1
|
Kraak JT, Verhoef K, Kramer SE, Merkus P. Barriers to and enablers of the use of the Otology Questionnaire Amsterdam in clinical practice-a qualitative post-implementation study. J Patient Rep Outcomes 2024; 8:96. [PMID: 39141062 PMCID: PMC11324631 DOI: 10.1186/s41687-024-00741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/03/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The Otology Questionnaire Amsterdam (OQUA) is developed to evaluate multiple ear complaints and their impact on patients' daily lives. The current clinical use of this questionnaire is below the potential utilization. AIM To identify the barriers and enablers of using the OQUA as perceived by ENT surgeons and patients and provide recommendations for an implementation strategy. METHODS Prospective and qualitative analysis was performed using focus groups and interviews with ENT professionals (n = 15) and patients (n = 25) with ear complaints of one tertiary referral hospital and two regional hospitals. Barriers and enablers were identified and classified by using the Capability-Opportunity-Motivation-Behavior model and the Theoretical Domains Framework. Suggestions for an implementation strategy will be made accordingly. RESULTS ENT professionals' barriers included lack of knowledge and skills to use the OQUA, inadequate technological support and perceived time constraints during consultation, uncertainty about the clinical relevance and lack of feedback on the outcomes of the OQUA. Enablers included beneficial consequences of the OQUA for the professional, organization and science. Patients' barriers included lack of knowledge about the objective and usefulness of the OQUA, perceived burden, difficulties in completing the questionnaire and insufficient feedback during consultation. Patient enablers included beliefs about beneficial consequences of the OQUA for the patient, health care and society. Suggested interventions involved education, training, environmental restructuring and incentivisation. CONCLUSION Based on the findings, we propose an implementation strategy should focus on education and training about the objective, outcomes and relevance of the OQUA, environmental restructuring regarding the optimal use of the OQUA, and incentivisation with feedback on the valuable outcomes of the OQUA for the patient, professional and healthcare. Future research is needed to determine the feasibility of the implementation strategy.
Collapse
Affiliation(s)
- J T Kraak
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing and Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, The Netherlands.
| | - K Verhoef
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing and Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, The Netherlands
| | - S E Kramer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing and Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, The Netherlands
| | - P Merkus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing and Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Anderson M, van Kessel R, Wood E, Stokes A, Fistein J, Porter I, Mossialos E, Valderas JM. Understanding factors impacting patient-reported outcome measures integration in routine clinical practice: an umbrella review. Qual Life Res 2024:10.1007/s11136-024-03728-7. [PMID: 39023733 DOI: 10.1007/s11136-024-03728-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Patient-report outcome measures (PROMs) have gained widespread support as a mechanism to improve healthcare quality. We aimed to map out key enablers and barriers influencing PROMs implementation strategies in routine clinical practice. METHODS An umbrella review was conducted to identify reviews exploring enablers and barriers related to the integration of PROMs in routine clinical practice from January 2000 to June 2023. Information on key enablers and barriers was extracted and summarised thematically according to the Theoretical Domains Framework. RESULTS 34 reviews met our criteria for inclusion. Identified reviews highlighted barriers such as limited PROMs awareness among clinicians and patients, perceived low value by clinicians and patients, PROMs that were too complex or difficult for patients to complete, poor usability of PROMs systems, delayed feedback of PROMs data, clinician concerns related to use of PROMs as a performance management tool, patient concerns regarding privacy and security, and resource constraints. Enablers encompassed phased implementation, professional training, stakeholder engagement prior to implementation, clear strategies and goals, 'change champions' to support PROMs implementation, systems to respond to issues raised by PROMs, and integration into patient pathways. No consensus favoured paper or electronic PROMs, yet offering both options to mitigate digital literacy bias and integrating PROMs into electronic health records emerged as important facilitators. CONCLUSIONS The sustainable implementation of PROMs is a complex process that requires multicomponent organisational strategies covering training and guidance, necessary time and resources, roles and responsibilities, and consultation with patients and clinicians.
Collapse
Affiliation(s)
- Michael Anderson
- Health Organisation, Policy, Economics (HOPE), Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, UK.
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Eleanor Wood
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Adam Stokes
- Centre for Global Health, St Georges, University of London, London, UK
| | - Jon Fistein
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
- Centre for Research On Health Systems Performance, National University of Singapore, Singapore, Singapore
| |
Collapse
|
3
|
Singh GK, Mudge A, Matthews R, Yates P, Phillips JL, Virdun C. Experience of care from the perspectives of inpatients with palliative care needs: a cross-sectional study using a patient reported experience measure (PREM). BMC Palliat Care 2024; 23:177. [PMID: 39026237 PMCID: PMC11256639 DOI: 10.1186/s12904-024-01494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Improving palliative care for inpatients is urgently needed. Data from patient-reported experience measures (PREM) can assist in identifying areas for focused improvement. This study aimed to describe patient reported experience of care in inpatients with palliative care needs, to inform a baseline understanding of care experience and identify key areas for improvement. METHODS Cross-sectional study design where inpatients with palliative care needs were invited to complete 'consideRATE,' a patient reported experience measure of care, over six months in 2022. Inpatients with palliative care needs receiving care on an oncology, general medicine/renal and general medicine/respiratory ward (n = 3) at an Australian metropolitan hospital were screened for eligibility. Carers could provide proxy responses where inpatients were unable to participate. Descriptive statistics were used to analyse quantitative ratings, whilst free text responses were analysed using integrated thematic analysis. RESULTS One-hundred and twenty participants (108 patients and 12 carers) completed consideRATE. The questions with the highest number of 'very good' responses were attention to symptoms, attention to feelings and attention to what matters most; the questions with the lowest number of 'very good' responses was attention to patients' affairs, what to expect, and the environment of care. Almost half (n = 57, 48%) indicated that attention to patients' affairs 'did not apply' to their inpatient stay. Analysis of 532 free text responses across 8 questions highlighted the importance of feeling supported, feeling informed, feeling heard and navigating the clinical environment. CONCLUSION Enabling inpatients with palliative care needs to provide feedback about their experience of care is one method of ensuring improvements matter to patients. Supporting clinical teams to understand and use these data to make tailored improvements is the next step in this multi-phase research.
Collapse
Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
| | - Alison Mudge
- Greater Brisbane Medical School, The University of Queensland, Herston, QLD, Australia
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Robyn Matthews
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Patsy Yates
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Jane L Phillips
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Claudia Virdun
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Baniulyte G, Esson M. Exploring patient perspectives: orthognathic surgery outcomes and experiences assessed by patient-reported outcome measures and patient-reported experience measures. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00171-2. [PMID: 39127557 DOI: 10.1016/j.bjoms.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 08/12/2024]
Abstract
Evaluating the effectiveness of orthognathic treatment can be difficult. To address this issue, patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) have been proposed as valuable instruments for understanding the quality of healthcare from the patients' standpoint. Therefore, the aim of this project was to employ PROMs and PREMs questionnaires to capture the patients' perspectives regarding their experience during the orthognathic treatment process, as well as their perception of their postoperative state. Preoperative and postoperative questionnaires were offered to patients at consenting appointment and at various timepoints after the surgery. The assessment of statistical relationships was carried out by means of Fisher's exact test. A total of 64 preoperative and 126 postoperative responses were received. The primary motivators for pursuing the surgery were the improvement of facial and dental aesthetics, as well as increased satisfaction with photographic and video appearances. These three factors were also cited as the most important postoperative benefits. Of the respondents, 58% reported experiencing altered sensation to the lower lip at the 24-month follow up (p = 0.02); however, the affected patients reported that this did not have an impact on their daily activities. The use of PROMs and PREMs to appraise the quality of life constitutes a valuable method for surgeons to gauge their treatment efficacy. Above all, such tools are particularly useful for evaluating patient satisfaction, which is the ultimate objective of any treatment.
Collapse
Affiliation(s)
- Gabriele Baniulyte
- Department of Oral and Maxillofacial Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, UK.
| | - Michael Esson
- Department of Oral and Maxillofacial Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, UK
| |
Collapse
|
6
|
Hriberšek M, Eibensteiner F, Bukowski N, Yeung AWK, Atanasov AG, Schaden E. Research areas and trends in family-centered care in the 21st century: a bibliometric review. Front Med (Lausanne) 2024; 11:1401577. [PMID: 38933103 PMCID: PMC11201138 DOI: 10.3389/fmed.2024.1401577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Family-centered care (FCC) is a model of care provision that sees a patient's loved ones as essential partners to the health care team and positively influences the psychological safety of patients and loved ones. Objectives This review aims to present an overview of impactful publications, authors, institutions, journals, countries, fields of application and trends of FCC in the 21st century as well as suggestions on further research. Methods The Web of Science Database was searched for publications on FCC between January 2000 and Dezember 2023. After screening for duplicates, VOS Viewer and CiteSpace were used to analyze and visualize the data. Results Scientific interest in FCC has grown and resulted in the scientific output of 4,836 publications originating from 103 different countries. Based on the frequent author keywords, FCC was of greatest interest in neonatology and pediatrics, nursing, critical and intensive care, end-of-life and palliative care, and patient-related outcomes. The recent research hotspots are "patient engagement," "qualitative study," and "health literacy." Conclusion FCC has gained recognition and spread from the pediatric to the adult palliative, intensive, end-of-life and geriatric care settings. This is a very reassuring development since adults, especially when older, want and need the assistance of their social support systems. Recent research directions include the involvement of patients in the development of FCC strategies, health literacy interventions and the uptake of telemedicine solutions.
Collapse
Affiliation(s)
- Mojca Hriberšek
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Clinical Department of Pediatric Nephrology and Gastroenterology, University Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nils Bukowski
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Andy Wai Kan Yeung
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Institute of Genetics and Animal Biotechnology, Polish Academy of Sciences, Magdalenka, Poland
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
7
|
Drury A, Boland V, Dowling M. Patient-Reported Outcome and Experience Measures in Advanced Nursing Practice: What Are Key Considerations for Implementation and Optimized Use? Semin Oncol Nurs 2024; 40:151632. [PMID: 38658204 DOI: 10.1016/j.soncn.2024.151632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/10/2024] [Accepted: 03/17/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To discuss the opportunities and challenges of implementing patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) within advanced practice nursing services in cancer care. METHODS This discussion paper has been informed by an environmental scan of evidence from systematic reviews and primary studies evaluating the use and implementation of PROMs and PREMs. Literature from the contexts of cancer and chronic disease, including nursing and multidisciplinary supportive care literature, has been included. RESULTS Advanced practice nurses are well-positioned to evaluate and respond to PROMs and PREMs data; several studies have highlighted improved patient outcomes concerning quality of life, symptom distress, and functional status within nurse-led services. Nevertheless, the implementation of PROMs and PREMs in cancer care and nurse-led services is variable. Previous studies have highlighted implementation challenges, which can hinder comparability and generalizability of PROMs and PREMs instruments. Advanced practice nurses should consider these challenges, including ways to use standardized PROM instruments. Electronic PROMs, while efficient, may exclude individuals at risk of inequity. Complex, lengthy, and frequent administration of PROMs may also overburden people living with or after cancer, with people affected by cancer expressing preference for flexible use in some studies. Therefore, the involvement of people affected by cancer in planning for PROMs/PREMs implementation may overcome this challenge. Finally, organizational considerations in implementation should address financial investments, including initial costs for technology and training and consideration of the operationalization of PROMs within existing infrastructure for the seamless utilization of PROMs data. CONCLUSION Despite the potential of advanced practice nursing services to enhance patient-reported outcomes and experiences, variability in the implementation of PROMs and PREMs poses challenges. Use of validated measures, electronic or paper-based instruments, and the preferences of people affected by cancer for the use of PROMs and PREMs must be carefully considered in consultation with end users for successful implementation. IMPLICATIONS FOR PRACTICE In planning for the implementation of PROMs and PREMs within nurse-led services, implementation risks may be mitigated through establishing clear guidelines for their use, investment in the development of the required infrastructure, user education, and rigorous implementation processes, including patient involvement in PROMs/PREMs selection.
Collapse
Affiliation(s)
- Amanda Drury
- Associate Professor in General Nursing, School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin, Ireland.
| | - Vanessa Boland
- Assistant Professor in General Nursing, School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Maura Dowling
- Associate Professor, School of Nursing and Midwifery, University of Galway, Ireland
| |
Collapse
|
8
|
Fabi A, Rossi A, Mocini E, Cardinali L, Bonavolontà V, Cenci C, Magno S, Barberi V, Moretti A, Besharat ZM, Iolascon G, Baldari C, Ferretti E, Botticelli A, Paris I, Scambia G, Migliaccio S. An Integrated Care Approach to Improve Well-Being in Breast Cancer Patients. Curr Oncol Rep 2024; 26:346-358. [PMID: 38400984 PMCID: PMC11021235 DOI: 10.1007/s11912-024-01500-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Breast cancer (BC) treatment has recently been revolutionized by the introduction of newer targeted agents, that helped tailoring therapies around the single patient. Along with increased survival rates, a careful evaluation of diet, lifestyle habits, physical activity, emotional and psychological experiences linked to the treatment journey, is now mandatory. However, a true proposal for an omnicomprehensive and "integrative" approach is still lacking in literature. METHODS A scientific board of internationally recognized specialists throughout different disciplines designed a shared proposal of holistic approach for BC patients. RESULTS A narrative review, containing information on BC treatment, endocrinological and diet aspects, physical activity, rehabilitation, integrative medicine, and digital narrative medicine, was developed. CONCLUSIONS In the context of a patient-centered care, BC treatment cannot be separated from a patient's long-term follow-up and care, and an organized interdisciplinary collaboration is the future in this disease's cure, to make sure that our patients will live longer and better. TRIAL REGISTRATION NCT05893368: New Model for Integrating Person-based Care (PbC) in the Treatment of Advanced HER2-negative Breast Cancer (PERGIQUAL). Registration date: 29th May 2023.
Collapse
Affiliation(s)
- Alessandra Fabi
- Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Alessandro Rossi
- Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Department of Movement, Human and Health Sciences, University Foro Italico of Rome, Rome, Italy
| | - Edoardo Mocini
- Department of Experimental Medicine, University Sapienza of Rome, Rome, Italy
| | - Ludovica Cardinali
- Department of Experimental Medicine, University Sapienza of Rome, Rome, Italy
- Bone Metabolic Diseases Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Valerio Bonavolontà
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | | | - Stefano Magno
- Center for Integrative Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vittoria Barberi
- Medical Oncology 1, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Antimo Moretti
- Multidisciplinary Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Giovanni Iolascon
- Multidisciplinary Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Carlo Baldari
- Department of Theoretical and Applied Sciences, eCampus University, Rome, Italy
| | - Elisabetta Ferretti
- Department of Experimental Medicine, University Sapienza of Rome, Rome, Italy
| | - Andrea Botticelli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, University Foro Italico of Rome, Rome, Italy
- Department of Experimental Medicine, University Sapienza of Rome, Rome, Italy
| |
Collapse
|
9
|
Forbes C, Tanner S, Engstrom T, Lee WR, Patel D, Walker R, Bradford N, Pole JD. Patient Reported Fatigue Among Adolescent and Young Adult Cancer Patients Compared to Non-Cancer Patients: A Systematic Review and Meta-Analysis. J Adolesc Young Adult Oncol 2024; 13:242-250. [PMID: 37902970 DOI: 10.1089/jayao.2023.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Adolescent and young adult (AYA) cancer patients and survivors are a growing population due to more frequent diagnoses and improved survival. Fatigue is a common symptom experienced by cancer patients and it is often missed by health care professionals. Patient reported outcome measures (PROMs) can assist in evaluating patient reported fatigue. This systematic review aims to determine if AYA cancer patients report more fatigue than AYAs who have not been diagnosed with cancer. We used a subset of articles from a larger review that searched PubMed, EMBASE, CINAHL, and PsycINFO to determine which PROMs and domains are currently being used to evaluate AYA cancer. This study identified 175 articles related to PROMs in the AYA cancer population. Articles with PROMs reporting on fatigue/vitality were used in this review. From the original 175 articles, we identified 8 fatigue/vitality articles for this review. All eight articles found an increase in fatigue/decrease in vitality in the AYA cancer population compared to healthy controls. A meta-analysis was performed on four articles that used the same PROM tool (EORTC QLQ-C30). This found a statistically significant and clinically meaningful increase in mean fatigue of 12.5 95% confidence interval: 3.3-21.8 points (scale 0-100, higher number indicates more fatigue) in the AYA cancer group compared to healthy noncancer controls. Fatigue in the AYA cancer population is a significant issue, it is often undetected and underreported, and early interventions are needed to prevent the negative subsequent sequelae.
Collapse
Affiliation(s)
- Cheryl Forbes
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Sarah Tanner
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Teyl Engstrom
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Wen Ray Lee
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Dhaval Patel
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
| | - Rick Walker
- School of Medicine, The University of Queensland, Herston, Australia
- Oncology Service, Queensland Children's Hospital, Brisbane, Australia
- Cancer Care, Princess Alexandra Hospital, Brisbane, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Jason D Pole
- Centre for Health Services Research, and The University of Queensland, Herston, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| |
Collapse
|
10
|
Mishra B, Sudheer P, Rajan R, Agarwal A, Srivastava MVP, Nilima N, Vishnu VY. Bridging the gap between statistical significance and clinical relevance: A systematic review of minimum clinically important difference (MCID) thresholds of scales reported in movement disorders research. Heliyon 2024; 10:e26479. [PMID: 38439837 PMCID: PMC10909673 DOI: 10.1016/j.heliyon.2024.e26479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/16/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024] Open
Abstract
Background Minimum clinically important difference (MCID) is the smallest change in an outcome measure that is considered clinically meaningful. Using validated MCID thresholds for outcomes powers trials adequately to detect meaningful treatment effects, aids in their interpretation and guides development of new outcome measures. Objectives To provide a comprehensive summary of MCID thresholds of various symptom severity scales reported in movement disorder. Methods We conducted systematic review of the literature and included studies of one or more movement disorders, and reporting MCID scales. Results 2763 reports were screened. Final review included 32 studies. Risk of bias (RoB) assessment showed most studies were of good quality. Most commonly evaluated scale was Unified Parkinson's Disease Rating Scale (UPDRS) (11 out of 32). Four studies assessing MDS-UPDRS had assessed its different sub-parts, reporting a change of 2.64,3.05,3.25 and 0.9 points to detect clinically meaningful improvement and 2.45,2.51,4.63 and 0.8 points to detect clinically meaningful worsening, for the Part I, II, III and IV, respectively. For Parts II + III, I + II + III and I + II + III + IV, MCID thresholds reported for clinically meaningful improvement were 5.73, 4.9, 6.7 and 7.1 points respectively; while those for clinically meaningful worsening were 4.7, 4.2, 5.2 and 6.3 points, respectively. MCID thresholds reported for other scales included Abnormal Involuntary Movement Scale (AIMS), Toronto Western Spasmodic Torticollis Rating Scale (TWSRS), and Burke-Fahn-Marsden Dystonia Scale (BFMD). Conclusion This review summarizes all the MCID thresholds currently reported in Movement disorders research and provides a comprehensive resource for future trials, highlighting the need for standardized and validated MCID scales in movement disorder research.
Collapse
Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pachipala Sudheer
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Nilima Nilima
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
11
|
Bense JE, Guilonard N, Zwaginga F, Stiggelbout AM, Louwerens M, Mekelenkamp H, Lankester AC, Pieterse AH, de Pagter APJ. The value of using patient-reported outcomes for health screening during long-term follow-up after paediatric stem cell transplantation for nonmalignant diseases. Health Expect 2024; 27:e13902. [PMID: 38102818 PMCID: PMC10768862 DOI: 10.1111/hex.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION The assessment of using patient-reported outcomes (PROs) within comprehensive care follow-up programmes, specifically focused on health screening, remains largely unexplored. PROs were implemented in our late effects and comprehensive care programme after paediatric hematopoietic stem cell transplantation (HSCT) for nonmalignant diseases. The programme focuses solely on screening of physical and mental health and on discussing PROs during the consultation. METHODS The primary method of this study was semistructured interviews to explore the perspective of both patients and healthcare providers' (HCP) on the use of PROs, which were thematically analyzed. Additionally, an explorative quantitative approach with patient-reported experience measures (PREMS) was used, with a pretest-posttest design, to assess whether the use of PROs was accompanied by more patient-centred care. RESULTS From the patient-interviews (N = 15) four themes were extracted: use of PROs (1) help to discuss topics; (2) make the patients feel understood; (3) create a moment of self-reflection; and (4) make consultations more efficient. Pre- and postimplementation analysis of PREMs (N = 40) did not show significant differences in terms of patient-centeredness. CONCLUSION Our results demonstrate the added value of integrating PROs for health screening purposes within the long-term follow-up programme after paediatric HSCT, as perceived by both patient and HCP. With the active use of PROs, patients are stimulated to consciously assess their health status. PATIENT CONTRIBUTION This study included patients as participants. Caregivers were approached if patients were below a certain age. Additionally, preliminary results were shared with all patients (including nonparticipants) during a patient conference day.
Collapse
Affiliation(s)
- Joëll E. Bense
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Nicole Guilonard
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Femke Zwaginga
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Anne M. Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Marloes Louwerens
- Department of Internal MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - Hilda Mekelenkamp
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Arjan C. Lankester
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| | - Arwen H. Pieterse
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
| | - Anne P. J. de Pagter
- Department of Pediatrics, Willem‐Alexander Children's Hospital, Division of Stem Cell TransplantationLeiden University Medical CenterLeidenThe Netherlands
| |
Collapse
|
12
|
Rose SW, Highland KB, Kelkar AA. Clinical Utility of Patient-Reported Outcome Instruments in the Management of Pulmonary Hypertension: A Systematic Review. JACC. HEART FAILURE 2024; 12:366-376. [PMID: 37897461 DOI: 10.1016/j.jchf.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Despite the greater sensitivity and specificity of disease-specific patient-reported outcome measures (PROM) to detect clinical change, only recently have such instruments been developed for pulmonary hypertension (PH), specifically pulmonary arterial hypertension (PAH) and chronic thromboembolic disease (CTEPH). Although these valuable tools are now being incorporated into clinical studies of PH, they have not yet reached widespread integration into routine clinical care. OBJECTIVES In this systematic review, the authors assess the psychometric properties of PROM developed for PH, compare PROM with other clinical outcomes in PH, and address the utility of PROM in clinical care. METHODS The authors performed a systematic search of papers published between January 1, 2006, and October 1, 2022, using the MEDLINE database to identify PROM developed and validated for PH. The identified PROM were found to have been developed only in groups with PAH and CTEPH. The authors evaluated the identified instruments according to established psychometric criteria. An additional search was performed to identify randomized controlled trials (RCTs) utilizing these PROM for comparison with clinical outcomes. RESULTS From 527 papers retrieved, a total of 35 PROM were identified. Of these, 5 disease-specific instruments were included in the final analysis. While both CAMPHOR (Cambridge Pulmonary Hypertension Outcome Review) and emPHasis-10 performed well in patients with PAH and CTEPH with regard to their psychometric properties, emPHasis-10 demonstrated superior feasibility for use in clinical practice due to its concise format. The Pulmonary Arterial Hypertension-Symptoms and Impacts Questionnaire performed well in the authors' analysis, though additional data is needed regarding interpretability and feasibility. CONCLUSIONS EmPHasis-10 demonstrated strong psychometric properties and the greatest feasibility for clinical use. Further study assessing the integration of PROM into routine clinical care for PH is needed.
Collapse
Affiliation(s)
- Scott W Rose
- Sections of Critical Care and Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | | | - Anita A Kelkar
- Section of Cardiovascular Medicine, Department of Veterans Affairs, Kernersville, North Carolina, USA.
| |
Collapse
|
13
|
Kauppi KJ, Roos ET, Borg PT, Cantell KS, Torkki PM. What is wellness? Investigating the importance of different domains of wellness among laypeople and experts: A survey study. Scand J Public Health 2024:14034948231217360. [PMID: 38217305 DOI: 10.1177/14034948231217360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
AIMS Lack of consensus on wellness has led to a vast number of different conceptualisations, which hinder international efforts to monitor individual-level wellness and social progress comparably. This study aimed to aid in the harmonisation of the concept by contributing to the scarce research on laypeople's views on wellness. The study investigates whether the importance of different areas of wellness varies depending on age, gender, education or socio-economic position. Furthermore, considering that wellness models are often constructed by expert panels, this study aimed to shed light on how experts' and laypeople's views on wellness vary. METHODS Altogether, 1152 laypeople and 23 Finnish experts rated the importance of 61 systematic review-based wellness domains. Each domain received an ordinal number, which, together with the Mann-Whitney U-test or Kruskal-Wallis test, was used to examine the differences between the groups. RESULTS Thirteen wellness domains were found at the top of the lists, regardless of whether the results were analysed based on gender, age, education or socio-economic position. When looking at the priority order of different domains, we were able to identify several differences between the expert panel and laypeople. CONCLUSIONS To ensure the relevance of wellness models, it is vital to understand the areas that laypeople consider to be important for their comprehensive wellness. This study offers 13 domains that could be combined with an expert view on wellness and used as a starting point for creating a more comprehensive, inclusive and better-suited wellness instrument.
Collapse
Affiliation(s)
- Krista J Kauppi
- Department of Public Health, Faculty of Medicine, University of Helsinki, Finland
| | - Eira T Roos
- Department of Public Health, Faculty of Medicine, University of Helsinki, Finland
- Aava Medical Centre, Finland
| | | | | | - Paulus M Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Finland
| |
Collapse
|
14
|
Holm A, Rodkjær LØ, Bekker HL. Integrating Patient Involvement Interventions within Clinical Practice: A Mixed-Methods Study of Health Care Professional Reasoning. MDM Policy Pract 2024; 9:23814683241229987. [PMID: 38362059 PMCID: PMC10868494 DOI: 10.1177/23814683241229987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/13/2024] [Indexed: 02/17/2024] Open
Abstract
Background. Patient involvement interventions are complex interventions that improve patient involvement in treatment and care in health care systems. Studies report several benefits of patient involvement interventions and that health care professionals are positive about using them. However, they have not been explored as a collected group of interventions throughout the continuum of care and treatment. In addition, the relationship between patient involvement interventions and the clinical reasoning process of health care professionals has not been thoroughly studied. Design. This mixed-methods study was conducted at Aarhus University Hospital in Denmark between April and November 2022 using interview data from 12 health care professionals and survey data from 420 health care professionals. Informants were medical doctors, nurses, midwives, dietitians, physiotherapists, and occupational therapists who had direct contact with patients during their daily care and treatment. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed via inductive and deductive content analysis. Results. Communication and interaction were seen as overarching aspects of patient involvement, with patient involvement interventions being defined as concrete tools and methods to enhance health care professionals' explicit clinical reasoning process. Limitations. It is unclear if results are representative of all health care professionals at the hospital or only those with a positive view of patient involvement interventions. Conclusions. Patient involvement interventions are viewed as beneficial for patients and fit with the clinical reasoning of health care professionals. Clinical reasoning may be an active ingredient in the development and implementation of patient involvement interventions. Implications. In practice, health care professionals need training in person-centered communication and the ability to articulate their clinical reasoning explicitly. In research, a more in-depth understanding of the interrelations between patient involvement interventions and clinical reasoning is needed. Highlights Communication and interaction are the fundamental goals of patient involvement in practice, regardless of which patient involvement intervention is being used.Clinical reasoning is often an unconscious process using tacit knowledge, but the use of patient involvement interventions may be a way for health care professionals (at both individual and group levels) to become more explicit about and aware of their reflections.Clinical reasoning can be viewed as a mechanism of change in the development and implementation of patient involvement interventions.
Collapse
Affiliation(s)
- Anna Holm
- Research Centre for Patient Involvement, Department of Public Health, Aarhus University and Aarhus University Hospital, Denmark
- Department of Intensive Care, Aarhus University Hospital, Denmark
| | - Lotte Ørneborg Rodkjær
- Research Centre for Patient Involvement, Department of Public Health, Aarhus University and Aarhus University Hospital, Denmark
- Department of Infectious Disease, Aarhus University Hospital, Denmark
| | - Hilary Louise Bekker
- Research Centre for Patient Involvement, Department of Public Health, Aarhus University and Aarhus University Hospital, Denmark
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
15
|
Consolo L, Basile I, Colombo S, Rusconi D, Pasquot L, Campa T, Caraceni A, Lusignani M. Exploring patient perspectives on electronic patient-reported outcome measures in home-based cancer palliative care: A qualitative study. Digit Health 2024; 10:20552076241249962. [PMID: 38665884 PMCID: PMC11044777 DOI: 10.1177/20552076241249962] [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] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background Electronic patient-reported outcomes (ePROMs) enhance symptom management and patients' engagement in palliative cancer care. However, integrating them into this setting brings challenges, including patients' familiarity with technological devices and declining health status. Prioritizing the patient's acceptability and feasibility is crucial for their adoption. However, more knowledge is needed about patients' perspectives on the adoption of ePROMs in the community, especially for home-based palliative care. Aim Explore patient viewpoints on utilizing ePROMs for symptom reporting in home-based oncology palliative care. Design A qualitative interpretative approach was used to evaluate patients' points of view on using ePROMs in this specific care setting. Semistructured interviews were carried out. Data were analyzed using a reflexive thematic analysis. Setting/participants A total of 25 patients receiving oncological home palliative care from the advanced palliative care unit of the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy, were invited to participate. Twenty interviews were conducted, as five patients declined due to deteriorating health. Results Four themes were identified: (1) strategic value of ePROMs and subjective appreciation; (2) enhancing patient centeredness through ePROMs; (3) exploring and addressing concerns about the use of ePROMs and (4) intersecting factors influencing the efficacy of ePROMs. Conclusion Despite initial reticence, home palliative care patients consider ePROMs as potentially valuable allies monitoring symptoms, enhancing their quality of life, and amplifying their voices on less explored aspects of care. Continuous dialog between healthcare professionals and patients is crucial for addressing patient skepticism about ePROMs and their impact on the human aspect of care.
Collapse
Affiliation(s)
- Letteria Consolo
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Bachelor School of Nursing, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Basile
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Stella Colombo
- Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Daniele Rusconi
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Loredana Pasquot
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tiziana Campa
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
16
|
Desai AP, Madathanapalli A, Tang Q, Orman ES, Lammert C, Patidar KR, Nephew LD, Ghabril M, Monahan PO, Chalasani N. PROMIS Profile-29 is a valid instrument with distinct advantages over legacy instruments for measuring the quality of life in chronic liver disease. Hepatology 2023; 78:1788-1799. [PMID: 37222262 PMCID: PMC10674041 DOI: 10.1097/hep.0000000000000480] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/02/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND AIMS The Patient-Reported Outcomes Measurement Information System (PROMIS) is increasingly used to measure health-related quality of life, yet, it has not been well-studied in chronic liver disease (CLD). This study compares PROMIS Profile-29 to Short-Form Health Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ) in patients with CLD. APPROACH AND RESULTS In all, 204 adult outpatients with CLD completed PROMIS-29, CLDQ, SF-36 and usability questionnaires. Mean scores were compared between groups, the correlation between domain scores was assessed, and floor/ceiling effects were calculated. Etiologies of CLD were NAFLD (44%), hepatitis C (16%), and alcohol (16%). Fifty-three percent had cirrhosis and 33% were Child-Pugh B/C with a mean model for end-stage liver disease score of 12.0. In all 3 tools, the poorest scores were in physical function and fatigue. The presence of cirrhosis or complications was associated with worse scores in most PROMIS Profile-29 domains, indicating known group validity. Strong correlations ( r ≥ 0.7) were present between Profile-29 and SF-36 or CLDQ domains measuring similar concepts, indicating strong convergent validity. Profile-29 was completed faster than SF-36 and CLDQ (5.4 ± 3.0, 6.7 ± 3.3, 6.5 ± 5.2 min, p = 0.003) and rated equally on usability. All CLDQ and SF-36 domains reached the floor or ceiling, while none were noted for Profile-29. These floor/ceiling effects were magnified when assessed in those with and without cirrhosis, indicating the improved depth of measurement by Profile-29. CONCLUSIONS Profile-29 is a valid, more efficient, well-received tool that provides an improved depth of measurement when compared to SF-36 and CLDQ and, therefore, an ideal tool to measure general health-related quality of life in CLD.
Collapse
Affiliation(s)
- Archita P. Desai
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis IN, USA
| | | | - Qing Tang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eric S. Orman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis IN, USA
| | - Craig Lammert
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis IN, USA
| | - Kavish R. Patidar
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis IN, USA
| | - Lauren D. Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis IN, USA
| | - Marwan Ghabril
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis IN, USA
| | - Patrick O. Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis IN, USA
| |
Collapse
|
17
|
Bele S, Paolucci EO, Johnson DW, Quan H, Santana MJ. Implementing paediatric patient-reported outcome measures in outpatient asthma clinics: a feasibility assessment study. BMJ Open 2023; 13:e073260. [PMID: 37945296 PMCID: PMC10649366 DOI: 10.1136/bmjopen-2023-073260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Implementation of patient-reported outcome measures (PROMs) is limited in paediatric routine clinical care. The KidsPRO programme has been codesigned to facilitate the implementation of PROMs in paediatric healthcare settings. Therefore, this study (1) describes the development of innovative KidsPRO programme and (2) reports on the feasibility of implementing PedsQL (Pediatric Quality of Life Inventory) PROM in asthma clinics using the KidsPRO programme. DESIGN Feasibility assessment study. SETTING Outpatient paediatric asthma clinics in the city of Calgary, Canada. PARTICIPANTS Five paediatric patients, four family caregivers and three healthcare providers were recruited to pilot the implementation of PedsQL PROM using KidsPRO. Then, a survey was used to assess its feasibility among these study participants. MAIN OUTCOME MEASURES Participants' understanding of using PROMs, the adequacy of support provided to them, the utility of using PROMs as part of their appointment, and their satisfaction with using PROMs. ANALYSES The quantitative data generated through closed-ended questions was analysed and represented in the form of bar charts for each category of study participants (ie, patients, their family caregivers and healthcare providers). The qualitative data generated through the open-ended questions were content analysed and categorised into themes. RESULTS The experience of using PROMs was overwhelmingly positive among patients and their family caregivers, results were mixed among healthcare providers. Qualitative data collected through open-ended questions also complemented the quantitative findings. CONCLUSION The evidence from this study reveals that the implementation of PROMs in routine paediatric clinical care asthma clinics in Alberta is seems to be feasible.
Collapse
Affiliation(s)
- Sumedh Bele
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Oddone Paolucci
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - David W Johnson
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria-Jose Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
18
|
Torbjørnsen A, Jensen AL, Singstad T, Weldingh NM, Holmen H. Patient-reported outcome measures in diabetes outpatient care: a scoping review. BMJ Open Diabetes Res Care 2023; 11:e003628. [PMID: 37963648 PMCID: PMC10649597 DOI: 10.1136/bmjdrc-2023-003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures are increasingly used in clinical diabetes care to increase patient involvement and improve healthcare services. The objectives were to identify instruments used to measure PROs in outpatient diabetes clinics and to investigate the use of these PRO measures alongside the experiences of patients and healthcare personnel in a clinical setting. RESEARCH DESIGN AND METHODS A scoping review was conducted according to the framework of Arksey and O'Malley with scoping searches of Cinahl, EMBASE, Medline and Health and Psychosocial Instruments. Studies reporting on adults with diabetes in a clinical setting where the PRO measure response directly affected patient care were eligible for inclusion. RESULTS In total, 35 197 citations were identified, of which 7 reports presenting 4 different PRO measures were included in the review. All four of the included items measured psychosocial aspects of diabetes, and three included elements of the Problem Areas in Diabetes scale. All the patients were satisfied with the use of PRO measures in clinical care, whereas the level of satisfaction among healthcare personnel with PRO measures varied within and among studies. CONCLUSIONS The limited number of eligible studies in this review suggests that research on PRO measures for diabetes outpatient care is scarce. Patients welcome the opportunity to express their concerns through the systematic collection of PRO measures, and some healthcare personnel value the broader insight that PRO measures provide into the impact of diabetes on patients' lives. However, the heterogeneity among services and among patients challenges the implementation of PRO measures. Research is needed to explore how PRO measures in clinical outpatient care affect healthcare personnel workflow. REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/46AHC.
Collapse
Affiliation(s)
- Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Annesofie Lunde Jensen
- Health Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Tone Singstad
- Department of Endocrinology Outpatient Service, Akershus University Hospital, Lorenskog, Norway
| | | | - Heidi Holmen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Intervention Centre, Oslo Universitetssykehus, Oslo, Norway
| |
Collapse
|
19
|
Ramirez MM, Shepherd MH, Melnick SJ, Hanebuth C, Bazemore C, Couce L, Hendren S, Horn ME. Patient-reported outcome measures in physical therapy practice for neck pain: an overview of reviews. J Patient Rep Outcomes 2023; 7:97. [PMID: 37782344 PMCID: PMC10545655 DOI: 10.1186/s41687-023-00637-0] [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: 05/21/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Understanding which patient-reported outcome measures are being collected and utilized in clinical practice and research for patients with neck pain will help to inform recommendations for a core set of measures that provide value to patients and clinicians during diagnosis, clinical decision-making, goal setting and evaluation of responsiveness to treatment. Therefore, the aim of this study was to conduct a review of systematic reviews using a qualitative synthesis on the use of patient-reported outcome measures (PROMs) for patients presenting with neck pain to physical therapy. METHODS An electronic search of systematic reviews and guideline publications was performed using MEDLINE (OVID), Embase (Elsevier), CINAHL Complete (EBSCOhost), and Web of Science (Clarivate) databases to identify reviews that evaluated physical therapy interventions or interventions commonly performed by a physical therapist for individuals with neck pain and included at least one patient-reported outcome measure. The frequency and variability in which the outcome measures were reported among the studies in the review and the constructs for which they measured were evaluated. The evaluation of a core set of outcome measures was assessed. Risk of bias and quality assessment was performed using A Measurement Tool to Assess systematic Reviews 2. RESULTS Of the initial 7,003 articles, a total of 37 studies were included in the final review. Thirty-one PROMs were represented within the 37 reviews with eleven patient-reported outcome measures in three or more reviews. The eleven PROMs assessed the constructs of disability, pain intensity, psychosocial factors and quality of life. The greatest variability was found amongst individual measures assessing psychosocial factors. Assessment of psychosocial factors was the least represented construct in the included studies. Overall, the most frequently utilized patient reported outcome measures were the Neck Disability Index, Visual Analog Scale, and Numeric Pain Rating Scale. The most frequently used measures evaluating the constructs of disability, pain intensity, quality of life and psychosocial functioning included the Neck Disability Index, Visual Analog Scale, Short-Form-36 health survey and Fear Avoidance Belief Questionnaire respectively. Overall risk of bias and quality assessment confidence levels ranged from critically low (2 studies), low (12 studies), moderate (8 studies), and high (15 studies). CONCLUSION This study identified a core set of patient-reported outcome measures that represented the constructs of disability, pain intensity and quality of life. This review recommends the collection and use of the Neck Disability Index and the Numeric Pain Rating Scale or Visual Analog Scale. Recommendation for a QoL measure needs to be considered in the context of available resources and administrative burden. Further research is needed to confidently recommend a QoL and psychosocial measure for patients presenting with neck pain. Other measures that were not included in this review but should be further evaluated for patients with neck pain are the Patient Reported Outcomes Measurement Information System (PROMIS) Physical function, PROMIS Pain Interference and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool.
Collapse
Affiliation(s)
- Michelle M Ramirez
- Department of Population Health Sciences, Department of Orthopaedic Surgery, Duke University School of Medicine, 215 Morris Street, Suite 200, Durham, NC, 27708, USA.
| | - Mark H Shepherd
- Department of Physical Therapy, Bellin College, 3201 Eaton Rd, Greenbay, WI, 54311, USA
| | - S Jacob Melnick
- Doctor of Physical Therapy Program, Hawai'i Pacific University, 500 Ala Moana Blvd, Honolulu, HI, 96813, USA
| | - Cannon Hanebuth
- Division of Physical Therapy, Duke University School of Medicine, DUMC Box 104002, Durham, NC, 27710, USA
| | - Caroline Bazemore
- Division of Physical Therapy, Duke University School of Medicine, DUMC Box 104002, Durham, NC, 27710, USA
| | - Logan Couce
- Sugar House Health Center, University of Utah, 1280 E. Stringham Ave, Salt Lake City, UT, 84106, USA
| | - Steph Hendren
- Research & Education Librarian, Duke University Medical Center Library & Archives, Seeley G. Mudd Bldg., 103, Durham, NC, 27710, USA
| | - Maggie E Horn
- Department of Orthopaedic Surgery, Division of Physical Therapy, Department of Population Health Sciences, Duke University School of Medicine, DUMC Box 104002, Durham, NC, 27710, USA
| |
Collapse
|
20
|
Taylor S, Chaudhary P, McCartin F, Higham C. Understanding the impact of radiotherapy related insufficiency fractures and exploring satisfaction with two existing patient reported outcome measures: A qualitative interview study. Tech Innov Patient Support Radiat Oncol 2023; 27:100210. [PMID: 37250199 PMCID: PMC10209447 DOI: 10.1016/j.tipsro.2023.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Radiotherapy related insufficiency fractures (RRIFs) occur in approximately 10-15% of cancer survivors who underwent pelvic radiotherapy. Little research has been conducted to explore the impact of RRIFs on quality of life (QOL). Patient reported outcome measures (PROMs) are often used in oncology to measure side effects and QOL. The study aims to understand the influence of RRIF on QOL and to discover whether available PROMs address their needs. Materials and methods Twenty-five patients randomly selected from a Tertiary Oncology Centre bone health clinic database of patients referred with RRIFs were approached. Interested patients were sent two existing PROMs and a patient information sheet. Eleven patients agreed to take part in a semi-structured interview to explore their experiences and their opinion on the existing PROMs. Telephone interviews were conducted. Interviews were audio recorded, transcribed, and analysed using thematic analysis. Results Four themes were identified: 1) Route to diagnosis, 2) management of RRIFs and 3) resilience all had an impact on 4) QOL. Additionally, participants discussed PROMs and how they might be integrated into clinical practice. The data highlights the wide ranging QOL impacts experienced and highlights potential areas for improvement in terms of diagnosis and management pathways. Discussion The impact of RRIFs on QOL is considerable. Participants highlighted key areas for improvement including the provision of more information, more access to support and improved management pathways. Participants also highlighted the potential benefits of PROMs but suggested existing measures could be improved.
Collapse
Affiliation(s)
- Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
- School of Nursing and Midwifery, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Prabhav Chaudhary
- Department of Endocrinology, The Christie Hospital NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Fiona McCartin
- Department of Endocrinology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Claire Higham
- Department of Endocrinology, The Christie Hospital NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| |
Collapse
|
21
|
Kasturi S, Ahearn EL, Batterman A, Horton R, Kleinman J, Rose-Smith J, LeClair AM, Mandl LA. Measuring What Matters: A Qualitative Study of the Relevance and Clinical Utility of PROMIS Surveys in Systemic Lupus Erythematosus. J Rheumatol 2023; 51:jrheum.2023-0184. [PMID: 37399463 PMCID: PMC10757986 DOI: 10.3899/jrheum.2023-0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate the relevance and clinical utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) surveys in patients with systemic lupus erythematosus (SLE). METHODS Adults with SLE receiving routine outpatient care at a tertiary care academic medical center participated in a qualitative study. Patients completed PROMIS computerized adaptive tests (CATs) in 12 selected domains and rated the relevance of each domain to their experience with SLE. Focus groups and interviews were conducted to elucidate the relevance of the PROMIS surveys, identify additional domains of importance, and explore the utility of the surveys in clinical care. Focus group and interview transcripts were coded, and a thematic analysis was performed using an iterative inductive process. RESULTS Twenty-eight women and 4 men participated in 4 focus groups and 4 interviews, respectively. Participants endorsed the relevance and comprehensiveness of the selected PROMIS domains in capturing the effect of SLE on their lives. They ranked fatigue, pain interference, sleep disturbance, physical function, and applied cognition abilities as the most salient health-related quality of life (HRQOL) domains. They suggested that the disease-agnostic PROMIS questions holistically captured their lived experience of SLE and its common comorbidities. Participants were enthusiastic about using PROMIS surveys in clinical care and described potential benefits in enabling disease monitoring and management, facilitating communication, and empowering patients. CONCLUSION PROMIS includes the HRQOL domains that are of most importance to individuals with SLE. Patients suggest that these universal tools can holistically capture the impact of SLE and enhance routine clinical care.
Collapse
Affiliation(s)
- Shanthini Kasturi
- S. Kasturi, MD, MS, Division of Rheumatology, Tufts Medical Center, Boston, MA
| | - Emily L Ahearn
- E.L. Ahearn, BS, Tufts University School of Medicine, Boston, Massachusetts
| | - Adena Batterman
- A. Batterman, MSW, LCSW, Department of Social Work, Hospital for Special Surgery, New York, New York
| | - Roberta Horton
- R. Horton, LCSW, ACSW, Department of Social Work, Hospital for Special Surgery, New York, New York
| | - Juliette Kleinman
- J. Kleinman, LCSW, ACSW, Department of Social Work, Montefiore Health System, Bronx, New York
| | - Jillian Rose-Smith
- J. Rose-Smith, PhD, MPH, LCSW, Department of Social Work, Hospital for Special Surgery, New York, New York
| | - Amy M LeClair
- A.M. LeClair, PhD, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Lisa A Mandl
- L.A. Mandl, MD, MPH, Division of Rheumatology, Hospital for Special Surgery, and Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
22
|
Mishra B, Sudheer P, Agarwal A, Srivastava MVP, Nilima, Vishnu VY. Minimal Clinically Important Difference (MCID) in Patient-Reported Outcome Measures for Neurological Conditions: Review of Concept and Methods. Ann Indian Acad Neurol 2023; 26:334-343. [PMID: 37970301 PMCID: PMC10645230 DOI: 10.4103/aian.aian_207_23] [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: 03/10/2023] [Revised: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 11/17/2023] Open
Abstract
The concept of the minimal clinically important difference (MCID) emerged from the recognition that statistical significance alone is not enough to determine the clinical relevance of treatment effects in clinical research. In many cases, statistically significant changes in outcomes may not be meaningful to patients or may not result in any tangible improvements in their health. This has led to a growing emphasis on the importance of measuring patient-reported outcome measures (PROMs) in clinical trials and other research studies, in order to capture the patient perspective on treatment effectiveness. MCID is defined as the smallest change in scores that is considered meaningful or important to patients. MCID is particularly important in fields such as neurology, where many of the outcomes of interest are subjective or based on patient-reported symptoms. This review discusses the challenges associated with interpreting outcomes of clinical trials based solely on statistical significance, highlighting the importance of considering clinical relevance and patient perception of change. There are two main approaches to estimating MCID: anchor-based and distribution-based. Anchor-based approaches compare change scores using an external anchor, while distribution-based approaches estimate MCID values based on statistical characteristics of scores within a sample. MCID is dynamic and context-specific, and there is no single 'gold standard' method for estimating it. A range of MCID thresholds should be defined using multiple methods for a disease under targeted intervention, rather than relying on a single absolute value. The use of MCID thresholds can be an important tool for researchers, neurophysicians and patients in evaluating the effectiveness of treatments and interventions, and in making informed decisions about care.
Collapse
Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pachipala Sudheer
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nilima
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
23
|
Antunes A, Racha-Pacheco R, Esteves C, Tavares A, Mendez J, Pacheco P, Short D. PRO-Act: a healthcare provider workshop outlining the added value of implementing PROs in routine HIV practice. J Patient Rep Outcomes 2023; 7:50. [PMID: 37261556 DOI: 10.1186/s41687-023-00584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
Patient Reported Outcomes (PROs) are an evidenced way of adding value to routine clinical care. As a source of unique information on the effect of a medical condition and its treatment from the patients' perspective (Mercieca-Bebber et al. in Patient Relat Outcome Meas 9: 353-367, https://doi.org/10.2147/PROM.S156279 , 2018), PROs allow for an improved assessment in routine clinical care of symptoms, side effects, functional outcomes (physical, sexual, social, emotional, cognitive functioning), and health-related quality of life (HRQoL). By helping to align healthcare providers' interventions with what matters most to the patient, PROs contribute to the individualized choice of Anti-Retroviral Therapy (Carfora et al. in PLoS ONE 17(4): e0267030, https://doi.org/10.1371/journal.pone.0267030 , 2022) as a paramount component of tailored and person-centred care management, in routine clinical practice. This article outlines a practical framework and process tested in Portugal to raise awareness of PROs' added value, and to help guide first steps in the implementation and seamless integration of PROs, in routine HIV care.
Collapse
Affiliation(s)
- António Antunes
- ViiV Healthcare Medical Department, Rua Dr. António Loureiro Borges, nº 3 - Arquiparque - Miraflores, 1495-131, Algés, Portugal
| | | | - Catarina Esteves
- Infectious Diseases Ward, Hospital de Cascais, Av. Brigadeiro Victor Novais Gonçalves, 2755-009, Alcabideche, Portugal
| | - Ana Tavares
- ViiV Healthcare Medical Department, Rua Dr. António Loureiro Borges, nº 3 - Arquiparque - Miraflores, 1495-131, Algés, Portugal
| | - Josefina Mendez
- Hospital Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | | | - Duncan Short
- ViiV Healthcare Implementation Science Department, 980 Great West Road, Brentford Middlesex, TW8 9GS, UK
| |
Collapse
|
24
|
Gehr S, Balasubramaniam NK, Russmann C. Use of mobile diagnostics and digital clinical trials in cardiology. Nat Med 2023; 29:781-784. [PMID: 37002368 DOI: 10.1038/s41591-023-02263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Affiliation(s)
- Sinje Gehr
- Charité Universitätsmedizin Berlin, Berlin, Germany
- Health Campus Goettingen, University of Applied Sciences and Arts, Goettingen, Lower Saxony, Germany
| | | | - Christoph Russmann
- Health Campus Goettingen, University of Applied Sciences and Arts, Goettingen, Lower Saxony, Germany.
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
25
|
Mikkelsen LB, Wedderkopp N, Mose LS. Patient experiences with patient-reported outcome measures: an interview study of patients undergoing total hip- and knee arthroplasty. J Patient Rep Outcomes 2023; 7:19. [PMID: 36862315 PMCID: PMC9981839 DOI: 10.1186/s41687-023-00561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Internationally, patient-reported outcome measures are increasingly applied in clinical settings to patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA). Current literature does not provide an understanding of the patient experience with these tools, as remarkably few studies are published investigating patient perspectives on completing PROMs. Thus, the aim of this study was to investigate patient experiences, perspectives, and understanding with usage of PROMs for total hip and total knee arthroplasty in a Danish orthopedic clinic. METHODS Patients who were scheduled for, or recently had, a THA or TKA for primary osteoarthritis were recruited to participate in individual interviews, which were audio-recorded and transcribed verbatim. The analysis was based on qualitative content analysis. RESULTS In total, 33 adult patients (18 female) were interviewed. Average age was 70.15 (range 52-86). The following themes were derived from the analysis: a) motivation and demotivation for completion, b) to complete a PROM questionnaire, c) environment for completion, and d) suggestions for use of PROMs. CONCLUSION The majority of participants scheduled for TKA/THA were not fully aware of the purpose of completing PROMs. Motivation to do so arose from a desire to help others. Demotivation was affected by inabilities to use electronic technology. In terms of completing PROMs, participants expressed varied ease of use, and some perceived technical challenges. The participants expressed satisfaction with the flexibility of completing PROMs in outpatient clinics or at home; nevertheless, some did not manage completion on their own. Help was of great importance for completion, especially for participants with limited electronic capabilities.
Collapse
Affiliation(s)
- Laura Bjerg Mikkelsen
- Department of Orthopedics, University Hospital of Southwest Jutland, 6700, Esbjerg, Denmark.
| | - Niels Wedderkopp
- Department of Orthopedics, University Hospital of Southwest Jutland, 6700 Esbjerg, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Louise Schlosser Mose
- Department of Neurology, University Hospital of Southwest Jutland, 6700 Esbjerg, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| |
Collapse
|
26
|
Remote follow-up based on patient-reported outcomes in patients with chronic kidney disease: A qualitative study of patient perspectives. PLoS One 2023; 18:e0281393. [PMID: 36763600 PMCID: PMC9916608 DOI: 10.1371/journal.pone.0281393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are increasingly used in outpatient follow-up. PRO-based remote follow-up offers a new healthcare delivery model, where PROs are used as the basis for outpatient follow-up in patients with chronic kidney disease. However, the patient's perspective of this novel remote care delivery remains unknown. OBJECTIVES This study aimed to explore the patients' experiences using PROs in remote care and how this mode of follow-up may enhance patient engagement. DESIGN A qualitative approach was employed, guided by Focused Ethnography and Interpretive Description. PARTICIPANTS Purposively, 15 patients with chronic kidney disease experienced with PRO-based remote follow-up in 3 renal outpatient clinics in the Central Denmark Region, were recruited. MEASURES Field studies comprising participant observation in remote PRO consultations and individual, semi-structured interviews with the patients constituted the empirical data. Thematic analysis was performed according to Braun and Clarke's six-phase process. RESULTS PRO-based remote follow-up may enhance patient engagement by a) improving communication, b) increasing disease knowledge, c) inducing flexibility, d) ensuring clinician feedback on PRO data, and e) prompting clinical action. Barriers to enhanced patient engagement were identified as a) lack of feedback on PRO data, b) lower disease knowledge, c) PRO in competition with biomedical data, and d) loss of personal relation. CONCLUSION PRO-based follow-up in remote care holds several advantages for the patients. However, some barriers need clinical awareness before PROs may enhance the patients' engagement in remote follow-up. Future studies should explore the impact of involving relatives in PRO-based follow-up.
Collapse
|
27
|
van der Willik EM, Milders J, Bart JAJ, Bos WJW, van Ittersum FJ, Ten Dam MAGJ, Hemmelder MH, Dekker FW, Meuleman Y. Discussing results of patient-reported outcome measures (PROMs) between patients and healthcare professionals in routine dialysis care: a qualitative study. BMJ Open 2022; 12:e067044. [PMID: 36396312 PMCID: PMC9677037 DOI: 10.1136/bmjopen-2022-067044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) provide insight into patients' experienced health and needs, and can improve patient-professional communication. However, little is known about how to discuss PROM results. This study aimed to provide in-depth knowledge of patients' and healthcare professionals' experiences with and perspectives on discussing PROM results as part of routine dialysis care. DESIGN A qualitative study was performed using an interpretive description approach. Individual semistructured interviews were conducted with 22 patients and healthcare professionals. Interviews focused on general and specific situations (eg, addressing sensitive topics or when no medical treatment is available). Interviews were transcribed verbatim and analysed inductively using thematic analysis. SETTING Participants were purposively sampled from eight dialysis centres across the Netherlands. PARTICIPANTS Interviews were conducted with 10 patients receiving dialysis treatment and 12 healthcare professionals (nephrologists and nurses). RESULTS Patients and healthcare professionals provided practical guidance for optimal discussion about PROM results. First, patients and healthcare professionals emphasised that PROM results should always be discussed and indicated how to create a suitable setting, adequately prepare, deal with time constraints and use PROMs as a tool for personalised holistic consultations. Second, patients should actively participate and healthcare professionals should take a guiding role. A trusting patient-professional relationship was considered a prerequisite and patient-professional interaction was described as a collaboration in which both contribute their knowledge, experiences and ideas. Third, follow-up after discussing PROM results was considered important, including evaluations and actions (eg, symptom management) structurally embedded into the multidisciplinary treatment process. These general themes also applied to the specific situations, for example: results should also be discussed when no medical treatment is available. Though, healthcare professionals were expected to take more initiative and a leading role when discussing sensitive topics. CONCLUSIONS This study provides insight into how to organise and conduct conversations about PROM results and lays the foundation for training healthcare professionals to optimally discuss PROM results in routine nephrology care. Further research is needed to provide guidance on follow-up actions in response to specific PROM results.
Collapse
Affiliation(s)
- Esmee M van der Willik
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jet Milders
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Willem Jan W Bos
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Frans J van Ittersum
- Department of Nephrology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marc A G J Ten Dam
- Nefrovisie Foundation, Utrecht, The Netherlands
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|