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Rajput R, Prasad S D, Pai CG. Assessing the Impact of Medication and Stenting on the Quality of Life of Patients With Chronic Pancreatitis: A Prospective Study. Cureus 2023; 15:e50106. [PMID: 38186534 PMCID: PMC10771073 DOI: 10.7759/cureus.50106] [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] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
This research aimed to assess the effect of pharmacotherapy alone versus the combination of pharmacotherapy and endoscopic stenting on the quality of life (QoL) outcomes of chronic pancreatitis patients. Chronic pancreatitis, an inflammatory disease, often presents with persistent pain, affecting patients' quality of life. Thirty patients treated either with pharmacotherapy alone or with the addition of endoscopic stenting were analyzed. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used to gather data on the patients' QoL. Results showed that both treatment groups experienced improvements in global health, role functioning, fatigue, and abdominal pain scores over follow-ups. Specifically, the stenting group saw notable enhancements in global health and role functioning. The study's conclusions provide valuable insights into the potential benefits of both treatments, with stenting offering significant improvements in certain QoL parameters. However, the sample size and source limit generalizability, suggesting the need for more extensive research across diverse settings.
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Affiliation(s)
| | - Durga Prasad S
- Pharmacology, American University of Antigua College of Medicine, St. John's, ATG
| | - C Ganesh Pai
- Gastroenterology, Kasturba Medical College, Manipal, IND
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2
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Lundeby T, Finset A, Kaasa S, Wester TE, Hjermstad MJ, Dajani O, Wist E, Aass N. A complex communication skills training program for physicians providing advanced cancer care - content development and barriers and solutions for implementation. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:46-57. [PMID: 36919800 DOI: 10.1080/17538068.2022.2039468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Early integration of oncology and patient-centered palliative care is the recommended clinical practice model for patients with advanced cancer. General and specific communication skills are necessary to achieve integrated patient-centered care, but require organized training to be adequately mastered. Challenges and barriers on several levels, i.e. organizational, professional and individual may, however, hamper implementation. The development, implementation, and evaluation of such an educational program focusing on communication skills contain many steps, considerations and lessons learned, which are described in this article.Methods: A multi-professional faculty developed, implemented, and evaluated an educational program through a 5-step approach. The program was part of a Norwegian cluster-randomized controlled trial aiming to test the effect of early integration of oncology and palliative care for patients with advanced cancer.Results: The result is the PALLiON educational program; a multi-faceted, evidence-based, and learner-centered program with a specific focus on physicians' communication skills. Four modules were developed: lectures, discussion groups, skills training, and coaching. These were implemented at the six intervention hospitals using different teaching strategies. Evaluation in a subgroup of participants showed a positive appraisal of the group discussions and skills training.Conclusion:We present our experiences and reflections regarding implementation and lessons learned, which should be considered in future developments and implementations; (1) Include experienced faculty with various backgrounds, (2) Be both evidence-based and learner-centered, (3) Choose teaching strategies wisely, (4) Expect resistance and skepticism, (5) Team up with management and gatekeepers, (6) Expect time to fly, and (7) Plan thorough assessment of the evaluation and effect.Trial registration: ClinicalTrials.gov identifier: NCT03088202.
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Affiliation(s)
- Tonje Lundeby
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Arnstein Finset
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torunn Elin Wester
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Erik Wist
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Aass
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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3
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Castillo C, Alfonso AL, Dapueto JJ, Camejo N, Silva M. Inclusion of information technology-based assessments of health-related quality of life in routine oncology practice in Uruguay. J Patient Rep Outcomes 2022; 6:65. [PMID: 35695970 PMCID: PMC9192877 DOI: 10.1186/s41687-022-00458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background Previous research has shown that the inclusion of patient-reported outcomes measures in the patient’s visit to the oncologists might improve the quality of global health care. The aim of the study was to assess the feasibility, acceptance, and utility perceived by patients and oncologists of health-related quality of life (HRQL) assessments obtained prior to clinical visits, and to evaluate if this has an impact on patient’s well-being in a sample of Spanish-speaking patients from Uruguay. Methods Patients assisted regularly in the Oncology Clinic were randomized into two groups: an intervention group that completed a set of questionnaires (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and Hospital Anxiety and Depression Scale using a touch screen device and a control group that did not respond to these questionnaires. At 2 months, the responses of all the participants to the Functional Assessment of Cancer Therapy-General (FACT-G) were collected over a telephone to determine whether there were differences in the HRQL between the intervention and control groups. The graphed scores of the intervention group were included in the clinical history of the patient during consultation. Patients and physicians completed the questionnaires on the usefulness of these measurements. Results In total, 58 patients participated in this study: 36 in the intervention group and 22 in the control group; 65% of the participants were female, and median age was 59 years (18–79). Regarding patients, 97% found the questionnaires easy to complete and thought that they included important questions. As for oncologists, 68.8% used the information and 87.5% found it useful for the consultation. There were no significant differences in the FACT-G scores between the intervention and control groups. Conclusions The routine HRQL assessments using an electronic device prior to the consultations were positively valued by almost all patients and physicians. This could significantly contribute to a better understanding of the patient's overall problems during consultation. These results confirm the benefits of integrating the patient’s self-reported quality of life outcomes into consultations.
Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00458-7.
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Reynolds E, Byrne M, Ganetzky R, Parikh S. Pediatric single large-scale mtDNA deletion syndromes: The power of patient reported outcomes. Mol Genet Metab 2021; 134:301-308. [PMID: 34862134 DOI: 10.1016/j.ymgme.2021.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
There is a limited understanding of system-level clinical outcomes and interventions associated with single large-scale mitochondrial DNA deletion syndromes (SLSMDS). Additionally, no research exists that describes patient reported outcomes (PROs) of children with SLSMDS. A global and observational registry was established to understand the multi-systemic course of SLSMDS and track clinical outcomes. The development and design of the registry is described. Demographic characteristics, history and diagnoses, and system level prevalence of problems and interventions are reported for 42 children. System level problems and interventions include information on the following body systems: audiology, cardiac, endocrine, gastrointestinal (including pancreatic and hepatobiliary system), hematological, metabolic, neurological (including autonomic, mobility, & learning), ophthalmic, psychiatric, renal, and respiratory. Results emphasize the need of patient registries and suggest that the diagnostic odyssey and burden of disease for children with SLSMDS is significant. System-level findings may help families and clinical providers with diagnosis, prognostication, and treatment. A multidisciplinary team of clinical experts with a central coordinating specialist for children with SLSMDS is recommended.
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Affiliation(s)
- Elizabeth Reynolds
- The Champ Foundation, 4711 Hope Valley Road 4F PMB 1171, Durham, NC 27707, United States of America.
| | - Matthew Byrne
- University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, United States of America
| | - Rebecca Ganetzky
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States of America; Mitochondrial Medicine Frontier Program, Division of Human Genetics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Sumit Parikh
- Mitochondrial Medicine Center, Neurosciences Institute, 9500 Euclid Avenue Cleveland, OH 44195, United States of America.
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Whisenant MS, Bamidele O, Cleeland C, Williams LA. Preferences of Individuals With Cancer for Patient-Reported Outcome Measures. Oncol Nurs Forum 2021; 48:173-183. [PMID: 33600396 DOI: 10.1188/21.onf.173-183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Symptom monitoring and management using patient-reported outcome (PRO) measures improves outcomes for individuals with cancer. The purpose of the current study was to provide a qualitative assessment of preferences of individuals with cancer for PRO measures. PARTICIPANTS & SETTING 15 patients receiving systemic therapy at the University of Texas MD Anderson Cancer Center. METHODOLOGIC APPROACH Participants completed three PRO measures. Qualitative interviews were conducted, and content analysis was used to identify relevant themes. FINDINGS Identified themes were the importance of communicating various aspects of the disease and treatment experience to the oncology team, the importance of systematic PRO assessments, congruence among PRO questionnaires and questions clinicians ask at clinic visits, concerns about the length of PRO questionnaires, the importance of the response options available in PRO questionnaires, and willingness to complete PRO measures frequently. IMPLICATIONS FOR NURSING Oncology nurses are critical facilitators of the systematic use of PRO measures across the cancer care continuum.
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Murakawa Y, Sakayori M, Otsuka K. Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in Japan. BMC Palliat Care 2019; 18:45. [PMID: 31159782 PMCID: PMC6547558 DOI: 10.1186/s12904-019-0428-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to analyze the determinants of patients' choice between palliative chemotherapy and best supportive care (BSC) and to investigate how this choice affects overall survival (OS) and length of hospitalization according to Eastern Cooperative Oncology Group (ECOG) performance status (PS). METHODS An oncologist explained the palliative chemotherapy and BSC options to 129 patients with incurable cancer during their first consultation. Data on the ECOG PS, treatment decision, OS, and the length of hospitalization were retrospectively collected over 4 years. RESULTS Patients with an ECOG PS of 0-2 chose palliative chemotherapy more often than those with an ECOG PS of 3-4 (P < 0.01). Patients with ≤70 years chose palliative chemotherapy more often than those with > 70 (P < 0.05). And patients with gastric cancer and colon cancer chose palliative chemotherapy more often than those with CUP (carcinoma of unknown primary) (P < 0.05, P < 0.05 respectively). Factors associated with a significantly poorer OS in an adjusted analysis included the ECOG PS and treatment decision (hazard ratios: 0.18 and 0.43; P < 0.001, P < 0.01 respectively). In patients with an ECOG PS of 0-2, palliative chemotherapy was not associated with a longer OS compared with BSC (median OS: 14.5 vs. 6.8 months, respectively; P = 0.144). In patients with an ECOG PS of 3-4, palliative chemotherapy resulted in a significant survival gain compared to with BSC (median OS: 3.8 vs. 1.4 months, respectively; P < 0.05). Strong positive correlations between OS and the length of hospitalization were observed in patients with an ECOG PS of 3-4 who underwent palliative chemotherapy (r2 = 0.683) and the length of hospitalization was approximately one-third of their OS. CONCLUSIONS The determinants for treatment choice were age, ECOG PS and type of cancer, not sex difference. Oncologists should explain to patients that OS and the length of hospitalization vary according to the ECOG PS when selecting between palliative chemotherapy and BSC.
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Affiliation(s)
- Yasuko Murakawa
- Department of Medical Oncology, Miyagi Cancer Center, Nodayama 47-1, Medeshima, Natori, Japan.
| | - Masato Sakayori
- Department of Medical Oncology, Miyagi Cancer Center, Nodayama 47-1, Medeshima, Natori, Japan
| | - Kazunori Otsuka
- Department of Medical Oncology, Miyagi Cancer Center, Nodayama 47-1, Medeshima, Natori, Japan
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Almario CV, Spiegel BMR. Employing Irritable Bowel Syndrome Patient-Reported Outcomes in the Clinical Trenches. Clin Gastroenterol Hepatol 2018; 16:462-466.e2. [PMID: 29555225 DOI: 10.1016/j.cgh.2017.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California; Division of Digestive and Liver Diseases, Division of Health Services Research, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California; Division of Digestive and Liver Diseases, Division of Health Services Research, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California.
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8
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Westhoff PG, de Graeff A, Monninkhof EM, Berveling MJ, van Vulpen M, Leer JWH, Marijnen CAM, Reyners AKL, van der Linden YM. Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress. Acta Oncol 2017; 56:1720-1727. [PMID: 28893119 DOI: 10.1080/0284186x.2017.1374557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Psychological distress (PD) has a major impact on quality of life. We studied the incidence of PD before and after radiotherapy for painful bone metastases. Furthermore, we aimed to identify factors predictive for PD. METHODS Between 1996 and 1998, the Dutch Bone Metastasis Study included 1157 patients with painful bone metastases. Patients were randomized between two fractionation schedules. The study showed a pain response of 74% in both groups. Patients filled out weekly questionnaires for 13 weeks, then monthly for two years. The questionnaires included a subscale for PD on the Rotterdam Symptom Checklist. We used generalized estimating equations and multivariable logistic regression analyses. RESULTS At baseline, 290 patients (27%) had a high level of PD. For the entire group, the level of PD remained constant over time. The majority of patients with a low level of PD at baseline remained at a low level during follow-up. In patients with a high level of PD at baseline, the mean level of PD decreased after treatment and stabilized around the cutoff level. Female patients, higher age, worse performance, lower pain score and worse self-reported QoL were associated with an increased chance of PD, although the model showed moderate discriminative power. CONCLUSIONS A substantial proportion of patients had a high level of PD before and after radiotherapy for painful bone metastases. Most patients who reported high levels of PD when referred for palliative radiotherapy remained at high levels thereafter. Therefore, screening of PD prior to treatment seems appropriate, in order to select patients requiring intervention.
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Affiliation(s)
- Paulien G. Westhoff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiotherapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evelyn M. Monninkhof
- Julius center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maaike J. Berveling
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco van Vulpen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Willem H. Leer
- Department of Radiotherapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie A. M. Marijnen
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna K. L. Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Patient-reported outcomes in hematology: is it time to focus more on them in clinical trials and hematology practice? Blood 2017; 130:859-866. [DOI: 10.1182/blood-2017-03-737403] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/23/2017] [Indexed: 12/24/2022] Open
Abstract
Abstract
In less than 2 decades, major clinical advances have been made in various areas of hematologic malignancies. Clinicians and patients now frequently face challenging choices regarding various treatments that are often similar in regard to safety or clinical effectiveness; hence, medical decision making has grown in complexity. For example, several novel drugs have been developed as oral agents, introducing an additional challenge in patient management, such as ensuring an optimal adherence to therapy in order to maximize drug effectiveness. This rapidly changing scenario provides a rationale for a more systematic collection of patient-reported outcomes (PRO) in clinical research and routine care. In the former case, PRO may help to better understand overall treatment effectiveness of a new drug being tested. In the latter case, it may aid in making more informed, individualized treatment decisions in daily practice by obtaining more accurate information on the actual symptom burden experienced by the patient. In any case, evaluating PRO requires making several, and often challenging, decisions depending, for example, on the population being studied and the specific setting. Therefore, if PROs are to fulfill their potential of generating clinically meaningful data that robustly inform patient care, special attention should be given to methodological rigor. We outline the value of a more systematic and rigorous implementation of PRO assessment in the current hematology arena, by providing some real world examples of how PRO data have contributed in better understanding the value of new therapies. We also discuss practical considerations in PRO assessment in clinical research.
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Prospective Longitudinal Quality of Life Assessment in Patients With Neuroendocrine Tumor Liver Metastases Treated With 90Y Radioembolization. Clin Nucl Med 2016; 41:e493-e497. [DOI: 10.1097/rlu.0000000000001383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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11
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Almario CV, Chey WD, Khanna D, Mosadeghi S, Ahmed S, Afghani E, Whitman C, Fuller G, Reid M, Bolus R, Dennis B, Encarnacion R, Martinez B, Soares J, Modi R, Agarwal N, Lee A, Kubomoto S, Sharma G, Bolus S, Spiegel BM. Impact of National Institutes of Health Gastrointestinal PROMIS Measures in Clinical Practice: Results of a Multicenter Controlled Trial. Am J Gastroenterol 2016; 111:1546-1556. [PMID: 27481311 PMCID: PMC5097031 DOI: 10.1038/ajg.2016.305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The National Institutes of Health (NIH) created the Patient Reported Outcomes Measurement Information System (PROMIS) to allow efficient, online measurement of patient-reported outcomes (PROs), but it remains untested whether PROMIS improves outcomes. Here, we aimed to compare the impact of gastrointestinal (GI) PROMIS measures vs. usual care on patient outcomes. METHODS We performed a pragmatic clinical trial with an off-on study design alternating weekly between intervention (GI PROMIS) and control arms at one Veterans Affairs and three university-affiliated specialty clinics. Adults with GI symptoms were eligible. Intervention patients completed GI PROMIS symptom questionnaires on an e-portal 1 week before their visit; PROs were available for review by patients and their providers before and during the clinic visit. Usual care patients were managed according to customary practices. Our primary outcome was patient satisfaction as determined by the Consumer Assessment of Healthcare Providers and Systems questionnaire. Secondary outcomes included provider interpersonal skills (Doctors' Interpersonal Skills Questionnaire (DISQ)) and shared decision-making (9-item Shared Decision Making Questionnaire (SDM-Q-9)). RESULTS There were 217 and 154 patients in the GI PROMIS and control arms, respectively. Patient satisfaction was similar between groups (P>0.05). Intervention patients had similar assessments of their providers' interpersonal skills (DISQ 89.4±11.7 vs. 89.8±16.0, P=0.79) and shared decision-making (SDM-Q-9 79.3±12.4 vs. 79.0±22.0, P=0.85) vs. CONCLUSIONS This is the first controlled trial examining the impact of NIH PROMIS in clinical practice. One-time use of GI PROMIS did not improve patient satisfaction or assessment of provider interpersonal skills and shared decision-making. Future studies examining how to optimize PROs in clinical practice are encouraged before widespread adoption.
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Affiliation(s)
- Christopher V. Almario
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - William D. Chey
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Sasan Mosadeghi
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Shahzad Ahmed
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Elham Afghani
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Cynthia Whitman
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Garth Fuller
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Mark Reid
- Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Roger Bolus
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Buddy Dennis
- UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA
| | - Rey Encarnacion
- UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA
| | - Bibiana Martinez
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Jennifer Soares
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Rushaba Modi
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Nikhil Agarwal
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Aaron Lee
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Scott Kubomoto
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Gobind Sharma
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Sally Bolus
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Brennan M.R. Spiegel
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
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Westhoff PG, Verdam MG, Oort FJ, Jobsen JJ, van Vulpen M, Leer JWH, Marijnen CA, de Graeff A, van der Linden YM. Course of Quality of Life After Radiation Therapy for Painful Bone Metastases: A Detailed Analysis From the Dutch Bone Metastasis Study. Int J Radiat Oncol Biol Phys 2016; 95:1391-1398. [DOI: 10.1016/j.ijrobp.2016.03.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/15/2016] [Accepted: 03/22/2016] [Indexed: 12/25/2022]
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Quality of life and satisfaction with care among palliative cancer patients in Saudi Arabia. Palliat Support Care 2016; 14:621-627. [PMID: 27323905 DOI: 10.1017/s1478951516000432] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to determine the relationship between quality of life and satisfaction with care among cancer patients in palliative care in Saudi Arabia. METHODS A total of 130 palliative cancer patients were invited to participate in our cross-sectional study. Patients were recruited from a large tertiary hospital within the Ministry of Health in Saudi Arabia. All eligible participants answered a three-part questionnaire that included demographic data and the validated European Organization for Research and Treatment of Cancer (EORTC QLQ-C15-PAL) and (EORTC IN-PATSAT32) questionnaires. RESULTS Participants were mostly female (103/130, 79%) and married (93/130, 71%), and more than half had breast cancer (69/130, 53%). They were between 17 and 86 years of age (mean = 46.7, SD = 16.50). The correlation test showed that the relationship with physical function was weak, while emotional function and global health status had a moderate relationship with general satisfaction (r = 0.21, p < 0.01; r = 0.32, p < 0.001; r = 0.26, p < 0.01, respectively). Our results suggest that emotional function is the more important factor in predicting satisfaction with care among palliative cancer patients. An increase in emotional function leads to increased general satisfaction. SIGNIFICANCE OF RESULTS The emotional function of palliative cancer patients was more closely associated with overall satisfaction with care than physical function or global health status. All palliative care team members are thus required to provide adequate psychosocial support. It is recommended that interdisciplinary and collaborative approaches be integrated in palliative care of cancer patients.
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King S, Exley J, Parks S, Ball S, Bienkowska-Gibbs T, MacLure C, Harte E, Stewart K, Larkin J, Bottomley A, Marjanovic S. The use and impact of quality of life assessment tools in clinical care settings for cancer patients, with a particular emphasis on brain cancer: insights from a systematic review and stakeholder consultations. Qual Life Res 2016; 25:2245-56. [PMID: 27039304 PMCID: PMC4980409 DOI: 10.1007/s11136-016-1278-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 11/24/2022]
Abstract
Purpose Patient-reported data are playing an increasing role in health care. In oncology, data from quality of life (QoL) assessment tools may be particularly important for those with limited survival prospects, where treatments aim to prolong survival while maintaining or improving QoL. This paper examines the use and impact of using QoL measures on health care of cancer patients within a clinical setting, particularly those with brain cancer. It also examines facilitators and challenges, and provides implications for policy and practice. Design We conducted a systematic literature review, 15 expert interviews and a consultation at an international summit. Results The systematic review found no relevant intervention studies specifically in brain cancer patients, and after expanding our search to include other cancers, 15 relevant studies were identified. The evidence on the effectiveness of using QoL tools was inconsistent for patient management, but somewhat more consistent in favour of improving patient–physician communication. Interviews identified unharnessed potential and growing interest in QoL tool use and associated challenges to address. Conclusion Our findings suggest that the use of QoL tools in cancer patients may improve patient–physician communication and have the potential to improve care, but the tools are not currently widely used in clinical practice (in brain cancer nor some other cancer contexts) although they are in clinical trials. There is a need for further research and stakeholder engagement on how QoL tools can achieve most impact across cancer and patient contexts. There is also a need for policy, health professional, research and patient communities to strengthen information exchange and debate, support awareness raising and provide training on tool design, use and interpretation. Electronic supplementary material The online version of this article (doi:10.1007/s11136-016-1278-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah King
- RAND Europe, Westbrook Centre, Cambridge, CB4 1YG, UK
| | | | - Sarah Parks
- RAND Europe, Westbrook Centre, Cambridge, CB4 1YG, UK
| | - Sarah Ball
- RAND Europe, Westbrook Centre, Cambridge, CB4 1YG, UK
| | | | - Calum MacLure
- RAND Europe, Westbrook Centre, Cambridge, CB4 1YG, UK
| | - Emma Harte
- RAND Europe, Westbrook Centre, Cambridge, CB4 1YG, UK
| | | | | | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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15
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Rahimzadeh V, Bartlett G, Longo C, Crimi L, Macdonald ME, Jabado N, Ells C. Promoting an ethic of engagement in pediatric palliative care research. BMC Palliat Care 2015; 14:50. [PMID: 26474573 PMCID: PMC4608148 DOI: 10.1186/s12904-015-0048-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/08/2015] [Indexed: 11/12/2022] Open
Abstract
Background This paper defends the ethical and empirical significance of direct engagement with terminally ill children and adolescents in PPC research on health-related quality of life. Clinical trials and other forms of health research have resulted in tremendous progress for improving clinical outcomes among children and adolescents diagnosed with a life-threatening illness. Less attention has been paid, however, to engaging this patient population directly in studies aimed at optimizing health-related quality of life in PPC. Though not restricted to care at the end of life, PPC—and by extension PPC research—is in part dependent on recognizing the social complexities of death and dying and where health-related quality of life is a fundamental element. To explore these complexities in depth requires partnership with terminally ill children and adolescents, and acknowledgement of their active social and moral agency in research. Discussion Principles of pediatric research ethics, theoretical tenets of the “new sociology of the child(hood),” and human rights codified in the United Nations Convention on the Rights of the Child (UNCRC) underpin the position that a more engagement-centered approach is needed in PPC research. The ethics, sociologies and human rights of engagement will each be discussed as they relate to research with terminally ill children and adolescents in PPC. Qualitative method(ologies) presented in this paper, such as deliberative stakeholder consultations and phenomenology of practice can serve as meaningful vehicles for achieving i) participation among terminally ill children and adolescents; ii) evidence-bases for PPC best practices; and iii) fulfillment of research ethics principles. Conclusion PPC research based on direct engagement with PPC patients better reflects their unique expertise and social epistemologies of terminal illness. Such an approach to research would strengthen both the ethical and methodological soundness of HRQoL inquiry in PPC.
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Affiliation(s)
- Vasiliki Rahimzadeh
- Department of Family Medicine, Centre of Genomics and Policy, McGill University, 5858 Côte-des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada.
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada
| | - Cristina Longo
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada
| | - Laura Crimi
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada
| | - Mary Ellen Macdonald
- Division of Oral Health and Society, Pediatric Palliative Care Research, Montreal Children's Hospital, McGill University, #530-2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada
| | - Nada Jabado
- Department of Pediatrics, Montreal Children's Hospital Research Institute, McGill University Health Center, 1001 Décarie Boulevard, Montreal, H4A 3J1, QC, Canada
| | - Carolyn Ells
- Biomedical Ethics Unit, McGill University, 3647 Peel St, Montreal, QC, H3A 1X1, Canada
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Prinsen C, Spuls P, Lindeboom R, Sprangers M, de Rie M, de Korte J. The efficacy of a health-related quality-of-life intervention during 48 weeks of biologic treatment of patients with moderate to severe psoriasis: results of a multicentre randomized controlled trial. Br J Dermatol 2015; 173:1091-4. [DOI: 10.1111/bjd.13906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- C.A.C. Prinsen
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
- Department of Epidemiology and Biostatistics; EMGO+ Institute for Health and Care Research; VU University Medical Center; De Boelelaan 1089a 1081 HV Amsterdam the Netherlands
| | - P.I. Spuls
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - R. Lindeboom
- Division of Clinical Methods and Public Health; Master Evidence Based Practice; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - M.A.G. Sprangers
- Department of Medical Psychology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
| | - M.A. de Rie
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
- Department of Dermatology; VU University Medical Center; De Boelelaan 1117 P.O. Box 7057 1007 MB Amsterdam the Netherlands
| | - J. de Korte
- Department of Dermatology; Academic Medical Center; University of Amsterdam; Meibergdreef 9 1105 AZ Amsterdam the Netherlands
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Badgwell B, Bruera E, Klimberg SV. Can patient reported outcomes help identify the optimal outcome in palliative surgery? J Surg Oncol 2013; 109:145-50. [PMID: 24132785 DOI: 10.1002/jso.23466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 09/15/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this pilot study was to determine whether an open-ended questionnaire captures severe symptoms in cancer patients undergoing palliative surgical consultation that a structured, validated quality-of-life assessment does not capture. METHODS We prospectively used the Functional Assessment of Cancer Therapy-General (FACT-G) and an open-ended questionnaire to assess the symptoms of patients with incurable malignancies who underwent palliative surgical consultation at our institution between January 2011 and September 2012. RESULTS Of the 69 patients enrolled, the most common indications for consultation were bowel obstruction (54%), jaundice (13%), wound problems (10%), and gastrointestinal bleeding (7%). Of the severe symptoms patients reported, 76% were identified with the FACT-G alone, 22% were identified with the open-ended questionnaire alone, and 2% were duplicate responses captured with both the FACT-G and open-ended questionnaire. The open-ended questionnaire captured 68 instances of severe symptoms in 47 patients that the FACT-G did not capture; of these symptoms, 52 were considered to be highly relevant to surgery and potential outcome measures. CONCLUSIONS An open-ended questionnaire can identify severe symptoms that a global quality of life survey cannot capture and could be used in conjunction with a global survey to reassess symptoms after palliative surgical consultation.
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Affiliation(s)
- Brian Badgwell
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Basch E, Abernethy AP, Mullins CD, Reeve BB, Smith ML, Coons SJ, Sloan J, Wenzel K, Chauhan C, Eppard W, Frank ES, Lipscomb J, Raymond SA, Spencer M, Tunis S. Recommendations for incorporating patient-reported outcomes into clinical comparative effectiveness research in adult oncology. J Clin Oncol 2012; 30:4249-55. [PMID: 23071244 DOI: 10.1200/jco.2012.42.5967] [Citation(s) in RCA: 355] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Examining the patient's subjective experience in prospective clinical comparative effectiveness research (CER) of oncology treatments or process interventions is essential for informing decision making. Patient-reported outcome (PRO) measures are the standard tools for directly eliciting the patient experience. There are currently no widely accepted standards for developing or implementing PRO measures in CER. Recommendations for the design and implementation of PRO measures in CER were developed via a standardized process including multistakeholder interviews, a technical working group, and public comments. Key recommendations are to include assessment of patient-reported symptoms as well as health-related quality of life in all prospective clinical CER studies in adult oncology; to identify symptoms relevant to a particular study population and context based on literature review and/or qualitative and quantitative methods; to assure that PRO measures used are valid, reliable, and sensitive in a comparable population (measures particularly recommended include EORTC QLQ-C30, FACT, MDASI, PRO-CTCAE, and PROMIS); to collect PRO data electronically whenever possible; to employ methods that minimize missing patient reports and include a plan for analyzing and reporting missing PRO data; to report the proportion of responders and cumulative distribution of responses in addition to mean changes in scores; and to publish results of PRO analyses simultaneously with other clinical outcomes. Twelve core symptoms are recommended for consideration in studies in advanced or metastatic cancers. Adherence to methodologic standards for the selection, implementation, and analysis/reporting of PRO measures will lead to an understanding of the patient experience that informs better decisions by patients, providers, regulators, and payers.
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Affiliation(s)
- Ethan Basch
- Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Blum D, Koeberle D, Ribi K, Schmitz SFH, Utiger U, Klingbiel D, Strasser F. Electronic monitoring of symptoms and syndromes associated with cancer: methods of a randomized controlled trial SAKK 95/06 E-MOSAIC. BMC Palliat Care 2012; 11:19. [PMID: 23006802 PMCID: PMC3517324 DOI: 10.1186/1472-684x-11-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 09/19/2012] [Indexed: 12/03/2022] Open
Abstract
Background In patients with advanced, incurable cancer, anticancer treatment may be used to alleviate cancer-related symptoms, but monitoring of them in daily practice is rarely done. We aim to test the effectiveness of a real-time symptom and syndrome assessment using the E-MOSAIC software installed in handheld computer generating a longitudinal monitoring sheet (LoMoS) provided to the oncologists in a phase III setting. Methods In this prospective multicentre cluster randomized phase-III trial patients with any incurable solid tumor and having defined cancer related symptoms, who receive new outpatient chemotherapy in palliative intention (expected tumor-size response rate ≤20%) are eligible. Immediately before the weekly visit to oncologists, all patients complete with nurse assistance the E-MOSAIC Assessment: Edmonton Symptom Assessment Scale, ≤3 additional symptoms, estimated nutritional intake, body weight, Karnofsky and medications for pain and cachexia. Experienced oncologists will be randomized to receive the LoMoS or not. To minimize contamination, LoMoS are removed from the medical charts after visits. Primary endpoint is the difference in global quality of life (items 29 & 30 of EORTC-QlQ-C30) between baseline and last study visit at week 6, with a 10 point between-arm difference considered to be clinically relevant. 20 clusters (=oncologists) per treatment arm with 4–8 patients each are aimed for to achieve a significance level of 5% and a power of 80% in a mixed model approach. Selected co- variables are included in the model for adjustment. Secondary endpoints include patient-perceived patient-physician communication symptom burden over time, and oncologists’ symptom management performance (predefined thresholds of symptoms compared to oncologists’ pharmacological, diagnostic or counselling actions [structured chart review]). Discussion This trial will contribute to the research question, whether structured, longitudinal monitoring of patients’ multidimensional symptoms, indicators for symptom management, and clinical benefit outcomes can influence patients’ quality of life and symptom distress, in a setting of routine oncology practice. Trial registration Current Controlled Trials NCT00477919
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Affiliation(s)
- David Blum
- Oncological Palliative Medicine, Section Oncology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital St, Gallen, Rorschacherstrasse 95, St, Gallen 9007, Switzerland.
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20
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[The benefits of using patient-reported outcomes in cancer treatment: an overview]. Wien Klin Wochenschr 2012; 124:293-303. [PMID: 22538839 DOI: 10.1007/s00508-012-0168-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 04/03/2012] [Indexed: 10/28/2022]
Abstract
The patient's perspective evaluated by patient-reported outcomes (PROs) gains more and more importance, since treatment efficacy is no longer solely linked to clinical outcomes like cure and overall survival. Ailments like pain, fatigue and social isolation can only be assessed by patients' direct expression without any interpretation made by medical staff. PROs facilitate the disclosure of quality of life issues and patients feel a stronger support due to improved communication. PROs offer many further advantages like saving of time, cost and staff, targeted intervention and sensitizing of clinicians. Also, internationally validated questionnaires are available and the development of electronic PROs eases data-collection, calculation and storage. PROs collected within clinical routine are versatile concerning their applicability: They can be used for scientific analyses, quality assurance, and health technology assessment.
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21
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Basch E, Abernethy AP. Supporting Clinical Practice Decisions With Real-Time Patient-Reported Outcomes. J Clin Oncol 2011; 29:954-6. [DOI: 10.1200/jco.2010.33.2668] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ethan Basch
- Memorial Sloan-Kettering Cancer Center, New York, NY
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22
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Snyder CF, Blackford AL, Aaronson NK, Detmar SB, Carducci MA, Brundage MD, Wu AW. Can patient-reported outcome measures identify cancer patients' most bothersome issues? J Clin Oncol 2011; 29:1216-20. [PMID: 21343558 DOI: 10.1200/jco.2010.33.2080] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-reported outcome (PRO) questionnaires are being investigated for their ability to aid in individual patient management. We evaluated whether PROs can identify patients' most bothersome quality-of-life issues and compared approaches for interpreting PRO scores. METHODS This secondary data analysis included 130 patients with cancer (mean age, 57 years; 71% female) receiving outpatient palliative chemotherapy. Patients completed a PRO (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire [QLQ-C30]) at up to three consecutive visits and reported one or two of their most bothersome function and symptom issues from categories based on QLQ-C30 domains. We compared two approaches for interpreting PRO scores and identified which way better identified patients' most bothersome issues: worst scores in absolute terms or worst change from the previous time point. RESULTS For patients reporting one bothersome issue, absolute scores identified it correctly 91% of the time for both function and symptoms versus change scores' accuracy of 40% for function and 26% for symptoms. For patients reporting two bothersome issues, absolute scores identified at least one correctly 98% of the time for both function and symptoms versus change scores' 63% for function and 62% for symptoms. Absolute scores identified both issues correctly 42% of the time for function and 66% of the time for symptoms versus change scores' performance of 23% for both function and symptoms. CONCLUSION Absolute scores identify patients' most bothersome quality-of-life issues better than change scores. These results support the use of PROs in clinical practice and suggest that clinicians may want to focus on the worst absolute scores when examining PRO score reports.
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Affiliation(s)
- Claire F Snyder
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Abstract
Given that such a substantial proportion of oncology patients have advanced and/or incurable cancer oncologists invariably face enormous challenges in maintaining or improving the quality of life of this cohort of their practice. The provision of supportive and palliative care for these patients is a core element of quality cancer care. As the primary professional health care provider to the cancer patient, the oncologist has a special, significant, and challenging role in the care of these patients and their families. This article addresses the scope of these responsibilities and challenges and provides some introductory insights relating to practice that will be elaborated upon in the other contributions in this special issue of the Cancer Journal.
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McNair AGK, Brookes ST, Davis CR, Argyropoulos M, Blazeby JM. Communicating the results of randomized clinical trials: do patients understand multidimensional patient-reported outcomes? J Clin Oncol 2010; 28:738-43. [PMID: 20065187 DOI: 10.1200/jco.2009.23.9111] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evidence suggests that patient-reported outcomes (PROs) from randomized trials in oncology may not influence clinical decision making and patient choice. Reasons for this are currently unclear and little is known about patients' interpretation of PROs. This study assessed patients' understanding of multidimensional PROs in a graphical format. PATIENTS AND METHODS Semistructured interviews in which patients interpreted a series of graphs depicting simple, then multiple different hypothetical PROs associated with two treatments with identical chances of survival were audio recorded. The interviewer and a blinded observer (listening to audio recordings) scored patients' understanding of the graphs. Logistic regression examined the associations between patient understanding of the graphs and clinical and sociodemographic details. Results One hundred thirty-two patients with esophageal and gastric cancer were interviewed and 115 understood the first two graphs depicting different PROs of two treatments (87%; 95% CI,81 to 93). Simultaneous interpretation of adverse and beneficial treatment effects was achieved by 74 (66%; 95% CI, 57 to 75). Graphs showing complex, longitudinal data were correctly interpreted by 97 (73%; 95% CI, 66 to 81) and 108 (81%; 95% CI, 75 to 88), respectively. Univariable analyses demonstrated associations between patient understanding and patient age, educational level, and cancer site (P < or = .02 for all); however, in a multivariable model each of these associations was attenuated. CONCLUSION Most patients understand graphical multidimensional PROs, although a smaller majority were able to interpret more complex, or simultaneous, presentations. Additional work is needed to define methods for communicating clinical and PRO data from trials to allow patients to make informed treatment choices.
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Affiliation(s)
- Angus G K McNair
- MRCS, Department of Social Medicine, Canynge Hall, 39 Whatley Rd, Bristol, BS8 2PS, United Kingdom.
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The applications of PROs in clinical practice: what are they, do they work, and why? Qual Life Res 2008; 18:115-23. [PMID: 19105048 DOI: 10.1007/s11136-008-9430-6] [Citation(s) in RCA: 390] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 11/27/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Precisely defining the different applications of patient-reported outcome measures (PROs) in clinical practice can be difficult. This is because the intervention is complex and varies amongst different studies in terms of the type of PRO used, how the PRO is fed back, and to whom it is fed back. METHODS A theory-driven approach is used to describe six different applications of PROs in clinical practice. The evidence for the impact of these applications on the process and outcomes of care are summarised. Possible explanations for the limited impact of PROs on patient management are then discussed and directions for future research are highlighted. RESULTS The applications of PROs in clinical practice include screening tools, monitoring tools, as a method of promoting patient-centred care, as a decision aid, as a method of facilitating communication amongst multidisciplinary teams (MDTs), and as a means of monitoring the quality of patient care. Evidence from randomised controlled trials suggests that the use of PROs in clinical practice is valuable in improving the discussion and detection of HRQoL problems but has less of an impact on how clinicians manage patient problems or on subsequent patient outcomes. Many of the reasons for this may lie in the ways in which PROs fit (or do not fit) into the routine ways in which patients and clinicians communicate with each other, how clinicians make decisions, and how healthcare as a whole is organised. CONCLUSIONS Future research needs to identify ways in with PROs can be better incorporated into the routine care of patients by combining qualitative and quantitative methods and adopting appropriate trial designs.
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Serin D, Brédart A, Debled M, Fumoleau P. Chimiothérapie et qualité de vie dans le cancer du sein métastatique: état des lieux. ONCOLOGIE 2008. [DOI: 10.1007/s10269-008-0932-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kaasa S, Loge JH, Fayers P, Caraceni A, Strasser F, Hjermstad MJ, Higginson I, Radbruch L, Haugen DF. Symptom Assessment in Palliative Care: A Need for International Collaboration. J Clin Oncol 2008; 26:3867-73. [DOI: 10.1200/jco.2007.15.8881] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This article describes the research strategy for the development of a computerized assessment tool as part of a European Union (EU)–funded project, the European Palliative Care Research Collaborative (EPCRC). The EPCRC is funded through the Sixth Framework Program of the EU with major objectives to develop a computer-based assessment and classification tool for pain, depression, and cachexia. A systematic approach will be applied for the tool development with emphasis on multicultural and multilanguage challenges across Europe. The EPCRC is based on a long lasting collaboration within the European Association for Palliative Care Research Network. The ongoing change in society towards greatly increased use of communication as well as information transfer via digital systems will rapidly change the health care system. Therefore, patient-centered outcome assessment tools applicable for both clinic and research should be developed. Report of symptoms via digital media provides a start for face-to-face communication, treatment decisions, and assessment of treatment effects. The increased use of electronic media for exchange of information may facilitate the development and use of electronic assessment tools and decision-making systems in oncology. In the future, patients may find that a combination of a face-to-face interview plus a transfer of information of subjective symptoms by electronic means will optimize treatment.
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Affiliation(s)
- Stein Kaasa
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Jon Håvard Loge
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Peter Fayers
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Augusto Caraceni
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Florian Strasser
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Marianne Jensen Hjermstad
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Irene Higginson
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Lukas Radbruch
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Dagny Faksvåg Haugen
- From the Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Palliative Medicine Unit, Department of Oncology, St Olavs University Hospital, Trondheim; National Resource Centre for Studies of Long-Term Effects After Cancer, Rikshospitalet University Hospital; Department of Oncology, Ulleval University Hospital, Oslo, and the Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Magai C, Consedine NS, Adjei BA, Hershman D, Neugut A. Psychosocial influences on suboptimal adjuvant breast cancer treatment adherence among African American women: implications for education and intervention. HEALTH EDUCATION & BEHAVIOR 2007; 35:835-54. [PMID: 17909222 DOI: 10.1177/1090198107303281] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite lower incidence, African American women are at increased risk of dying from breast cancer relative to their European American counterparts. Although there are key differences in both screening behavior and tumor characteristics, an additional part of this mortality difference may lie in the fact that African American women receive suboptimal adjuvant chemotherapy and may receive suboptimal hormonal therapy, therapies that are known to increase survival. The authors consider ethnic differences in the psychosocial factors that have been shown to relate to poor screening adherence and consider how they may influence adherence to breast cancer adjuvant treatment, thus the receipt of suboptimal adjuvant chemo or hormonal therapy. To this end, they review ethnic differences in cognitive, emotional, and social network variables. Psychosocial variables should be included in research designed to understand cancer disparities as well interventions that can be tailored to culturally diverse populations to improve treatment adherence.
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Affiliation(s)
- Carol Magai
- Department of Psychology, Long Island University, Brooklyn, New York 11201, USA.
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Abstract
Over the past 20 years, there has been tremendous progress in the area of patient-reported outcomes (PROs). A PRO instrument is defined as any measure of a patient's health status that is elicited directly from the patient and assesses how the patient "feels or functions with respect to his or her health condition." The advances seen in clinical research regarding PROs has been mirrored in research in cystic fibrosis (CF). A large number of instruments have been used for both therapeutic and nontherapeutic clinical research for many chronic conditions. This review will summarize a history of the development of PROs and how PROs are viewed by the U.S. Food and Drug Administration. We will then review the current state of the art of patient-reported outcomes in CF, specifically addressing the evaluation of different PRO instruments in terms of their reliability and validity. Finally, we will delineate further areas for development of PROs in CF. We believe that the future of CF research will incorporate a more diverse selection of PRO outcome measures; these outcome measures ultimately may be incorporated into clinical care to standardize symptom assessment and provide information regarding the need for specific clinical interventions to improve the quality of care delivered to these patients.
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Affiliation(s)
- Christopher H Goss
- Department of Medicine, University of Washington Medical Center, Seattle, Washington 98195, USA.
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Adaptation française du Patient Generated Index: qualités métrologiques et limites pratiques. PSYCHO-ONCOLOGIE 2007. [DOI: 10.1007/s11839-007-0016-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Snyder CF, Dy SM, Hendricks DE, Brahmer JR, Carducci MA, Wolff AC, Wu AW. Asking the right questions: investigating needs assessments and health-related quality-of-life questionnaires for use in oncology clinical practice. Support Care Cancer 2007; 15:1075-85. [PMID: 17318591 DOI: 10.1007/s00520-007-0223-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 01/17/2007] [Indexed: 10/23/2022]
Abstract
GOALS OF WORK Questionnaires used in oncology practice for individual patient management need to address issues patients find important and want help with and issues cancer center health professionals can address. We investigated the item content from two health-related quality-of-life (HRQOL) questionnaires and two needs assessments for this purpose. PATIENTS AND METHODS In this preliminary study, 61 cancer patients and 19 cancer center health professionals rated the item content from the EORTC-QLQ-C30, FACT-G, Supportive Care Needs Survey-34 (SCNS), and Kingston Needs Assessment--Cancer. Patients rated each item's importance and whether they wanted help with it; health professionals rated each item's importance and whether they felt able to help patients address it. Patients and health professionals also reported their overall questionnaire preference. MAIN RESULTS Patients rated information about treatments (options, benefits, side effects) and care coordination as the most important issues and those for which they most wanted help from their health professionals. Health professionals rated pain and other symptom/side effect items as most important to patients and those for which they were most able to help. Findings were consistent across tumor type and treatment status. Patients had an overall preference for the SCNS. Health professionals had no clear questionnaire preference. CONCLUSIONS This preliminary study suggests that the issues patients most want help with may not be the issues that health professionals feel most able to address. If these findings are confirmed in more representative samples, interventions may be needed to assist health professionals in managing cancer patients' HRQOL issues and needs.
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Affiliation(s)
- Claire F Snyder
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 624 N. Broadway, 6th Floor, Baltimore, MD 21205, USA.
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Bezjak A, Tu D, Seymour L, Clark G, Trajkovic A, Zukin M, Ayoub J, Lago S, de Albuquerque Ribeiro R, Gerogianni A, Cyjon A, Noble J, Laberge F, Chan RTT, Fenton D, von Pawel J, Reck M, Shepherd FA. Symptom improvement in lung cancer patients treated with erlotinib: quality of life analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21. J Clin Oncol 2006; 24:3831-7. [PMID: 16921034 DOI: 10.1200/jco.2006.05.8073] [Citation(s) in RCA: 233] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE This report describes the quality of life (QOL) findings of a randomized placebo controlled study of erlotinib, an epidermal growth factor receptor inhibitor, in patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS This double-blind phase III trial randomly assigned 731 patients with NSCLC who had progressed after prior chemotherapy to erlotinib 150 mg daily or placebo, with survival as the primary study outcome. QOL was assessed by European Organisation for Research and Treatment of Cancer QLQ-C30 and the lung cancer module QLQ-LC13. The primary end points for QOL analysis were time to deterioration of three common lung cancer symptoms: cough, dyspnea, and pain. RESULTS Survival was significantly longer (hazard ratio, 0.70; P < .0001) in the erlotinib arm. Compliance with QOL was 87% at baseline and more than 70% during treatment. Patients receiving erlotinib had significantly longer median time to deterioration for all three symptoms (4.9 v 3.7 months for cough [P = .04]; 4.7 v 2.9 months for dyspnea [P = .04], and 2.8 v 1.9 months for pain [P = .03]). QOL response analyses showed that 44%, 34%, and 42% of patients receiving erlotinib had improvement in these three symptoms, respectively. This was accompanied by a significant improvement in the physical function (31% erlotinib v 19% placebo, P = .01), and global QOL (35% v 26%, P < .0001). Patients with complete or partial response were more likely to have improvement in the QOL response than patients with stable or progressive disease (P < .01). CONCLUSION Erlotinib not only improves survival in previously treated patients with NSCLC, but also improves tumor-related symptoms and important aspects of QOL.
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Affiliation(s)
- Andrea Bezjak
- Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Affiliation(s)
- Mellar P Davis
- The Harry R Horvitz Center for Palliative Medicine, Cleveland Clinic Foundation, Ohio, USA
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Malin JL. Bridging the Divide: Integrating Cancer-Directed Therapy and Palliative Care. J Clin Oncol 2004; 22:3438-40. [PMID: 15277538 DOI: 10.1200/jco.2004.06.917] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wyrwich KW, Spertus JA, Kroenke K, Tierney WM, Babu AN, Wolinsky FD. Clinically important differences in health status for patients with heart disease: an expert consensus panel report. Am Heart J 2004; 147:615-22. [PMID: 15077075 DOI: 10.1016/j.ahj.2003.10.039] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of the study was to develop clinically important difference (CID) standards for patients with coronary artery disease and congestive heart failure that identify small, moderate, and large intraindividual changes with time in a modified version of the Chronic Heart Failure Questionnaire (CHQ) and the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36, version 2). Prior work in ascertaining important difference standards for the CHQ have centered on patient-perceived changes. No important difference standards for the SF-36 have been published for patients with heart disease. This development of CIDs would facilitate the use of health status measures in daily clinical decision-making. METHODS We used a modification of the RAND Appropriateness Method to assemble and guide a 9-member consensus panel of physicians with substantial experience in using the CHQ or the SF-36 among patients with heart disease. RESULTS On the basis of their own experience using these measures and an extensive review of articles describing the development and use of these instruments, the expert panel achieved consensus on small, medium, and large clinically relevant changes in scores for the CHQ and SF-36. The CID standards established by this panel were slightly higher than the minimal important difference standards previously established for the CHQ using patient-perceived changes. CONCLUSIONS The CID standards established by this expert panel provide an important and useful tool for determining whether routine clinical health status assessments will benefit patients and enhance physicians' decision-making capacity in clinical settings.
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Affiliation(s)
- Kathleen W Wyrwich
- Department of Research Methodology, Saint Louis University, St Louis, MO 63103, USA.
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Velikova G, Booth L, Smith AB, Brown PM, Lynch P, Brown JM, Selby PJ. Measuring Quality of Life in Routine Oncology Practice Improves Communication and Patient Well-Being: A Randomized Controlled Trial. J Clin Oncol 2004; 22:714-24. [PMID: 14966096 DOI: 10.1200/jco.2004.06.078] [Citation(s) in RCA: 982] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose To examine the effects on process of care and patient well-being, of the regular collection and use of health-related quality-of-life (HRQL) data in oncology practice. Patients and Methods In a prospective study with repeated measures involving 28 oncologists, 286 cancer patients were randomly assigned to either the intervention group (regular completion of European Organization for Research and Treatment of Cancer-Core Quality of Life Questionnaire version 3.0, and Hospital Anxiety and Depression Scale on touch-screen computers in clinic and feedback of results to physicians); attention-control group (completion of questionnaires, but no feedback); or control group (no HRQL measurement in clinic before encounters). Primary outcomes were patient HRQL over time, measured by the Functional Assessment of Cancer Therapy-General questionnaire, physician-patient communication, and clinical management, measured by content analysis of tape-recorded encounters. Analysis employed mixed-effects modeling and multiple regression. Results Patients in the intervention and attention-control groups had better HRQL than the control group (P = .006 and P = .01, respectively), but the intervention and attention-control groups were not significantly different (P = .80). A positive effect on emotional well-being was associated with feedback of data (P = .008), but not with instrument completion (P = .12). A larger proportion of intervention patients showed clinically meaningful improvement in HRQL. More frequent discussion of chronic nonspecific symptoms (P = .03) was found in the intervention group, without prolonging encounters. There was no detectable effect on patient management (P = .60). In the intervention patients, HRQL improvement was associated with explicit use of HRQL data (P = .016), discussion of pain, and role function (P = .046). Conclusion Routine assessment of cancer patients' HRQL had an impact on physician-patient communication and resulted in benefits for some patients, who had better HRQL and emotional functioning.
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Affiliation(s)
- Galina Velikova
- Cancer Research UK Clinical Centre-Leeds, Cancer Medicine Research Unit, St James's University Hospital, Beckett St, Leeds LS9 7TF, UK.
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