- Ana C. Muñoz Amezcua
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
| | - Jennifer M. Jones
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University, Raleigh, NC 27606, USA;
| | - Margaret E. Gruen
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
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16
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Gettel CJ, Suter LG, Bagshaw K, Sheares KD, Balestracci KMB, Lin Z, Venkatesh AK. Patient-Reported Outcome-Based Performance Measures in Alternative Payment Models: Current Use, Implementation Barriers, and Principles to Succeed. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:199-205. [PMID: 38042334 PMCID: PMC10872237 DOI: 10.1016/j.jval.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES Patient-reported outcome (PRO)-based performance measures (PRO-PMs) offer opportunities to aggregate survey data into a reliable and valid assessment of performance at the entity-level (eg, clinician, hospital, and accountable care organization). Our objective was to address the existing literature gap regarding the implementation barriers, current use, and principles for PRO-PMs to succeed. METHODS As quality measurement experts, we first highlighted key principles of PRO-PMs and how alternative payment models (APMs) may be integral in promoting more widespread use. In May 2023, we reviewed the Centers for Medicare and Medicaid Services (CMS) Measures Inventory Tool for active PRO-PM usage within CMS programs. We finally present principles to prioritize as part PRO-PMs succeeding within APMs. RESULTS We identified 5 implementation barriers to PRO-PM use: original development of instrument, response rate sufficiency, provider burden, hesitancy regarding fairness, and attribution of desired outcomes. There existed 54 instances of active PRO-PM usage across CMS programs, including 46 unique PRO-PMs within 14 CMS programs. Five principles to prioritize as part of greater PRO-PM development and incorporation within APMs include the following: (1) clinical salience, (2) adequate sample size, (3) meaningful range of performance among measured entities and the ability to detect performance change in a reasonable time frame, (4) equity focus, and (5) appropriate risk adjustment. CONCLUSIONS Identified barriers and principles to prioritize should be considered during PRO-PM development and implementation phases to link available and novel measures to payment programs while ensuring provider and stakeholder engagement.
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Affiliation(s)
- Cameron J Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA.
| | - Lisa G Suter
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA; Section of Rheumatology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Health System, West Haven, CT, USA
| | - Kyle Bagshaw
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA
| | - Karen D Sheares
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Zhenqiu Lin
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA; Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA
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17
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Bemmouna D, Lagzouli A, Weiner L. The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls. Mol Autism 2023; 14:47. [PMID: 38110995 PMCID: PMC10726572 DOI: 10.1186/s13229-023-00580-3] [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: 06/30/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), whose aetiology has been attributed to biosocial factors. In autism spectrum condition (ASC), although ED is prevalent and is associated with decreased well-being (e.g. self-harm, suicidality), it has been understudied, especially in adults. It is therefore crucial to further understand ED in autistic adults to improve its treatment. Our study investigates ED, its behavioural correlates (e.g. self-harm, suicidality) and biosocial predictors in autistic adults relative to BPD and nonclinical controls (NC). METHODS A total of 724 participants (ASC = 154; BPD = 111; NC = 459) completed 11 self-reported questionnaires assessing ED, ASC and BPD traits, co-occurring disorders, alexithymia, emotional vulnerability and invalidating experiences (e.g. bullying, autistic camouflaging). The occurrence of ED behavioural correlates (i.e. self-harm, history of suicide attempts, and psychiatric hospitalizations) was collected. In addition, between-groups analyses, linear regressions and machine learning (ML) models were used to identify ED predictors in each group. RESULTS ED and its behavioural correlates were higher in ASC compared to NC, but milder than in BPD. While gender did not predict ED scores, autistic women had increased risk factors to ED, including sexual abuse and camouflaging. Interestingly, BPD traits, emotional vulnerability and alexithymia strongly predicted ED scores across the groups. Using ML models, sensory sensitivity and autistic camouflaging were associated with ED in ASC, and ADHD symptoms with ED in BPD. LIMITATIONS ASC and BPD diagnoses were self-reported, which did not allow us to check their accuracy. Additionally, we did not explore the transactional and the moderating/mediating relationships between the different variables. Moreover, our research is cross-sectional and cannot draw conclusions regarding the direction and causality of relationships between ED and other clinical dimensions. CONCLUSIONS ED and its behavioural correlates are heightened in BPD compared to ASC and nonclinical controls. In the ASC group, there were no gender differences in ED, despite the heightened exposure of autistic women to ED risk factors. BPD traits, emotional vulnerability, and alexithymia are core to ED regardless of diagnosis. Although less central, sensory sensitivity and autistic camouflaging seem to be specific predictors of ED in autistic adults.
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Affiliation(s)
- Doha Bemmouna
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France.
| | - Amine Lagzouli
- MSME, CNRS UMR 8208, Paris-Est Créteil University, Gustave Eiffel University, 94010, Créteil, France
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Luisa Weiner
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France.
- Psychiatry Department, University Hospitals of Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France.
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18
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Boulanger MC, Petrillo LA, Temel JS. Listen to the patient: integrating patient-reported outcomes into clinical care. J Natl Cancer Inst 2023; 115:1451-1453. [PMID: 37740689 DOI: 10.1093/jnci/djad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 09/25/2023] Open
Affiliation(s)
- Mary C Boulanger
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Laura A Petrillo
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jennifer S Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Deacon RM, Mills L, Bruno R, Mammen K, Dunlop A, Childs S, Shakeshaft A, Holmes J, Lintzeris N. Identifying thresholds for clinically meaningful change among clients of drug and alcohol services using the Australian Treatment Outcomes Profile. Addiction 2023; 118:2457-2465. [PMID: 37421220 DOI: 10.1111/add.16295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/12/2023] [Indexed: 07/10/2023]
Abstract
AIMS The Austraian Treatment Outcomes Profile (ATOP) is a brief clinical outcomes tool used widely in the Australian alcohol and other drugs treatment sector to monitor clients' substance use, health, wellbeing and clinical risk factors. It has demonstrated reliability and validity, and has recommended clinical cut-offs for assessing single-occasion client-rated health scores. This study determined clinically meaningful change thresholds for ATOP substance use and health and wellbeing variables for use by clinicians in monitoring client progress, and for quality improvement and service evaluation. DESIGN, SETTING AND PARTICIPANTS A framework for assessing clinically meaningful changes scores was developed by (1) calculating statistically reliable change thresholds using data-driven techniques with a reference sample of clinical ATOP data and (2) conducting a multi-disciplinary subject matter expert group to review the utility and validity of data-derived clinically meaningful change. The study was conducted within Outpatient Alcohol and Other Drug treatment services in New South Wales, Australia. The reference sample comprised 6100 ATOPs from clients at entry to public outpatient Alcohol and Other Drug treatment services; the subject matter expert group comprised 29 key stakeholders from the specialist alcohol and other drug treatment sector. MEASUREMENTS AND FINDINGS We used the Reliable Change Index method to calculate clinically meaningful change thresholds for ATOP variables. For substance use variables, a change of 30% in days of use in the last 28 (minimum 4 days) was the threshold for clinically meaningful change for substance use; for health and wellbeing variables, a change of 2 or more points in psychological health, physical health or quality of life scores (measured on 0-10 scales) was the minimum clinically meaningful change. CONCLUSIONS Clinically meaningful change thresholds have been proposed for Australian Treatment Outcomes Profile substance use and health and wellbeing items, based on statistical reliability and subject matter expert assessment. These will be used in the development of an outcomes metric for assessing change and assigning meaning in aggregated data for evaluation of services.
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Affiliation(s)
- Rachel M Deacon
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, NSW, Australia
| | - Llewellyn Mills
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, NSW, Australia
| | - Raimondo Bruno
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, Australia
| | - Kristie Mammen
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, NSW, Australia
| | - Adrian Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, NSW, Australia
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, Australia
- Drug and Alcohol Services, Hunter New England Local Health District, Sydney, NSW, Australia
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Steven Childs
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, NSW, Australia
- Drug and Alcohol Services, Central Coast Local Health District, Gosford, NSW, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD, Australia
| | - Jennifer Holmes
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Nicholas Lintzeris
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, NSW, Australia
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20
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Nagase H, Ito R, Ishii M, Shibata H, Suo S, Mukai I, Zhang S, Rothnie KJ, Trennery C, Yuanita L, Ishii T. Relationship Between Asthma Control Status and Health-Related Quality of Life in Japan: A Cross-Sectional Mixed-Methods Study. Adv Ther 2023; 40:4857-4876. [PMID: 37698717 PMCID: PMC10567960 DOI: 10.1007/s12325-023-02660-5] [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: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION There is limited information regarding multidimensional relationships between asthma control and health-related quality of life (HRQoL), work productivity, and asthma symptom burden in Japan. Furthermore, systematic qualitative investigations about asthma burden have not been performed. METHODS This cross-sectional, mixed-methods study included Japanese patients (≥ 20 years) with asthma adherent to inhaled corticosteroids/long-acting β2-agonists (ICS/LABA). The primary endpoint was impact of asthma on HRQoL, measured using the Asthma Health Questionnaire-33 (AHQ-33). Secondary endpoints were cough burden (Japanese-adapted Leicester Cough Questionnaire [J-LCQ]) and impact of asthma on work/activities (asthma-specific Work Productivity and Activity Impairment Questionnaire [WPAI:Asthma]). Quantitative data were assessed for the overall population and for well-controlled (WC) and not well-controlled (NWC) asthma subgroups. Qualitative verbal interviews further assessed the impact of NWC asthma on patients' HRQoL; emergent themes were extracted using thematic analyses. RESULTS Of 454 patients, 45.2% (n = 205) had NWC asthma. Patients with NWC asthma had significantly worse asthma- and cough-related HRQoL across all AHQ-33 and J-LCQ domains and significantly greater work and activity impairment versus patients with WC asthma, across all assessed WPAI:Asthma domains. AHQ-33 total score was highly correlated with J-LCQ total and domain scores (r = - 0.8132 to r = - 0.7407). Nine themes emerged from qualitative interviews and confirmed that patients with NWC asthma had considerable HRQoL impairment due to asthma symptoms. CONCLUSIONS Patients with NWC asthma had higher symptom burden and worse HRQoL than patients with WC asthma, despite ICS/LABA adherence. Cough burden correlated with HRQoL, suggesting cough may be one of the key markers to inform treatment strategy for patients with asthma.
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Affiliation(s)
- Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Risako Ito
- Value Evidence and Outcomes, GSK, 1-8-1 Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
| | - Moe Ishii
- Mebix, Inc., Minato-ku, Tokyo, Japan
| | | | | | - Isao Mukai
- Medical Affairs Asthma & COPD, GSK, Minato-ku, Tokyo, Japan
| | - Shiyuan Zhang
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
| | | | | | - Liza Yuanita
- Medical Affairs Asthma & COPD, GSK, Minato-ku, Tokyo, Japan
| | - Takeo Ishii
- Value Evidence and Outcomes, GSK, 1-8-1 Akasaka, Minato-ku, Tokyo, 107-0052, Japan
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21
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Instenes I, Breivik K, Borregaard B, Larsen AI, Allore H, Bendz B, Deaton C, Rotevatn S, Norekvål TM. Phenotyping Self-Reported Health Profiles in Octogenarians and Nonagenarians After Percutaneous Coronary Intervention: A Latent Profile Analysis. Heart Lung Circ 2023; 32:1321-1333. [PMID: 37925313 DOI: 10.1016/j.hlc.2023.09.004] [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: 03/17/2023] [Revised: 07/11/2023] [Accepted: 09/01/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Little is known about self-reported health in octogenarians (≥80 years) and nonagenarians (≥90 years) following percutaneous coronary intervention (PCI), including characteristics of different health outcomes. This study aimed to phenotype latent health profiles of self-reported health in older adults 2 months post-PCI. METHODS A prospective, multicentre, real-world study (CONCARDPCI) of 270 octogenarians and nonagenarians was performed with five validated and standardised measures of self-reported health at 2 months post-PCI. Latent profile analysis was used to identify health profiles, and multinomial logistic regression analyses were used to investigate the associations between patient characteristics and health profiles. RESULTS Three latent health profiles were identified: The Poor health profile included 29%, the Moderate health profile included 39%, and the Good health profile included 32% of the participants. Older adults who were frail (OR 2.50, 95% CI 1.17-5.33), had a low exercise level (OR 0.49, 95% CI 0.39-0.95), and low alcohol intake (OR 0.61, 95% CI 0.39-0.95) were more likely to belong to the Poor health profile relative to the Good health profile. Furthermore, older age (OR 1.19, 95% CI 1.03-1.37) and lower exercise level (OR 0.64, 95% CI 0.43-0.97) were associated with belonging to the Moderate health profile relative to the Good health profile. CONCLUSION Two months after PCI, most participants displayed having Moderate to Good health profiles. Those with a Poor health profile were more likely to be frail and less active. These findings highlight that follow-up care has to be patient-centred and tailored to improve the health status of older adults.
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Affiliation(s)
- Irene Instenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare-West, Bergen, Norway
| | - Britt Borregaard
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Biostatistics, Yale School of Public Health, Yale University, Yale School of Public Health, New Haven, CT, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
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22
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Jayakumar P, Heng M, Okelana B, Vrahas M, Rodriguez-Villalon A, Joeris A. Patient-Reported Outcome Measurement in Orthopaedic Trauma. J Am Acad Orthop Surg 2023; 31:e906-e919. [PMID: 37796280 DOI: 10.5435/jaaos-d-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 10/06/2023] Open
Abstract
Patient-reported outcome (PRO) measurements are validated tools developed to quantify self-reported aspects of capability, mindset, and circumstances in a standardized fashion. While PRO measurements have primarily been used in the research realm, a growing body of work now underscores substantial opportunities in applying the data generated by these tools to advance patient-centered musculoskeletal care. Specifically, the insights into a patient's health status derived from these measures can augment the standard biomedical approach to the management of patients with orthopaedic trauma. For instance, PRO measures have demonstrated the high prevalence of psychological distress and social concerns within trauma populations and shown that mindsets and circumstances account for a substantial amount of the variation in levels of symptom intensity and capability in these patients. Such findings support the need for a more integrated, biopsychosocial, and multidisciplinary team-based approach to orthopaedic trauma care that include both technical and nontechnical skillsets. In this chapter, we explore the range of available fixed-scale and computer adaptive PRO measures that can quantify aspects of capability, mindsets, and circumstances of the patient with orthopaedic trauma during their experience of injury, recovery, and rehabilitation. Furthermore, we define human, technical, and system-level challenges within the often complex, dynamic, and clinically intense trauma setting. Finally, we highlight potential opportunities through successfully implementing PRO measurements for clinical decision support, shared decision making, predicting health outcomes, and developing advanced care pathways for patients and populations with orthopaedic trauma.
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Affiliation(s)
- Prakash Jayakumar
- From the AO Innovation Translation Center, Clinical Science, AO Foundation, Dübendorf, Switzerland (Jayakumar, Rodriguez-Villalon, and Joeris), the University of Miami Health System Miller School of Medicine, Miami, FL (Heng), The Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, TX (Dr. Okelana), Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA (Dr. Vrahas), and Advancing Outcomes and Building Expertise in Research for Trauma Consortium
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23
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Atreya S, Salins N. End-of-Life Care Education as Blended Learning Approach for General Practitioners: a Scoping Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1440-1458. [PMID: 37648949 PMCID: PMC10509089 DOI: 10.1007/s13187-023-02358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
General practitioners (GPs) are critical in providing primary palliative care in the community. Apprehensions about managing a dying person at home, difficulties in goals of care discussion, limited resources and lack of palliative care education often hinder end-of-life care provision in the community. This review focused on the end-of-life care training programs accessed by GPs and sought to understand if the training programs' content and mode of delivery aligned with their preferred needs. MEDLINE, EMBASE, CINAHL, and PsycINFO were searched to identify articles published in English between 01 January 1990 and 30 September 2022. Additionally, searches were conducted using SCOPUS, the Web of Science, and the Cochrane database using free texts. The reviewers screened the titles, abstracts, and full text to identify eligible studies and extracted textual data to analyse and generate themes. Out of 5532 citations initially accessed, 17 studies were included in the review. Six themes were generated: knowledge translation, skill development, a change in attitude, self-efficacy, satisfaction, and patient outcomes. The GPs' end-of-life care knowledge, skills, attitude, self-efficacy, and patient outcomes were better when their training had a combination of small-group interactive workshops, trigger case-based reflective learning, mentor-facilitated experiential learning, web-based modules, and peer learning. The synthesis of review findings supports blended learning as a training approach for general the practitioners' end-of-life care education as it facilitates learning and patient outcomes.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, 700160, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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24
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Spencer KL, Absolom KL, Allsop MJ, Relton SD, Pearce J, Liao K, Naseer S, Salako O, Howdon D, Hewison J, Velikova G, Faivre-Finn C, Bekker HL, van der Veer SN. Fixing the Leaky Pipe: How to Improve the Uptake of Patient-Reported Outcomes-Based Prognostic and Predictive Models in Cancer Clinical Practice. JCO Clin Cancer Inform 2023; 7:e2300070. [PMID: 37976441 PMCID: PMC10681558 DOI: 10.1200/cci.23.00070] [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: 04/24/2023] [Revised: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE This discussion paper outlines challenges and proposes solutions for successfully implementing prediction models that incorporate patient-reported outcomes (PROs) in cancer practice. METHODS We organized a full-day multidisciplinary meeting of people with expertise in cancer care delivery, PRO collection, PRO use in prediction modeling, computing, implementation, and decision science. The discussions presented here focused on identifying challenges to the development, implementation and use of prediction models incorporating PROs, and suggesting possible solutions. RESULTS Specific challenges and solutions were identified across three broad areas. (1) Understanding decision making and implementation: necessitating multidisciplinary collaboration in the early stages and throughout; early stakeholder engagement to define the decision problem and ensure acceptability of PROs in prediction; understanding patient/clinician interpretation of PRO predictions and uncertainty to optimize prediction impact; striving for model integration into existing electronic health records; and early regulatory alignment. (2) Recognizing the limitations to PRO collection and their impact on prediction: incorporating validated, clinically important PROs to maximize model generalizability and clinical engagement; and minimizing missing PRO data (resulting from both structural digital exclusion and time-varying factors) to avoid exacerbating existing inequalities. (3) Statistical and modeling challenges: incorporating statistical methods to address missing data; ensuring predictive modeling recognizes complex causal relationships; and considering temporal and geographic recalibration so that model predictions reflect the relevant population. CONCLUSION Developing and implementing PRO-based prediction models in cancer care requires extensive multidisciplinary working from the earliest stages, recognition of implementation challenges because of PRO collection and model presentation, and robust statistical methods to manage missing data, causality, and calibration. Prediction models incorporating PROs should be viewed as complex interventions, with their development and impact assessment carried out to reflect this.
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Affiliation(s)
- Katie L. Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kate L. Absolom
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Matthew J. Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Samuel D. Relton
- Leeds Institute of Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Jessica Pearce
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Kuan Liao
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Centre for Health Informatics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sairah Naseer
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Omolola Salako
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Daniel Howdon
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Corinne Faivre-Finn
- Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Hilary L. Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sabine N. van der Veer
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Centre for Health Informatics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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25
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Garcia BN, Tyser A, Roca H, Kazmers NH. Patient-Reported Outcome Measurement and Minimal Clinically Important Difference for Hand Surgeons. J Am Acad Orthop Surg 2023:00124635-990000000-00743. [PMID: 37418325 DOI: 10.5435/jaaos-d-23-00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/05/2023] [Indexed: 07/09/2023] Open
Abstract
Patient-reported outcome measurement (PROM) tools are used to evaluate health status and response to treatment and have been integral in the effort to improve the quality of care provided. Patient reported outcomes (PROs) have garnered additional attention since becoming a priority of the National Institutes of Health in the early part of this century, and their use in both clinical practice and research has subsequently increased. In the upper extremity, a variety of PRO instruments exist that can assist physicians in their ability to track and/or prognosticate outcomes, make comparisons between treatments as well as strengthen research methodologies, and help determine the value of care. A more complete interpretation of the clinical significance of patient-reported outcome measurements is informed by parameters such as minimal clinically important difference, substantial clinical benefit and patient acceptable symptom state.
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Affiliation(s)
- Brittany N Garcia
- From the Department of Orthopaedics, University of Utah, Salt Lake City, UT
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26
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Mokanyk AR, Taylor CL, De la Garza Ramos R, Tadepalli S, Girasulo SA, Rossi MCS, O'Donnell BA, Bauman JA, Sekhar R, Abbed KM, Matmati N, Yanamadala V. System-wide integration of patient reported outcome measure collection through an electronic medical record system: A state-wide retrospective study. J Clin Neurosci 2023; 114:137-143. [PMID: 37392561 DOI: 10.1016/j.jocn.2023.06.009] [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: 03/03/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND AND PURPOSE In spine neurosurgery practice, patient-reported outcome measures (PROMs) are tools used to convey information about a patient's health experience and are an integral component of a clinician's decision-making process as they help guide treatment strategies to improve outcomes and minimize pain. Currently, there is limited research showing effective integration strategies of PROMs into electronic medical records. This study aims to provide a framework for other healthcare systems by outlining the process from start to finish in seven Hartford Healthcare Neurosurgery outpatient spine clinics throughout the state of Connecticut. METHODS On March 1, 2021, a pilot implementation program began in one clinic and on July 1, 2021, all outpatient clinics were implementing the revised clinical workflow that included the electronic collection of PROMs within the electronic health record (EHR). A retrospective chart analysis studied all adult (18+) new patient visits in seven outpatient clinics by comparing the rates of PROMs collection in Half 1 (March 1, 2021-August 31, 2022) and in Half 2 (September 1, 2022-February 28, 2022) across all sites. Additionally, patient characteristics were studied to identify any variables that may lead to higher rates of collection. RESULTS During the study period, 3528 new patient visits were analyzed. There was a significant change in rates of PROMs collection across all departments between H1 and H2 (p < 0.05). Additional significant predictors for PROMs collection were the sex and ethnicity of the patient as well as the provider type for the visit (p < 0.05). CONCLUSIONS This study proved that implementing the electronic collection of PROMs into an already existing clinical workflow reduces previously identified collection barriers and enables PROMs collection rates that meet or exceed current benchmarks. Our results provide a successful step-by-step framework for other spine neurosurgery clinics to implement a similar approach.
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Affiliation(s)
- Abigail R Mokanyk
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA
| | - Christopher L Taylor
- Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA
| | - Rafael De la Garza Ramos
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine in New York City, USA
| | - Swetha Tadepalli
- University of Connecticut, College of Liberal Art and Sciences, Storrs, CT 06269, USA
| | - Samantha A Girasulo
- University of Connecticut, College of Liberal Art and Sciences, Storrs, CT 06269, USA
| | - Maria C S Rossi
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA
| | - Brooke A O'Donnell
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA
| | - Joel A Bauman
- Department of Neurosurgery, Hartford HealthCare Medical Group, Hartford, CT 06106, USA
| | - Rajat Sekhar
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA
| | - Khalid M Abbed
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA
| | - Nabil Matmati
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA.
| | - Vijay Yanamadala
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA
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McMullan C, Hughes SE, Aiyegbusi OL, Calvert M. Usability testing of an electronic patient-reported outcome system linked to an electronic chemotherapy prescribing and patient management system for patients with cancer. Heliyon 2023; 9:e16453. [PMID: 37260889 PMCID: PMC10227339 DOI: 10.1016/j.heliyon.2023.e16453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Background People affected by cancer experience a wide range of symptoms which have a major impact on their functioning and health-related quality of life (HRQoL). One way to measure the impact of cancer symptoms is through the use of patient-reported outcomes. Methods An electronic patient-reported outcome (ePRO) application (ChemoPRO®) was designed to be used by cancer patients to report their symptoms and communicate with their clinical team. Usability testing sessions were conducted with people with lived experience of cancer to understand how real users interact with the ChemoPRO® system. One-to-one testing sessions were conducted to assess use of the system and identify areas for further refinement. User satisfaction was assessed using a brief satisfaction questionnaire previously used by Aiyegbusi et al. (date). Results Ten people with lived experience of cancer took part in the usability study. Symptoms and HRQoL measures, including the Euroqol EQ5D5L and the PRO-CTCAE™ were included in the ePRO system. Participants had a mean age of 62.3 years. Three critical errors and 21 non-critical errors were reported. All participants were enthusiastic about the app. Participants liked the simplicity and responsiveness of the patient-facing app and highlighted the potential for communicating with their clinical team. The overall usability and satisfaction score was 4.5 (sd = 0.09). Conclusion This usability study suggests that people with lived experience of cancer found the ChemoPRO® app acceptable and easy to use. One of the key features of this particular ePRO system that should be developed further is system functionality to facilitate communication between patients and clinicians. Future testing should include testing in a clinical setting and testing with people from ethnic minorities.
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Affiliation(s)
- Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Sarah E. Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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Brady KJS, Peipert JD, Atkinson TM, Pompili C, Pinto M, Shaw JW, Roydhouse J. International Society for Quality of Life Research commentary on the US Food and Drug Administration draft guidance for industry on core patient-reported outcomes in cancer clinical trials. Qual Life Res 2023:10.1007/s11136-023-03396-z. [PMID: 37217665 PMCID: PMC10202747 DOI: 10.1007/s11136-023-03396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/24/2023]
Abstract
In June 2021, the US Food and Drug Administration (FDA) released a draft guidance for industry on core patient-reported outcomes (PROs) and related considerations for instrument selection and trial design in registrational cancer clinical trials, building on prior communications about the use of PROs to assess efficacy and tolerability in oncology drug development. The International Society for Quality of Life Research (ISOQOL) Standards and Best Practices Committee led an initiative to draft a commentary about the guidance, focusing on its positive aspects and areas that would benefit from additional clarification and consideration. For comprehensiveness, the authors reviewed existing public comments on the draft guidance, and the commentary underwent a thorough review process through three ISOQOL Special Interest Groups (Psychometrics, Clinical Practice, and Regulatory and Health Technology Assessment Engagement) followed by the ISOQOL Board. The goal of this commentary is to situate this new and relevant guidance document within the context of recent regulatory efforts on PROs and highlight areas in which further work may ultimately benefit the field.
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Affiliation(s)
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Cecilia Pompili
- Patient-Centred Outcomes Research (PCOR), University of Leeds, Leeds, UK
| | - Monica Pinto
- Rehabilitation Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | | | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
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Ge C, Guo K, Li Y, Li G, Zhang H, Yang J, Liu Y, Yin C, Liu S, Xie S, Chen X. Analysis of patient-reported outcomes in the approval of novel oncology drugs in the United States, 2017-2022. EClinicalMedicine 2023; 59:101953. [PMID: 37089618 PMCID: PMC10113764 DOI: 10.1016/j.eclinm.2023.101953] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Background With the growing notion of patient-focused drug development, the quality of life and other patient-reported outcomes (PROs) of cancer patients are gaining considerable attention. Several drug regulatory agencies, including the U.S. Food and Drug Administration (FDA), are calling attention to PROs. This review aims to comprehensively characterise the application of PROs and regulatory considerations for PROs in the FDA-approved novel oncology drugs. Methods The FDA review documents and labels for novel oncology drugs approved from July 2017 to July 2022 were retrieved. We collected and analysed drug approval information, types of endpoints for PROs, PRO measures, designs of trials including PROs, and regulatory comments on PRO-related contents. Findings Results demonstrated that PROs were used more commonly for solid tumours than hematologic malignancies, which might be correlated with the disease characteristics. We further categorised and analysed existing PRO measures, providing insight for tool selection in future oncology trial design. Our findings also indicated that PROs currently do not play a significant role in oncology drug approvals. The major deficiencies related to PROs commented on by FDA reviewers were analysed, followed by recommendations for improvements. Interpretation This review demonstrates that PROs currently do not play a significant role in oncology drug marketing review, and how they can be used to support the approval of new oncology drugs is still in the exploratory stage. This current situation is not only related to the deficiencies in the design and implementation of PRO-related contents in oncology trials, but more importantly, it is a reminder that we should pay more attention to patient experience in the development of oncology drugs. Funding This study was not supported by any funding.
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Affiliation(s)
- Chenghao Ge
- Tsinghua Clinical Research Institute, School of Medicine, Tsinghua University, Beijing, China
| | - Kaiyuan Guo
- School of Medicine, Tsinghua University, Beijing, China
| | - Yi Li
- Tsinghua Clinical Research Institute, School of Medicine, Tsinghua University, Beijing, China
| | - Guanqiao Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Hong Zhang
- Center for Drug Evaluation, National Medical Products Administration, Beijing, China
| | - Jiaxuan Yang
- School of Medicine, Tsinghua University, Beijing, China
| | - Yang Liu
- Tsinghua Clinical Research Institute, School of Medicine, Tsinghua University, Beijing, China
| | - Chen Yin
- Tsinghua Clinical Research Institute, School of Medicine, Tsinghua University, Beijing, China
| | - Sen Liu
- Tsinghua Clinical Research Institute, School of Medicine, Tsinghua University, Beijing, China
| | - Songmei Xie
- Center for Drug Evaluation, National Medical Products Administration, Beijing, China
- Corresponding author.
| | - Xiaoyuan Chen
- Tsinghua Clinical Research Institute, School of Medicine, Tsinghua University, Beijing, China
- Office of Clinical Trial Institute, Beijing Tsinghua Changgung Hospital, Beijing, China
- Corresponding author. Tsinghua Clinical Research Institute, Tsinghua University, Beijing, China.
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Coles T. Supporting Clinical Decision-Making in Emergency Departments With Patient-Reported Outcome Measures. JACC. ADVANCES 2023; 2:100339. [PMID: 38939590 PMCID: PMC11198564 DOI: 10.1016/j.jacadv.2023.100339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Theresa Coles
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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31
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Sutton SR, Taniguchi AN, Nguyen SA, Albergotti WG, Kaczmar JM, Kejner AE, Newman JG. The Inconsistent Assessment of Quality of Life in Patients Treated for Head and Neck Cancer with Anti-EGFR Inhibitors: A Systematic Scoping Review. Cancers (Basel) 2023; 15:cancers15092475. [PMID: 37173942 PMCID: PMC10177329 DOI: 10.3390/cancers15092475] [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: 04/07/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
In patients receiving treatment for head and neck cancer (HNC), there is a correlation between quality of life (QoL) scores and treatment outcomes. Higher QoL scores have been associated with improved survival. Despite this, the assessment of QoL in clinical trials varies considerably. Three databases (Scopus, PubMed, and Cinahl) were queried for articles published in English between 2006 and 2022. Two reviewers (SRS and ANT) performed study screening, data extraction, and risk of bias assessment. The authors identified 21 articles that met the inclusion criteria. A total of 5961 patients were evaluated. QoL was reported as average scores for specific variables across five different surveys in 12 included articles. Supplemental QoL data were available in 10 included studies. Critical appraisal of studies indicated a high risk of bias due to the inclusion of trials. There is no standard method for reporting QoL data in clinical trials for HNC patients undergoing treatment with anti-EGFR inhibitors. Future clinical trials should standardize their method for assessing and reporting quality-of-life data to increase patient-centered care and refine treatment choices to optimize survival.
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Affiliation(s)
- Sarah R Sutton
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
- School of Medicine, University of Nevada, Reno, NV 89557, USA
| | - April N Taniguchi
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - John M Kaczmar
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jason G Newman
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
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32
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Kawashima A, Evans CJ. Needs-based triggers for timely referral to palliative care for older adults severely affected by noncancer conditions: a systematic review and narrative synthesis. BMC Palliat Care 2023; 22:20. [PMID: 36890522 PMCID: PMC9996955 DOI: 10.1186/s12904-023-01131-6] [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: 04/29/2022] [Accepted: 02/01/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Older people with noncancer conditions are less likely to be referred to palliative care services due to the inherent uncertain disease trajectory and a lack of standardised referral criteria. For older adults with noncancer conditions where prognostic estimation is unpredictable, needs-based criteria are likely more suitable. Eligibility criteria for participation in clinical trials on palliative care could inform a needs-based criteria. This review aimed to identify and synthesise eligibility criteria for trials in palliative care to construct a needs-based set of triggers for timely referral to palliative care for older adults severely affected by noncancer conditions. METHODS A systematic narrative review of published trials of palliative care service level interventions for older adults with noncancer conditions. Electronic databases Medline, Embase, CINAHL, PsycINFO, CENTRAL, and ClinicalTrials.gov. were searched from inception to June 2022. We included all types of randomised controlled trials. We selected trials that reported eligibility criteria for palliative care involvement for older adults with noncancer conditions, where > 50% of the population was aged ≥ 65 years. The methodological quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Descriptive analysis and narrative synthesis provided descriptions of the patterns and appraised the applicability of included trial eligibility criteria to identify patients likely to benefit from receiving palliative care. RESULTS 27 randomised controlled trials met eligibility out of 9,584 papers. We identified six major domains of trial eligibility criteria in three categories, needs-based, time-based and medical history-based criteria. Needs-based criteria were composed of symptoms, functional status, and quality of life criteria. The major trial eligibility criteria were diagnostic criteria (n = 26, 96%), followed by medical history-based criteria (n = 15, 56%), and physical and psychological symptom criteria (n = 14, 52%). CONCLUSION For older adults severely affected by noncancer conditions, decisions about providing palliative care should be based on the present needs related to symptoms, functional status, and quality of life. Further research is needed to examine how the needs-based triggers can be operationalized as referral criteria in clinical settings and develop international consensus on referral criteria for older adults with noncancer conditions.
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Affiliation(s)
- Arisa Kawashima
- Department of Nursing for Advanced Practice, Division of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.,King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, London, UK. .,Sussex Community NHS Foundation Trust, Brighton, UK.
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33
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Cruz Rivera S, Liu X, Hughes SE, Dunster H, Manna E, Denniston AK, Calvert MJ. Embedding patient-reported outcomes at the heart of artificial intelligence health-care technologies. Lancet Digit Health 2023; 5:e168-e173. [PMID: 36828609 DOI: 10.1016/s2589-7500(22)00252-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/01/2022] [Accepted: 12/07/2022] [Indexed: 02/24/2023]
Abstract
Integration of patient-reported outcome measures (PROMs) in artificial intelligence (AI) studies is a critical part of the humanisation of AI for health. It allows AI technologies to incorporate patients' own views of their symptoms and predict outcomes, reflecting a more holistic picture of health and wellbeing and ultimately helping patients and clinicians to make the best health-care decisions together. By positioning patient-reported outcomes (PROs) as a model input or output we propose a framework to embed PROMs within the function and evaluation of AI health care. However, the integration of PROs in AI systems presents several challenges. These challenges include (1) fragmentation of PRO data collection; (2) validation of AI systems trained and validated against clinician performance, rather than outcome data; (3) scarcity of large-scale PRO datasets; (4) inadequate selection of PROMs for the target population and inadequate infrastructure for collecting PROs; and (5) clinicians might not recognise the value of PROs and therefore not prioritise their adoption; and (6) studies involving PRO or AI frequently present suboptimal design. Notwithstanding these challenges, we propose considerations for the inclusion of PROs in AI health-care technologies to avoid promoting survival at the expense of wellbeing.
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Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; Data-Enabled Medical Technologies and Devices Hub, University of Birmingham, Birmingham, UK.
| | - Xiaoxuan Liu
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah E Hughes
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; National Institute of Health Research Applied Research Collaborative West Midlands, Birmingham, UK
| | - Helen Dunster
- University of Birmingham Enterprise, University of Birmingham, Birmingham, UK
| | - Elaine Manna
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; Data-Enabled Medical Technologies and Devices Hub, University of Birmingham, Birmingham, UK; Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Health Data Research UK, London, UK; National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Hospital London NHS Foundation Trust and Institute of Ophthalmology, University College London, London, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; Data-Enabled Medical Technologies and Devices Hub, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK; Health Data Research UK, London, UK; National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Hospital London NHS Foundation Trust and Institute of Ophthalmology, University College London, London, UK; National Institute for Health and Care Research Birmingham-Oxford Blood and Transplant Research Unit in Precision Transplant and Cellular Theraputics, Birmingham, UK; National Institute for Health and Care Research Birmingham Biomedical Research Centre, Birmingham, UK; National Institute for Health and Care Research Surgical Reconstruction and Microbiology Centre, Birmingham, UK
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