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Perry MB, Taylor S, Khatoon B, Vercell A, Faivre-Finn C, Velikova G, Marsden A, Heal C, Yorke J. Examining the Effectiveness of Electronic Patient-Reported Outcomes in People With Cancer: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49089. [PMID: 39083791 PMCID: PMC11325109 DOI: 10.2196/49089] [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: 05/17/2023] [Revised: 02/07/2024] [Accepted: 04/10/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Electronic patient-reported outcomes (ePROs) are commonly used in oncology clinical practice and have shown benefits for patients and health resource use. OBJECTIVE The aim of this study was to compare the isolated effect of administering ePROs to patients with cancer versus a control condition. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Randomized controlled trials evaluating ePRO interventions that aimed to improve health-related outcomes among patients with cancer were included. The primary outcome was health-related quality of life (HRQOL), and the secondary outcomes were symptoms, hospital admissions, unplanned visits, chemotherapy completion, survival, and satisfaction with care. The effect sizes of ePROs on health-related outcomes were analyzed as standardized mean differences (SMDs) with 95% CIs using a random effects model. RESULTS The search identified 10,965 papers, of which 19 (0.17%) from 15 studies were included. The meta-analysis showed an improvement in HRQOL at 3 months, measured by the Functional Assessment of Cancer Therapy-General (SMD 0.28, 95% CI -1.22 to 1.78), and at 6 months, assessed using various HRQOL measures (SMD 0.07, 95% CI -1.24 to 1.39). The results should be interpreted with caution, given the wide 95% CIs. Of the 15 studies, 9 (60%) reported a positive signal on HRQOL, with two-thirds of the studies (n=6, 67%) including tailored patient advice and two-thirds (n=6, 67%) using clinician alert systems. CONCLUSIONS The meta-analysis showed a potential improvement in HRQOL at 6 months and in Functional Assessment of Cancer Therapy-General scores at 3 months for studies that included tailored advice and clinician alerts, suggesting that these elements may improve ePRO effectiveness. The findings will provide guidance for future use and help health care professionals choose the most suitable ePRO features for their patients. TRIAL REGISTRATION PROSPERO CRD42020175007; https://tinyurl.com/5cwmy3j6.
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Affiliation(s)
- Melissa Betty Perry
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Binish Khatoon
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Amy Vercell
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Science, The University of Manchester, Manchester, United Kingdom
- Clinical Oncology Department, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Galina Velikova
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- St James's Institute of Oncology, St James's University Hospital, Leeds, United Kingdom
| | - Antonia Marsden
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, United Kingdom
| | - Calvin Heal
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, United Kingdom
| | - Janelle Yorke
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, China (Hong Kong)
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Grove BE, Schougaard LMV, Mose F, Randers E, Hjollund NH, Ivarsen P, De Thurah A. Remote symptom monitoring with patient-reported outcome measures in outpatients with chronic kidney disease (PROKID): a multicentre randomised controlled non-inferiority study. Clin Kidney J 2024; 17:sfae176. [PMID: 39006159 PMCID: PMC11240050 DOI: 10.1093/ckj/sfae176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Indexed: 07/16/2024] Open
Abstract
Background The increasing incidence of chronic kidney disease (CKD) is straining the capacity of outpatient clinics. Remote healthcare delivery might improve CKD follow-up compared with conventional face-to-face follow-up. Patient-reported outcomes (PROs) are used to empower remote follow-up and patient engagement. The consequences of shifting from face-to-face follow-up to remote outpatient follow-up on kidney function, health resource utilisation and quality of life remain unknown. Methods We conducted a multicentre pragmatic non-inferiority trial at three outpatient clinics in the Central Denmark Region. A total of 152 incident outpatients with CKD were randomised (1:1:1) to either PRO-based, PRO-telephone follow-up or standard of care (SoC). The primary outcome was the annual change in kidney function measured by the slope of the estimated glomerular filtration rate (eGFR). The non-inferiority margin was an eGFR of 2.85 ml/min/1.73 m2/year. Mean differences were estimated using intention-to-treat (ITT), per protocol and random coefficient models. Results Mean eGFR slope differences between PRO-based and SoC were -0.97 ml/min/1.73 m2/year [95% confidence interval (CI) -3.00-1.07] and -1.06 ml/min/1.73 m2/year (95% CI -3.02-0.89) between PRO-telephone and SoC. Non-inferiority was only established in the per-protocol analysis due to CIs exceeding the margin in the ITT group. Both intervention groups had fewer outpatient visits: -4.95 (95% CI -5.82 to -4.08) for the PRO-based group and -5.21 (95% CI -5.95 to -4.46) for the PRO-telephone group. We found no significant differences in quality of life, illness perception or satisfaction. Conclusion Differences in the eGFR slope between groups were non-significant and results on non-inferiority were inconclusive. Thus, transitioning to remote PRO-based follow-up requires close monitoring of kidney function. Reducing patients' attendance in the outpatient clinic was possible without decreasing either quality of life or illness perception.ClinicalTrials.gov identifier: NCT03847766.
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Affiliation(s)
- Birgith Engelst Grove
- AmbuFlex - Centre for Patient-reported Outcomes, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Frank Mose
- Department of Renal Medicine, Gødstrup Hospital, Herning, Denmark
| | - Else Randers
- Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex - Centre for Patient-reported Outcomes, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Ivarsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Annette De Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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Torbjørnsen A, Spildo I, Mollestad MA, Jensen AL, Singstad T, Weldingh NM, Joranger P, Ribu L, Holmen H. Investigating Digital Patient-Reported Outcome Measures in Patient-Centered Diabetes Specialist Outpatient Care (DigiDiaS): Protocol for a Multimethod Prospective Observational Study. JMIR Res Protoc 2024; 13:e52766. [PMID: 38441955 PMCID: PMC10951827 DOI: 10.2196/52766] [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: 09/14/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Living with type 1 diabetes is challenging, and to support self-management, repeated consultations in specialist outpatient care are often required. The emergence of new digital solutions has revolutionized how health care services can be patient centered, providing unprecedented opportunities for flexible, high-quality care. However, there is a lack of studies exploring how the use of digital patient-reported outcome measures (PROMs) for flexible specialist care affects diabetes self-management. To provide new knowledge on the relevance of using PROMs in standard care, we have designed a multimethod prospective study. OBJECTIVE The overall aim of this protocol is to describe our prospective multimethod observational study designed to investigate digital PROMs in a routine specialist outpatient setting for flexible patient-centered diabetes care (DigiDiaS). METHODS This protocol outlines the design of a multimethod prospective observational cohort study that includes data from electronic health records, self-reported questionnaires, clinical consultation field observations, and individual in-depth interviews with patients and diabetes health care personnel. All patients with type 1 diabetes at a designated outpatient clinic were invited to participate and use the digital PROM implemented in clinical care. Both users and nonusers of the digital PROM were eligible for the prospective study, allowing for a comparison of the two groups. Data were collected at baseline and after 12 months, including self-management as the primary outcome assessed using the Patient Activation Measure, along with the secondary outcomes of digital health literacy, quality of life, health economy, and clinical variables such as glycated hemoglobin. RESULTS The digital solution was implemented for routine clinical care in the department in November 2021, and data collection for the prospective study started in October 2022. As of September 6, 2023, 84.6% (186/220) of patients among those in the digital PROM and 15.5% (34/220) of patients among the nonusers have consented to participate. We expect the study to have enough participants by the autumn of 2023. With 1 year of follow-up, the results are expected by spring 2025. CONCLUSIONS In conclusion, a multimethod prospective observational cohort study can offer valuable insights into the relevance, effectiveness, and acceptability of digital tools using PROMs in diabetes specialist care. Such knowledge is crucial for achieving broad and successful implementation and use of these tools in a large diabetes outpatient clinic. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52766.
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Affiliation(s)
- Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Ingeborg Spildo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Maria Aadland Mollestad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Annesofie Lunde Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- SDCA-Steno Diabetes Centre, Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Tone Singstad
- Division of Medicine, Akershus University Hospital, Akershus, Norway
| | - Nina Mickelson Weldingh
- Division of Research and Innovation, Department of Research Support Service, Akershus University Hospital, Akershus, Norway
| | - Pål Joranger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Lis Ribu
- The Centre for Senior Citizen Staff, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
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Wasan T, Hayhoe B, Cicek M, Lammila-Escalera E, Nicholls D, Majeed A, Greenfield G. The effects of community interventions on unplanned healthcare use in patients with multimorbidity: a systematic review. J R Soc Med 2024; 117:24-35. [PMID: 37449474 PMCID: PMC10858714 DOI: 10.1177/01410768231186224] [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: 01/09/2023] [Accepted: 05/08/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES To summarise the impact of community-based interventions for multimorbid patients on unplanned healthcare use. The prevalence of multimorbidity (co-existence of multiple chronic conditions) is rapidly increasing and affects one-third of the global population. Patients with multimorbidity have complex healthcare needs and greater unplanned healthcare usage. Community-based interventions allow for continued care of patients outside hospitals, but few studies have explored the effects of these interventions on unplanned healthcare usage. DESIGN A systematic review was conducted. MEDLINE, EMBASE, PsychINFO and Cochrane Library online databases were searched. Studies were screened and underwent risk of bias assessment. Data were synthesised using narrative synthesis. SETTING Community-based interventions. PARTICIPANTS Patients with multimorbidity. MAIN OUTCOME MEASURES Unplanned healthcare usage. RESULTS Thirteen studies, including a total of 6148 participants, were included. All included studies came from high-income settings and had elderly populations. All studies measured emergency department attendances as their primary outcome. Risk of bias was generally low. Most community interventions were multifaceted with emphasis on education, self-monitoring of symptoms and regular follow-ups. Four studies looked at improved care coordination, advance care planning and palliative care. All 13 studies found a decrease in emergency department visits post-intervention with risk reduction ranging from 0 (95% confidencec interval [CI]: -0.37 to 0.37) to 0.735 (95% CI: 0.688-0.785). CONCLUSIONS Community-based interventions have potential to reduce emergency department visits in patients with multimorbidity. Identification of specific successful components of interventions was challenging given the overlaps between interventions. Policymakers should recognise the importance of community interventions and aim to integrate aspects of these into existing healthcare structures. Future research should investigate the impact of such interventions with broader participant characteristics.
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Affiliation(s)
- Tavleen Wasan
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Meryem Cicek
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Elena Lammila-Escalera
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Dasha Nicholls
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
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Abbasi K. Fixing the NHS with public health and public engagement. J R Soc Med 2023; 116:39. [PMID: 36803296 PMCID: PMC9944234 DOI: 10.1177/01410768231154181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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