1
|
McMullan C, Retzer A, Hughes SE, Aiyegbusi OL, Bathurst C, Boyd A, Coleman J, Davies EH, Denniston AK, Dunster H, Frost C, Harding R, Hunn A, Kyte D, Malpass R, McNamara G, Mitchell S, Mittal S, Newsome PN, Price G, Rowe A, van Reil W, Walker A, Wilson R, Calvert M. Development and usability testing of an electronic patient-reported outcome (ePRO) solution for patients with inflammatory diseases in an Advanced Therapy Medicinal Product (ATMP) basket trial. J Patient Rep Outcomes 2023; 7:98. [PMID: 37812323 PMCID: PMC10562321 DOI: 10.1186/s41687-023-00634-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/10/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Electronic patient-reported outcome (ePRO) systems are increasingly used in clinical trials to provide evidence of efficacy and tolerability of treatment from the patient perspective. The aim of this study is twofold: (1) to describe how we developed an electronic platform for patients to report their symptoms, and (2) to develop and undertake usability testing of an ePRO solution for use in a study of cell therapy seeking to provide early evidence of efficacy and tolerability of treatment and test the feasibility of the system for use in later phase studies. METHODS An ePRO system was designed to be used in a single arm, multi-centre, phase II basket trial investigating the safety and activity of the use of ORBCEL-C™ in the treatment of patients with inflammatory conditions. ORBCEL-C™ is an enriched Mesenchymal Stromal Cells product isolated from human umbilical cord tissue using CD362+ cell selection. Usability testing sessions were conducted using cognitive interviews and the 'Think Aloud' method with patient advisory group members and Research Nurses to assess the usability of the system. RESULTS Nine patient partners and seven research nurses took part in one usability testing session. Measures of fatigue and health-related quality of life, the PRO-CTCAE™ and FACT-GP5 global tolerability question were included in the ePRO system. Alert notifications to the clinical team were triggered by PRO-CTCAE™ and FACT-GP5 scores. Patient participants liked the simplicity and responsiveness of the patient-facing app. Two patients were unable to complete the testing session, due to technical issues. Research Nurses suggested minor modifications to improve functionality and the layout of the clinician dashboard and the training materials. CONCLUSION By testing the effectiveness, efficiency, and satisfaction of our novel ePRO system (PROmicsR), we learnt that most people with an inflammatory condition found it easy to report their symptoms using an app on their own device. Their experiences using the PROmicsR ePRO system within a trial environment will be further explored in our upcoming feasibility testing. Research nurses were also positive and found the clinical dashboard easy-to-use. Using ePROs in early phase trials is important in order to provide evidence of therapeutic responses and tolerability, increase the evidence based, and inform methodology development. TRIAL REGISTRATION ISRCTN, ISRCTN80103507. Registered 01 April 2022, https://www.isrctn.com/ISRCTN80103507.
Collapse
Affiliation(s)
- Christel McMullan
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK.
| | - Ameeta Retzer
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Camilla Bathurst
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Jamie Coleman
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Alastair K Denniston
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute of Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, UK
| | | | | | - Rosie Harding
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | | | - Derek Kyte
- School of Allied Health & Community, University of Worcester, Worcester, UK
| | - Rebecca Malpass
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Philip N Newsome
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Anna Rowe
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Wilma van Reil
- Research Governance, University Hospital Birmingham, Birmingham, UK
| | - Anita Walker
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- National Cancer Research Institute (NCRI) Consumer Forum, London, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
- Health Data Research UK, London, UK
- Midlands Health Data Research UK, Birmingham, UK
| |
Collapse
|
2
|
Anderson NE, Kyte D, McMullan C, Cockwell P, Aiyegbusi OL, Verdi R, Calvert M. Global use of electronic patient-reported outcome systems in nephrology: a mixed methods study. BMJ Open 2023; 13:e070927. [PMID: 37438075 DOI: 10.1136/bmjopen-2022-070927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The use of electronic patient-reported outcome (ePRO) systems to support the management of patients with chronic kidney disease is increasing. This mixed-methods study aimed to comprehensively identify existing and developing ePRO systems, used in nephrology settings globally, ascertaining key characteristics and factors for successful implementation. STUDY DESIGN ePRO systems and developers were identified through a scoping review of the literature and contact with field experts. Developers were invited to participate in a structured survey, to summarise key system characteristics including: (1) system objectives, (2) population, (3) PRO measures used, (4) level of automation, (5) reporting, (6) integration into workflow and (7) links to electronic health records/national registries. Subsequent semistructured interviews were conducted to explore responses. SETTING AND PARTICIPANTS Eligible systems included those being developed or used in nephrology settings to assess ePROs and summarise results to care providers. System developers included those with a key responsibility for aspects of the design, development or implementation of an eligible system. ANALYTICAL APPROACH Structured survey data were summarised using descriptive statistics. Interview transcripts were analysed using Codebook Thematic Analysis using domains from the Consolidated Framework for Implementation Research. RESULTS Fifteen unique ePRO systems were identified across seven countries; 10 system developers completed the structured survey and 7 participated in semistructured interviews. Despite system heterogeneity, reported features required for effective implementation included early and sustained patient involvement, clinician champions and expanding existing electronic platforms to integrate ePROs. Systems demonstrated several common features, with the majority being implemented within research settings, thereby affecting system implementation readiness for real-world application. CONCLUSIONS There has been considerable research investment in ePRO systems. The findings of this study outline key system features and factors to support the successful implementation of ePROs in routine kidney care.Cite Now.
Collapse
Affiliation(s)
- Nicola Elizabeth Anderson
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - Christel McMullan
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Rav Verdi
- Patient Partner, Institute of Applied Health Research,Centre for Patient-Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| |
Collapse
|
3
|
Brundage MD, Crossnohere NL, O’Donnell J, Cruz Rivera S, Wilson R, Wu AW, Moher D, Kyte D, Reeve BB, Gilbert A, Chen RC, Calvert MJ, Snyder C. Listening to the Patient Voice Adds Value to Cancer Clinical Trials. J Natl Cancer Inst 2022; 114:1323-1332. [PMID: 35900186 PMCID: PMC9552306 DOI: 10.1093/jnci/djac128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/11/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Randomized clinical trials are critical for evaluating the safety and efficacy of interventions in oncology and informing regulatory decisions, practice guidelines, and health policy. Patient-reported outcomes (PROs) are increasingly used in randomized trials to reflect the impact of receiving cancer therapies from the patient perspective and can inform evaluations of interventions by providing evidence that cannot be obtained or deduced from clinicians' reports or from other biomedical measures. This commentary focuses on how PROs add value to clinical trials by representing the patient voice. We employed 2 previously published descriptive frameworks (addressing how PROs are used in clinical trials and how PROs have an impact, respectively) and selected 9 clinical trial publications that illustrate the value of PROs according to the framework categories. These include 3 trials where PROs were a primary trial endpoint, 3 trials where PROs as secondary endpoints supported the primary endpoint, and 3 trials where PROs as secondary endpoints contrast the primary endpoint findings in clinically important ways. The 9 examples illustrate that PROs add valuable data to the care and treatment context by informing future patients about how they may feel and function on different treatments and by providing clinicians with evidence to support changes to clinical practice and shared decision making. Beyond the patient and clinician, PROs can enable administrators to consider the cost-effectiveness of implementing new interventions and contribute vital information to policy makers, health technology assessors, and regulators. These examples provide a strong case for the wider implementation of PROs in cancer trials.
Collapse
Affiliation(s)
- Michael D Brundage
- Queen’s University Cancer Research Institute, Cancer Care and Epidemiology, Kingston, ON, Canada
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer O’Donnell
- Queen’s University Cancer Research Institute, Cancer Care and Epidemiology, Kingston, ON, Canada
| | - Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- DEMAND (Data-Enabled Medical Technologies and Devices) Hub, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- NCRI Consumer Forum National Cancer Research Institute, London, UK
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health and School of Medicine, Baltimore, MD, USA
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - Bryce B Reeve
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, Coventry, UK
- NIHR Surgical Reconstruction and Microbiology Centre, University of Birmingham, Birmingham, UK
| | - Claire Snyder
- Johns Hopkins Bloomberg School of Public Health and School of Medicine, Baltimore, MD, USA
| |
Collapse
|
4
|
Kyte D, Anderson N, Bishop J, Bissell A, Brettell E, Calvert M, Chadburn M, Cockwell P, Dutton M, Eddington H, Forster E, Hadley G, Ives NJ, Jackson LJ, O'Brien S, Price G, Sharpe K, Stringer S, Verdi R, Waters J, Wilcockson A. Results of a pilot feasibility randomised controlled trial exploring the use of an electronic patient-reported outcome measure in the management of UK patients with advanced chronic kidney disease. BMJ Open 2022; 12:e050610. [PMID: 35304391 PMCID: PMC8935185 DOI: 10.1136/bmjopen-2021-050610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The use of routine remote follow-up of patients with chronic kidney disease (CKD) is increasing exponentially. It has been suggested that online electronic patient-reported outcome measures (ePROMs) could be used in parallel, to facilitate real-time symptom monitoring aimed at improving outcomes. We tested the feasibility of this approach in a pilot trial of ePROM symptom monitoring versus usual care in patients with advanced CKD not on dialysis. DESIGN A 12-month, parallel, pilot randomised controlled trial (RCT) and qualitative substudy. SETTING AND PARTICIPANTS Queen Elizabeth Hospital Birmingham, UK. Adult patients with advanced CKD (estimated glomerular filtration rate ≥6 and ≤15 mL/min/1.73 m2, or a projected risk of progression to kidney failure within 2 years ≥20%). INTERVENTION Monthly online ePROM symptom reporting, including automated feedback of tailored self-management advice and triggered clinical notifications in the advent of severe symptoms. Real-time ePROM data were made available to the clinical team via the electronic medical record. OUTCOMES Feasibility (recruitment and retention rates, and acceptability/adherence to the ePROM intervention). Health-related quality of life, clinical data (eg, measures of kidney function, kidney failure, hospitalisation, death) and healthcare utilisation. RESULTS 52 patients were randomised (31% of approached). Case report form returns were high (99.5%), as was retention (96%). Overall, 73% of expected ePROM questionnaires were received. Intervention adherence was high beyond 90 days (74%) and 180 days (65%); but dropped beyond 270 days (46%). Qualitative interviews supported proof of concept and intervention acceptability, but highlighted necessary changes aimed at enhancing overall functionality/scalability of the ePROM system. LIMITATIONS Small sample size. CONCLUSIONS This pilot trial demonstrates that patients are willing to be randomised to a trial assessing ePROM symptom monitoring. The intervention was considered acceptable; though measures to improve longer-term engagement are needed. A full-scale RCT is considered feasible. TRIAL REGISTRATION NUMBER ISRCTN12669006 and the UK NIHR Portfolio (CPMS ID: 36497).
Collapse
Affiliation(s)
- Derek Kyte
- School of Applied Health & Community, University of Worcester, Worcester, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Anderson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew Bissell
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Marie Chadburn
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mary Dutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Eddington
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elliot Forster
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gabby Hadley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natalie J Ives
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sonia O'Brien
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keeley Sharpe
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Rav Verdi
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Judi Waters
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adrian Wilcockson
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
5
|
Bhachu HK, Fenton A, Cockwell P, Aiyegbusi O, Kyte D, Calvert M. Use of the kidney failure risk equation to inform clinical care of patients with chronic kidney disease: a mixed-methods systematic review. BMJ Open 2022; 12:e055572. [PMID: 35042708 PMCID: PMC8768913 DOI: 10.1136/bmjopen-2021-055572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
RATIONALE AND OBJECTIVE The Kidney Failure Risk Equation (KFRE) predicts the risk of end-stage kidney disease in patients with chronic kidney disease (CKD). This study aimed to evaluate the impact of the utility of KFRE in clinical practice. STUDY DESIGN Systematic review. SETTING AND STUDY POPULATIONS Adult patients with CKD but not receiving renal replacement therapy enrolled in studies where KFRE was used in clinical care pathways. SELECTION CRITERIA FOR STUDIES All studies published from April 2011 to October 2021 identified from Medline, Cumulative Index to Nursing and Allied Health Literature, Embase and reference and citation searches of included studies. DATA EXTRACTION Relevant data were extracted, and two reviewers independently assessed study quality using appropriate appraisal tools. ANALYTICAL APPROACH Findings reported as a narrative synthesis due to heterogeneity of the included studies. RESULTS Of 1635 studies identified, 440 duplicates were removed. The remaining 1195 titles and abstracts were screened. All five studies for full-text review were included in the analysis. Three uses of KFRE were assessed: (1) primary to specialty care interface; (2) general nephrology to multidisciplinary care transition; and (3) treatment planning. Evidence of impact on number of patient referrals into nephrology care was conflicting. However, wait times improved in one study. Although KFRE identified high-risk patients for increased multidisciplinary support, there was concern patients stepped down, no longer meeting eligibility criteria, may lack access to services. CONCLUSIONS This is the first systematic review of studies that have assessed the actual impact of KFRE in clinical practice with five studies of varying quality reported to date. Trials are in progress assessing the impact on clinical outcomes of using KFRE in clinical practice, and KFRE is being incorporated into guidelines for CKD management. Further studies are needed to assess the impact of KFRE on clinical care. TRIAL REGISTRATION NUMBER Protocol registered on PROSPERO before initiation of the study (Ref: CRD42020219926).
Collapse
Affiliation(s)
- Harjeet Kaur Bhachu
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Anthony Fenton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Olalekan Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR ARC, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- School of Allied Health and Community, University of Worcester, Worcester, Worcestershire, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR ARC, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| |
Collapse
|
6
|
Grove BE, Schougaard LMV, Ivarsen PR, Kyte D, Hjollund NH, de Thurah A. Patient-reported outcome measures for clinical decision-making in outpatient follow-up: validity and reliability of a renal disease questionnaire. J Patient Rep Outcomes 2021; 5:107. [PMID: 34655365 PMCID: PMC8520563 DOI: 10.1186/s41687-021-00384-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 10/05/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures are increasingly used by clinicians to support communication in telephone- or face-to-face consultations with patients. A renal disease questionnaire has been developed, but not sufficiently evaluated through clinimetrics in clinical setting. Hence, we aimed to evaluate the content validity, construct validity and the test-retest reliability of a renal disease questionnaire to be used for clinical decision-making. METHODS A content, construct validity and test-retest reliability study was conducted in 3 nephrology outpatient clinics in Central Denmark Region, Denmark. Content validity (face validity, comprehensibility and relevance) was assessed among 8 patients and 6 clinicians. Reliability was assessed by asking outpatients with chronic kidney disease to complete the questionnaire twice. Reliability was assessed by kappa statistics and agreement by percentage. Construct validity was determined using 4 a priori defined hypotheses and comparing 2 known groups. RESULTS Five new domains emerged, 6 items were rephrased and 3 items were removed following the content validity test. A total of 160 patients completed the questionnaire with median 8 days (IQR 2 days) between assessments. The test-retest reliability parameters of the single items in the questionnaire were substantial to almost perfect as all the observed weighted kappa values ranged from 0.61 to 0.91, 95% CI (0.34 to 0.95). In total, 61% of the single items showed almost perfect agreement. In total, 3 of the 4 hypotheses were accepted and 44% of the items showed satisfying known-group discriminative validity. CONCLUSION A renal disease questionnaire used for clinical decision-making in outpatient follow-up showed acceptable content validity and substantial to almost perfect reliability. Sufficient construct validity was not established. Incorporating the questionnaire into routine clinical practice may improve the evaluation of disease burden in patients with chronic kidney disease. We ask patients with chronic kidney disease (CKD) in Central Region Denmark to complete a questionnaire before each outpatient visit. The answers they provide are used to support communication with their health care provider. A questionnaire requires testing to ensure it can accurately capture important information about patient's symptoms and quality of life. When questionnaires are used to support communication between patients and health care professionals, they need to have good measurement properties. This means they need to be: (1) trustworthy, (2) relevant to a patient's health condition, (3) consistent and produce stable results every time. We explored the measurement properties of a questionnaire designed to be used in the face-to face outpatient visits for patients with CKD. We found that the questionnaire captured consistent and stable results. Using this questionnaire may help health care professionals to assess the patients´ burden of symptoms with a more patient-centered approach. Potentially, the use of the questionnaire will increase the patients´ ability to cope with their symptoms and strengthen patients´ involvement in the clinical decisions concerning their treatment.
Collapse
Affiliation(s)
- Birgith Engelst Grove
- AmbuFlex, Center for Patient-Reported Outcomes, Regional Hospital West Jutland, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Per Ramløv Ivarsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Derek Kyte
- School of Allied Health and Community, University of Worcester, Worcester, UK
- Aarhus University, Aarhus, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
7
|
Anderson NE, McMullan C, Calvert M, Dutton M, Cockwell P, Aiyegbusi OL, Kyte D. Using patient-reported outcome measures during the management of patients with end-stage kidney disease requiring treatment with haemodialysis (PROM-HD): a qualitative study. BMJ Open 2021; 11:e052629. [PMID: 34446501 PMCID: PMC8395280 DOI: 10.1136/bmjopen-2021-052629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/06/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Patients undergoing haemodialysis report elevated symptoms and reduced health-related quality of life, and often prioritise improvements in psychosocial well-being over long-term survival. Systematic collection and use of patient-reported outcomes (PROs) may help support tailored healthcare and improve outcomes. This study investigates the methodological basis for routine PRO assessment, particularly using electronic formats (ePROs), to maximise the potential of PRO use, through exploration of the experiences, views and perceptions of patients and healthcare professionals (HCPs) on implementation and use of PROs in haemodialysis settings. STUDY DESIGN Qualitative study. SETTING AND PARTICIPANTS Semistructured interviews with 22 patients undergoing haemodialysis, and 17 HCPs in the UK. ANALYTICAL APPROACH Transcripts were analysed deductively using the Consolidated Framework for Implementation Research (CFIR) and inductively using thematic analysis. RESULTS For effective implementation, the potential value of PROs needs to be demonstrated empirically to stakeholders. Any intervention must remain flexible enough for individual and aggregate use, measuring outcomes that matter to patients and clinicians, while maintaining operational simplicity. Any implementation must sit within a wider framework of education and support for both patients and clinicians who demonstrate varying previous experience of using PROs and often confuse related concepts. Implementation plans must recognise the multidimensionality of end-stage kidney disease and treatment by haemodialysis, while acknowledging the associated challenges of delivering care in a highly specialised environment. To support implementation, careful consideration needs to be given to barriers and facilitators including effective leadership, the role of champions, effective launch and ongoing evaluation. CONCLUSIONS Using the CFIR to explore the experiences, views and perceptions of key stakeholders, this study identified key factors at organisational and individual levels which could assist effective implementation of ePROs in haemodialysis settings. Further research will be required to evaluate subsequent ePRO interventions to demonstrate the impact and benefit to the dialysis community.
Collapse
Affiliation(s)
- Nicola Elzabeth Anderson
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR SMRC, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR SMRC, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Mary Dutton
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Allied Health and Community, University of Worcester, Worcester, UK
| |
Collapse
|
8
|
Retzer A, Calvert M, Ahmed K, Keeley T, Armes J, Brown JM, Calman L, Gavin A, Glaser AW, Greenfield DM, Lanceley A, Taylor RM, Velikova G, Brundage M, Efficace F, Mercieca‐Bebber R, King MT, Kyte D. International perspectives on suboptimal patient-reported outcome trial design and reporting in cancer clinical trials: A qualitative study. Cancer Med 2021; 10:5475-5487. [PMID: 34219395 PMCID: PMC8366078 DOI: 10.1002/cam4.4111] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Evidence suggests that the patient-reported outcome (PRO) content of cancer trial protocols is frequently inadequate and non-reporting of PRO findings is widespread. This qualitative study examined the factors influencing suboptimal PRO protocol content, implementation, and reporting, and use of PRO data during clinical interactions. METHODS Semi-structured interviews were conducted with four stakeholder groups: (1) trialists and chief investigators; (2) people with lived experience of cancer; (3) international experts in PRO cancer trial design; (4) journal editors, funding panelists, and regulatory agencies. Data were analyzed using directed thematic analysis with an iterative coding frame. RESULTS Forty-four interviews were undertaken. Several factors were identified that could influenced effective integration of PROs into trials and subsequent findings. Participants described (1) late inclusion of PROs in trial design; (2) PROs being considered a lower priority outcome compared to survival; (3) trialists' reluctance to collect or report PROs due to participant burden, missing data, and perceived reticence of journals to publish; (4) lack of staff training. Strategies to address these included training research personnel and improved communication with site staff and patients regarding the value of PROs. Examples of good practice were identified. CONCLUSION Misconceptions relating to PRO methodology and its use may undermine their planning, collection, and reporting. There is a role for funding, regulatory, methodological, and journalistic institutions to address perceptions around the value of PROs, their position within the trial outcomes hierarchy, that PRO training and guidance is available, signposted, and readily accessible, with accompanying measures to ensure compliance with international best practice guidelines.
Collapse
Affiliation(s)
- Ameeta Retzer
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR ARC West MidlandsLondonUK
| | - Melanie Calvert
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR ARC West MidlandsLondonUK
- Birmingham Health Partners Centre for Regulatory Science and InnovationUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
| | - Khaled Ahmed
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Thomas Keeley
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- GlaxoSmithKline (formerly of CPROR, University of BirminghamBirminghamUK
| | - Jo Armes
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- School of Health SciencesUniversity of SurreyGuildfordUK
- NIHR ARC KentLondonUK
| | | | - Lynn Calman
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Macmillan Survivorship Research GroupHealth SciencesUniversity of SouthamptonSouthamptonUK
| | - Anna Gavin
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- N. Ireland Cancer RegistryCentre for Public HealthQueens UniversityBelfastUK
| | - Adam W. Glaser
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Leeds Institute of Medical Research at St James’sUniversity of LeedsLeedsUK
| | - Diana M. Greenfield
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Sheffield Teaching Hospital NHS Foundation Trust and University of SheffieldSheffieldUK
| | - Anne Lanceley
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- UCL Elizabeth Garrett Anderson Institute for Women’s HealthMedical School BuildingUniversity College LondonLondonUK
| | - Rachel M. Taylor
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMARUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’sUniversity of LeedsLeedsUK
| | - Michael Brundage
- Queen’s Department of OncologyQueen’s Cancer Research InstituteKingstonONCanada
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMAHealth Outcomes Research UnitRomeItaly
| | - Rebecca Mercieca‐Bebber
- School of PsychologyUniversity of SydneySydneyNSWAustralia
- University of SydneyNHMRC Clinical Trials CentreSydneyNSWAustralia
| | | | - Derek Kyte
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- School of Applied Health & CommunityUniversity of WorcesterWorcesterUK
| |
Collapse
|
9
|
Miller C, Cross J, O'Sullivan J, Power DM, Kyte D, Jerosch-Herold C. Developing a core outcome set for traumatic brachial plexus injuries: a systematic review of outcomes. BMJ Open 2021; 11:e044797. [PMID: 34330851 PMCID: PMC8327802 DOI: 10.1136/bmjopen-2020-044797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To identify what outcomes have been assessed in traumatic brachial plexus injury (TBPI) research to inform the development of a core outcome set for TBPI. DESIGN Systematic review. METHOD Medline (OVID), EMBASE, CINAHL and AMED were systematically searched for studies evaluating the clinical effectiveness of interventions in adult TBPIs from January 2013 to September 2018 updated in May 2021. Two authors independently screened papers. Outcome reporting bias was assessed. All outcomes were extracted verbatim from studies. Patient-reported outcomes or performance outcome measures were extracted directly from the instrument. Variation in outcome reporting was determined by assessing the number of unique outcomes reported across all included studies. Outcomes were categorised into domains using a prespecified taxonomy. RESULTS Verbatim outcomes (n=1491) were extracted from 138 studies including 32 questionnaires. Unique outcomes (n=157) were structured into 4 core areas and 11 domains. Outcomes within the musculoskeletal domain were measured in 86% of studies, physical functioning in 25%, emotional functioning in 25% and adverse events in 33%. We identified 63 different methods for measuring muscle strength, 16 studies for range of movement and 63 studies did not define how they measured movement. More than two-thirds of the outcomes were incompletely reported in prospective studies. CONCLUSION This review of outcome reporting in TBPI research demonstrated an impairment focus and heterogeneity. A core outcome set would ensure standardised and relevant outcomes are reported to facilitate future systematic review and meta-analysis. PROSPERO REGISTRATION NUMBER CRD42018109843.
Collapse
Affiliation(s)
- Caroline Miller
- School of Health Sciences, The Queens Building, University of East Anglia, Norwich, UK
- Physiotherapy Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Jane Cross
- School of Health Sciences, The Queens Building, University of East Anglia, Norwich, UK
- Physiotherapy Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Joel O'Sullivan
- Physiotherapy Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Dominic M Power
- The Birmingham Peripheral Nerve Injury Service, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Derek Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christina Jerosch-Herold
- School of Health Sciences, The Queens Building, University of East Anglia, Norwich, UK
- Physiotherapy Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| |
Collapse
|
10
|
Calvert M, King M, Mercieca-Bebber R, Aiyegbusi O, Kyte D, Slade A, Chan AW, Basch E, Bell J, Bennett A, Bhatnagar V, Blazeby J, Bottomley A, Brown J, Brundage M, Campbell L, Cappelleri JC, Draper H, Dueck AC, Ells C, Frank L, Golub RM, Griebsch I, Haywood K, Hunn A, King-Kallimanis B, Martin L, Mitchell S, Morel T, Nelson L, Norquist J, O'Connor D, Palmer M, Patrick D, Price G, Regnault A, Retzer A, Revicki D, Scott J, Stephens R, Turner G, Valakas A, Velikova G, von Hildebrand M, Walker A, Wenzel L. SPIRIT-PRO Extension explanation and elaboration: guidelines for inclusion of patient-reported outcomes in protocols of clinical trials. BMJ Open 2021; 11:e045105. [PMID: 34193486 PMCID: PMC8246371 DOI: 10.1136/bmjopen-2020-045105] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/21/2020] [Accepted: 01/08/2021] [Indexed: 01/21/2023] Open
Abstract
Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of disease and treatment on patients' symptoms, function and quality of life. High-quality PRO data from trials can inform shared decision-making, regulatory and economic analyses and health policy. Recent evidence suggests the PRO content of past trial protocols was often incomplete or unclear, leading to research waste. To address this issue, international, consensus-based, PRO-specific guidelines were developed: the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-PRO Extension. The SPIRIT-PRO Extension is a 16-item checklist which aims to improve the content and quality of aspects of clinical trial protocols relating to PRO data collection to minimise research waste, and ultimately better inform patient-centred care. This SPIRIT-PRO explanation and elaboration (E&E) paper provides information to promote understanding and facilitate uptake of the recommended checklist items, including a comprehensive protocol template. For each SPIRIT-PRO item, we provide a detailed description, one or more examples from existing trial protocols and supporting empirical evidence of the item's importance. We recommend this paper and protocol template be used alongside the SPIRIT 2013 and SPIRIT-PRO Extension paper to optimise the transparent development and review of trial protocols with PROs.
Collapse
Affiliation(s)
- Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Institute of Translational Medicine, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Madeleine King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Mercieca-Bebber
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Olalekan Aiyegbusi
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Institute of Translational Medicine, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - E Basch
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jill Bell
- Oncology Digital Health, AstraZeneca, Gaithersburg, Maryland, USA
| | - Antonia Bennett
- Cancer Outcomes Research Program, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Jane Blazeby
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew Bottomley
- Department of Quality of Life, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Michael Brundage
- Department of Oncology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Joseph C Cappelleri
- Global Biometrics & Data Management-Statistics, Pfizer Inc, New York City, New York, USA
| | | | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - Carolyn Ells
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | | | | | - Kirstie Haywood
- Warwick Research in Nursing, University of Warwick, Warwick Medical School, Coventry, UK
| | | | | | | | | | - Thomas Morel
- Patient-Centered Outcomes Research, UCB Pharma, Brussels, Belgium
| | - Linda Nelson
- Value Evidence and Outcomes-Patient Centered Outcomes, GSK, Collegeville, Pennsylvania, USA
| | - Josephine Norquist
- Center for Observational Real-world Evidence (CORE), Patient-Centered Endpoints & Strategy, Merck & Co Inc, Kenilworth, New Jersey, USA
| | - Daniel O'Connor
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Michael Palmer
- Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Donald Patrick
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Gary Price
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Ameeta Retzer
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Jane Scott
- Johnson and Johnson, Janssen Global Services LLC, High Wycombe, UK
| | | | - Grace Turner
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Antonia Valakas
- EMD Serono Inc, Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Maria von Hildebrand
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Walker
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lari Wenzel
- University of California, Irvine, California, USA
| |
Collapse
|
11
|
Snyder C, Gilbert A, Moher D, Kyte D, Daniels E, King M, Calvert M, Chen RC, Brundage M. Recommendations for including or reviewing patient reported outcome endpoints in grant applications. BMJ 2021; 373:n1367. [PMID: 34193444 DOI: 10.1136/bmj.n1367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Claire Snyder
- Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ellie Daniels
- Cancer Prevention and Control Research, American Cancer Society, Atlanta, GA, USA
| | - Madeleine King
- University of Sydney, School of Psychology, Sydney, NSW, Australia
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, NIHR Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | | |
Collapse
|
12
|
Slade AL, Retzer A, Ahmed K, Kyte D, Keeley T, Armes J, Brown JM, Calman L, Gavin A, Glaser AW, Greenfield DM, Lanceley A, Taylor RM, Velikova G, Turner G, Calvert MJ. Systematic review of the use of translated patient-reported outcome measures in cancer trials. Trials 2021; 22:306. [PMID: 33902699 PMCID: PMC8074490 DOI: 10.1186/s13063-021-05255-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are used in clinical trials to assess the effectiveness and tolerability of interventions. Inclusion of participants from different ethnic backgrounds is essential for generalisability of cancer trial results. PRO data collection should include appropriately translated patient-reported outcome measures (PROMs) to minimise missing data and sample attrition. METHODS Protocols and/or publications from cancer clinical trials using a PRO endpoint and registered on the National Institute for Health Research Portfolio were systematically reviewed for information on recruitment, inclusion of ethnicity data, and use of appropriately translated PROMs. Semi-structured interviews were conducted with key stakeholders to explore barriers and facilitators for optimal PRO trial design, diverse recruitment and reporting, and use of appropriately translated PROMs. RESULTS Eighty-four trials met the inclusion criteria, only 14 (17%) (n = 4754) reported ethnic group data, and ethnic group recruitment was low, 611 (13%). Although 8 (57%) studies were multi-centred and multi-national, none reported using translated PROMs, although available for 7 (88%) of the studies. Interviews with 44 international stakeholders identified a number of perceived barriers to ethnically diverse recruitment including diverse participant engagement, relevance of ethnicity to research question, prominence of PROs, and need to minimise investigator burden. Stakeholders had differing opinions on the use of translated PROMs, the impact of trial designs, and recruitment strategies on diverse recruitment. Facilitators of inclusive research were described and examples of good practice identified. CONCLUSIONS Greater transparency is required when PROs are used as primary or secondary outcomes in clinical trials. Protocols and publications should demonstrate that recruitment was accessible to diverse populations and facilitated by trial design, recruitment strategies, and appropriate PROM usage. The use of translated PROMs should be made explicit when used in cancer clinical trials.
Collapse
Affiliation(s)
- A L Slade
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK. .,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, West Midlands, UK.
| | - A Retzer
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - K Ahmed
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - D Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK.,National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK
| | - T Keeley
- Patient Centred Outcomes, GlaxoSmithKline, Brentford, UK
| | - J Armes
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,School of Health Sciences, University of Surrey, Guildford, UK.,NIHR Applied Research Collaboration Kent Surrey & Sussex University of Surrey, Guildford, UK
| | - J M Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - L Calman
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Macmillan Survivorship Research Group, Health Sciences, University of Southampton, Highfield Campus, Southampton, UK
| | - A Gavin
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Northern Ireland Cancer Registry, Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - A W Glaser
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - D M Greenfield
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - A Lanceley
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R M Taylor
- National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship Clinical Studies Group subgroup: Understanding and measuring the consequences of cancer and its treatment, London, UK.,Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - G Turner
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - M J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, West Midlands, UK.,National Institute for Health Research Applied Research Collaboration, University of Birmingham, Birmingham, West Midlands, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, West Midlands, UK
| |
Collapse
|
13
|
Giesinger JM, Efficace F, Aaronson N, Calvert M, Kyte D, Cottone F, Cella D, Gamper EM. Past and Current Practice of Patient-Reported Outcome Measurement in Randomized Cancer Clinical Trials: A Systematic Review. Value Health 2021; 24:585-591. [PMID: 33840437 DOI: 10.1016/j.jval.2020.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/24/2020] [Accepted: 11/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES In our systematic review, we assessed past and current practice of patient-reported outcome (PRO) measurement in cancer randomized, controlled trials (RCTs). METHODS We included RCTs with PRO endpoints evaluating conventional medical treatments, conducted in patients with the most prevalent solid tumor types (breast, lung, colorectal, prostate, bladder, and gynecological cancers) and either published in 2004 to 2018 or registered on clinicaltrials.gov and initiated in 2014 to 2019. Frequency of use of individual PRO measures was assessed overall, over time, and by cancer site. RESULTS Screening of 42 095 database records and 3425 registered trials identified 480 published and 537 registered trials meeting inclusion criteria. Among published trials, the European Organisation for Research and Treatment of Cancer (EORTC) measures were used most often (54.8% of trials), followed by the Functional Assessment of Chronic Illness Therapy (FACIT) measures (35.8%), the EQ-5D (10.2%), the SF-36 (7.3%), and the MD Anderson Symptom Inventory (MDASI; 2.5%). Among registered trials, the EORTC measures were used in 66.1% of the trials, followed by the FACIT measures (25.9%), the EQ-5D (23.1%), the SF-36 (4.8%), the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE; 2.2%), the Patient-Reported Outcomes Measurement Information System (PROMIS) measures (1.7%), and the MDASI measures (1.1%). CONCLUSION The PRO measures most frequently used in RCTs identified in our review differ substantially in terms of content and domains, reflecting the ongoing debate among the scientific community, healthcare providers, and regulators on the type of PRO to be measured. Current findings may contribute to better informing the development of an internationally agreed core outcome set for future cancer trials.
Collapse
Affiliation(s)
- Johannes M Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center, Rome, Italy and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Neil Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Francesco Cottone
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center, Rome, Italy
| | - David Cella
- Department of Medical Social Sciences, and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Eva-Maria Gamper
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria
| |
Collapse
|
14
|
Kyte D, Anderson N, Auti R, Aiyegbusi OL, Bishop J, Bissell A, Brettell E, Calvert M, Chadburn M, Cockwell P, Dutton M, Eddington H, Forster E, Hadley G, Ives NJ, Jackson L, O'Brien S, Price G, Sharpe K, Stringer S, Stephenson G, Verdi R, Waters J, Wilcockson A, Williams J. Development of an electronic patient-reported outcome measure (ePROM) system to aid the management of patients with advanced chronic kidney disease. J Patient Rep Outcomes 2020; 4:55. [PMID: 32642867 PMCID: PMC7343684 DOI: 10.1186/s41687-020-00223-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/28/2020] [Indexed: 11/22/2022] Open
Abstract
Background Effective management of patients with chronic kidney disease (CKD) relies on timely detection of clinical deterioration towards end stage kidney failure. We aimed to design an electronic Patient-Reported Outcome Measure (ePROM) system, which would allow patients with advanced CKD (pre-dialysis) to: (i) remotely self-report their symptoms using a simple and secure online platform; (ii) share the data with the clinical team in real-time via the electronic patient record to help optimise care. We adopted a staged development process which included: a systematic review of PROMs used in CKD; formation of a co-design team; prototype system design/development, user acceptance testing and refinement; finalisation of the system for testing in a pilot/feasibility trial. Results A co-design team was convened, including patients with lived experience of CKD; clinical team members; IT/Informatics experts; academics; and Birmingham Clinical Trials Unit representatives. A prototype system was developed and iterative changes made before finalisation during a series of operational meetings. The system allows patients to remotely self-report their symptoms; provides tailored self-management advice; allows monitoring of real-time patient ePROM data; sends automated notifications to the patient/clinical team in the advent of a severe symptom report; and incorporates longitudinal ePROM symptom data into the electronic patient record. Feasibility of the system will be evaluated as part of the National Institute for Health Research funded RePROM (Renal electronic Patient-Reported Outcome Measure) pilot trial (ISRCTN12669006). Conclusions Routine ePROM collection with real-time feedback has the potential to improve outcomes and reduce health service costs. We have successfully developed a trial-ready ePROM system for advanced CKD, the feasibility of which is currently being explored in a pilot trial. Assuming feasibility is demonstrated, formal evaluation of efficacy will take place in a future multi-centre randomised controlled trial.
Collapse
Affiliation(s)
- Derek Kyte
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK. .,Institute of Applied Health Research, University of Birmingham, Birmingham, UK. .,National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK.
| | - Nicola Anderson
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ram Auti
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Andrew Bissell
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK.,National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Marie Chadburn
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mary Dutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Eddington
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elliot Forster
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gabby Hadley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natalie J Ives
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sonja O'Brien
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keeley Sharpe
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Gael Stephenson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rav Verdi
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Judi Waters
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adrian Wilcockson
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Jim Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
15
|
Cruz Rivera S, McMullan C, Jones L, Kyte D, Slade A, Calvert M. The impact of patient-reported outcome data from clinical trials: perspectives from international stakeholders. J Patient Rep Outcomes 2020; 4:51. [PMID: 32617713 PMCID: PMC7332593 DOI: 10.1186/s41687-020-00219-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/18/2020] [Indexed: 11/15/2022] Open
Abstract
Background Patient-reported outcomes (PROs) are increasingly collected in clinical trials as they provide unique information on the physical, functional and psychological impact of a treatment from the patient’s perspective. Recent research suggests that PRO trial data have the potential to inform shared decision-making, support pharmaceutical labelling claims and influence healthcare policy and practice. However, there remains limited evidence regarding the actual impact associated with PRO trial data and how to maximise PRO impact to benefit patients and society. Thus, our objective was to qualitatively explore international stakeholders’ perspectives surrounding: a) the impact of PRO trial data, b) impact measurement metrics, and c) barriers and facilitators to effectively maximise the impact of PRO trial data upon patients and society. Methods Semi-structured interviews with 24 international stakeholders were conducted between May and October 2018. Data were coded and analysed using reflexive thematic analysis. Results International stakeholders emphasised the impact of PRO trial data to benefit patients and society. Influence on policy-impact, including changes to clinical healthcare practice and guidelines, drug approval and promotional labelling claims were common types of PRO impact reported by interviewees. Interviewees suggested impact measurement metrics including: number of pharmaceutical labelling claims and interviews with healthcare practitioners to determine whether PRO data were incorporated in clinical decision-making. Key facilitators to PRO impact highlighted by stakeholders included: standardisation of PRO tools; consideration of health utilities when selecting PRO measures; adequate funding to support PRO research; improved reporting and dissemination of PRO trial data by key opinion leaders and patients; and development of legal enforcement of the collection of PRO data. Conclusions Determining the impact of PRO trial data is essential to better allocate funds, minimise research waste and to help maximise the impact of these data for patients and society. However, measuring the impact of PRO trial data through metrics is a challenging task, as current measures do not capture the total impact of PRO research. Broader international multi-stakeholder engagement and collaboration is needed to standardise PRO assessment and maximise the impact of PRO trial data to benefit patients and society.
Collapse
Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Laura Jones
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK. .,NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK. .,National Institute for Health Research (NIHR) Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK. .,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
| |
Collapse
|
16
|
Chauhan A, de Wildt G, Virmond MDCL, Kyte D, Galan NGDA, Prado RBR, Shyam-Sundar V. Perceptions and experiences regarding the impact of race on the quality of healthcare in Southeast Brazil: a qualitative study. Ethn Health 2020; 25:436-452. [PMID: 29366345 DOI: 10.1080/13557858.2018.1431206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Objective: To explore the impact of race on the quality of healthcare received by patients attending a primary care centre in Brazil.Design: This was a qualitative study consisting of 19 semi-structured interviews conducted on patients from six racial groups (as defined in Brazil as white, yellow, brown, black and indigenous and one self-identified 'other' group). The interviews were analysed using thematic analysis.Results: Four main themes were identified during analysis; factors affecting the access to healthcare, experiences regarding quality of healthcare, discrimination in healthcare and deep-rooted societal discrimination, which were categorised into a number of sub-themes. Within these themes, interviewees reported (1) experiences of racism in society towards the black racial group, (2) one personal perception and two observations of racial discrimination in healthcare, (3) perceived racial discrimination due to healthcare professional behaviour and (4) other factors, such as delays in appointments and long waiting times in health facilities were felt to impact access to care.Conclusion: The findings suggest that racial discrimination exists in Brazilian society but its direct impact on healthcare access was felt to be less obvious. Instead, organisational level factors were felt to contribute to difficulty accessing care. Interviewees perceived that racial discrimination may affect the quality of care, particularly for those designated as 'black'. Socio-economic factors were felt to influence discrimination in healthcare. The findings can help inform further studies and educational initiatives to help address discrimination and access to healthcare in Brazil.
Collapse
Affiliation(s)
- Aneela Chauhan
- Population Sciences and Humanities, University of Birmingham, Birmingham, UK
| | - Gilles de Wildt
- Primary Care Clinical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Marcos da Cunha Lopes Virmond
- Former President of the International Leprosy Association, Director at Instituto Lauro de Souza Lima, Bauru, Brazil
- Professor of Public Health, University of the Sacred Heart, Bauru, Brazil
| | - Derek Kyte
- Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Renata Bilion Ruiz Prado
- Scientific Researcher, Rehabilitation Techniques Team, Instituto Lauro de Souza Lima, Bauru, Brazil
| | | |
Collapse
|
17
|
McMullan C, Retzer A, Slade A, Kyte D, Jones L, Belli A, Calvert M, Turner GM. Care providers' and patients' attitudes toward using electronic-patient reported outcomes to support patients with traumatic brain injury: a qualitative study (PRiORiTy). Brain Inj 2020; 34:723-731. [PMID: 32223338 DOI: 10.1080/02699052.2020.1740944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To (a) identify residual symptoms and deficits resulting from a traumatic brain injury (TBI) and impact on patients' and their families' quality of life; (b) explore views and experience of care providers, researchers, patients, and carers of using PROMs; and (c) explore their attitudes toward reporting symptoms and impacts on an electronic platform. Methods: Qualitative semi-structured interviews with people with TBI and their carers; health-care professionals, researchers, and third sector staff members working with people with TBI. Results: Symptoms and long-term impacts of TBI included cognitive problems, difficulties functioning, anxiety, and depression. PROMs were seen as improving knowledge of residual symptoms and their impact post-TBI but not always accurately reflecting patients' residual problems. Challenges to completing PROMs were cognitive impairment and lack of insight into condition. Perceived advantages of an electronic platform included easy data collection; flexibility; improving workflow; and the ability to send/ receive feedback and reminders easily. Suggested features of an electronic platform included simple layout, lay language, short questions, few items on the screen, and capability to send/receive feedback and additional information. Conclusion: There is a demand for reporting symptoms and their impact electronically, providing the layout is kept simple and feedback from clinicians is provided.
Collapse
Affiliation(s)
- Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Brimingham, UK
| | - Ameeta Retzer
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Brimingham, UK
| | - Anita Slade
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Brimingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Brimingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Birmingham, UK
| | - Laura Jones
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Brimingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Brimingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Birmingham, UK
| | - Grace M Turner
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham , Brimingham, UK
| |
Collapse
|
18
|
Kyte D, Retzer A, Ahmed K, Keeley T, Armes J, Brown JM, Calman L, Gavin A, Glaser AW, Greenfield DM, Lanceley A, Taylor RM, Velikova G, Brundage M, Efficace F, Mercieca-Bebber R, King MT, Turner G, Calvert M. Systematic Evaluation of Patient-Reported Outcome Protocol Content and Reporting in Cancer Trials. J Natl Cancer Inst 2019; 111:1170-1178. [PMID: 30959516 PMCID: PMC6855977 DOI: 10.1093/jnci/djz038] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/11/2019] [Accepted: 04/04/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are captured within cancer trials to help future patients and their clinicians make more informed treatment decisions. However, variability in standards of PRO trial design and reporting threaten the validity of these endpoints for application in clinical practice. METHODS We systematically investigated a cohort of randomized controlled cancer trials that included a primary or secondary PRO. For each trial, an evaluation of protocol and reporting quality was undertaken using standard checklists. General patterns of reporting where also explored. RESULTS Protocols (101 sourced, 44.3%) included a mean (SD) of 10 (4) of 33 (range = 2-19) PRO protocol checklist items. Recommended items frequently omitted included the rationale and objectives underpinning PRO collection and approaches to minimize/address missing PRO data. Of 160 trials with published results, 61 (38.1%, 95% confidence interval = 30.6% to 45.7%) failed to include their PRO findings in any publication (mean 6.43-year follow-up); these trials included 49 568 participants. Although two-thirds of included trials published PRO findings, reporting standards were often inadequate according to international guidelines (mean [SD] inclusion of 3 [3] of 14 [range = 0-11]) CONSORT PRO Extension checklist items). More than one-half of trials publishing PRO results in a secondary publication (12 of 22, 54.5%) took 4 or more years to do so following trial closure, with eight (36.4%) taking 5-8 years and one trial publishing after 14 years. CONCLUSIONS PRO protocol content is frequently inadequate, and nonreporting of PRO findings is widespread, meaning patient-important information may not be available to benefit patients, clinicians, and regulators. Even where PRO data are published, there is often considerable delay and reporting quality is suboptimal. This study presents key recommendations to enhance the likelihood of successful delivery of PROs in the future.
Collapse
Affiliation(s)
- Derek Kyte
- Correspondence to: Derek Kyte, PhD, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK (e-mail: )
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Anderson NE, Calvert M, Cockwell P, Dutton M, Kyte D. In Reply to 'A Psychiatrist's View on Patient-Reported Outcomes in Patients Undergoing Hemodialysis'. Am J Kidney Dis 2019; 74:711-712. [PMID: 31543289 DOI: 10.1053/j.ajkd.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/16/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Nicola Elizabeth Anderson
- Centre for Patient Reported Outcomes Research, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Cockwell
- Centre for Patient Reported Outcomes Research, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mary Dutton
- Centre for Patient Reported Outcomes Research, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, University of Birmingham, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
20
|
Grove BE, Ivarsen P, de Thurah A, Schougaard LM, Kyte D, Hjøllund NH. Remote follow-up using patient-reported outcome measures in patients with chronic kidney disease: the PROKID study - study protocol for a non-inferiority pragmatic randomised controlled trial. BMC Health Serv Res 2019; 19:631. [PMID: 31484523 PMCID: PMC6727325 DOI: 10.1186/s12913-019-4461-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background Outpatient care is steadily changing from hospital consultations to other platforms, such as phone consultation and online virtual clinics. It is prudent to maintain quality of care with such initiatives. Currently, patients with chronic kidney disease (CKD) have frequent scheduled visits, but it may be possible to optimise the frequency of hospital consultations using information from patient-reported outcome (PRO) questionnaires filled in at home (PRO-based follow-up). This approach may provide a more individually tailored follow-up based on actual needs for clinical attention. We aimed to evaluate the effectiveness of the quality of care, use of resources and patient outcomes associated with PRO-based follow-up in patients with CKD. Methods This study is a pragmatic, non-inferiority, randomised controlled trial in outpatients with CKD (Grove BE et al., Qual Life Res 27: S143, 2018). Newly referred patients with an estimated glomerular filtration rate (eGFR) of ≤40 ml/min 1.73m2 will be randomised to either:
PRO-based remote follow-up PRO-based telephone consultation Usual outpatient follow-up (control group)
In the two intervention groups, a diagnosis-specific PRO questionnaire completed by the patient at home will substitute for usual outpatient follow-up visits. The PRO questionnaire will in part be used as a screening tool to identify patients in need of outpatient contact and to identify focus areas. Responses from the questionnaire will be processed according to a disease-specific algorithm and assigned green, yellow or red status according to patients’ needs. The primary outcome will be loss of renal function evaluated by eGFR. Secondary outcomes are 1. Clinical outcomes, including initiation of acute dialyses, hospitalisation and mortality, 2. Utilisation of healthcare resources and 3. PRO measures, primarily quality of life (Euroqol EQ-5D) and illness perception (Brief Illness Perception Questionnaire (BIPQ). Discussion Benefits and possible drawbacks of the PRO-based follow-up will be evaluated. If PRO-based follow-up proves non-inferior to usual outpatient follow-up, a reorganisation of routine clinical practice in nephrology outpatient clinics may occur. Further, results may impact other patient groups with chronic conditions attending regular follow-up. Trial registration ClinicalTrials.gov identifier NCT03847766 (Retrospectively registered on January 23, 2019).
Collapse
Affiliation(s)
- Birgith Engelst Grove
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark.
| | - Per Ivarsen
- Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Liv Marit Schougaard
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark
| | - Derek Kyte
- Health Research Methods, Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Niels Henrik Hjøllund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
21
|
Williams FR, Vallance A, Faulkner T, Towey J, Durman S, Kyte D, Elsharkawy AM, Perera T, Holt A, Ferguson J, Lord JM, Armstrong MJ. Home-Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study. Liver Transpl 2019; 25:995-1006. [PMID: 30859755 DOI: 10.1002/lt.25442] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/27/2019] [Indexed: 02/07/2023]
Abstract
Frailty is associated with increased mortality both before and after liver transplantation (LT). There are no standardized exercise programs, in particular home-based exercise programs (HBEPs), for patients awaiting LT. The aim was to investigate the feasibility of such a program in patients awaiting LT. Patients were randomly selected from the Birmingham LT waiting list and provided with a 12-week HBEP, including average daily step (ADS) targets and twice-weekly resistance exercises. Feasibility was based on patient eligibility (≥66% of waiting list), target recruitment (≥90% of n = 20), safety (no related serious adverse events), and adherence (≥66% adherence to 6-week HBEP). Measures of aerobic (incremental shuttle walk test [ISWT], ADS), functional capacity (short physical performance battery test [SPPBT]), and health-related quality of life (EuroQol 5-Dimension 5-Level (EQ-5D-5L) and hospital anxiety and depression score [HADS]) were taken at baseline and at 6 and 12 weeks. 18 patients (50% male; median age, 55 years) were recruited. All domains of the study feasibility criteria were met. ISWT improved after 6 weeks (50 m; P ≤ 0.01) and 12 weeks (210 m; P ≤ 0.01), despite withdrawal of the telephone health calls. Similarly, improvements were seen in ADS (2700/day; P ≤ 0.01) and the SPPBT (2.5; P = 0.02) after 12 weeks. There was no difference in HADS (median difference [MD] -3; P = 0.69), but EQ-5D-5L after 12 weeks (17.5%; P = 0.04). In conclusion, a 12-week HBEP, incorporating both easy-to-apply resistance and aerobic exercises, is safe and feasible in patients awaiting LT. Measures of aerobic and functional capacity demonstrate trends toward improvement that warrant further investigation in a randomized controlled trial.
Collapse
Affiliation(s)
- Felicity Rhian Williams
- National Institute for Health Research Biomedical Research Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Physiotherapy, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Alice Vallance
- Department of Physiotherapy, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Thomas Faulkner
- Department of Anaesthesia, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Jennifer Towey
- Department of Dietetics, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Simon Durman
- Advanced Personal Trainer, Virgin Active Solihull, Solihull, United Kingdom
| | - Derek Kyte
- National Institute for Health Research Biomedical Research Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ahmed Mohamed Elsharkawy
- National Institute for Health Research Biomedical Research Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Liver Transplant Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Thamara Perera
- Liver Transplant Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Andrew Holt
- National Institute for Health Research Biomedical Research Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Liver Transplant Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - James Ferguson
- National Institute for Health Research Biomedical Research Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Liver Transplant Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- National Institute for Health Research Biomedical Research Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Medical Research Council Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Matthew James Armstrong
- National Institute for Health Research Biomedical Research Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Liver Transplant Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| |
Collapse
|
22
|
Abstract
INTRODUCTION Traumatic brachial plexus injury (TBPI) involves major trauma to the large nerves of the arm which control the movement and sensation. Fifty per cent of injuries result in complete paralysis of the arm with many other individuals having little movement, sensation loss and unremitting pain. The injury often causes severe and permanent disability affecting work and social life, with an estimated cost to the National Health Service and the economy of £35 million per annum. Advances in microsurgery have resulted in an increase in interventions aimed at reconstructing these injuries. However, data to guide evidence-based decisions is lacking. Different outcomes are used across studies to assess the effectiveness of treatments. This has impeded our ability to synthesise results to determine which treatments work best. Studies frequently report short-term clinical outcomes but rarely report longer term outcomes and those focused on quality of life. This project aims to produce a core outcome set (COS) for surgical and conservative management of TBPI. The TBPI COS will contain a minimum set of outcomes to be reported and measured in effectiveness studies and collected through routine clinical care. METHODS AND ANALYSIS This mixed-methods project will be conducted in two phases. In phase 1 a long list of patient-reported and clinical outcomes will be identified through a systematic review. Interviews will then explore outcomes important to patients. In phase 2, the outcomes identified across the systematic review, and the interviews will be included in a three-round online Delphi exercise aiming to reach consensus on the COS. The Delphi process will include patient and healthcare participants. A consensus meeting will be held to achieve the final COS. ETHICS AND DISSEMINATION The use of a COS in TBPI will increase the relevance of research and clinical care to all stakeholders, facilitate evidence synthesis and evidence-based decision making. The study has ethical approval. TRIAL REGISTRATION NUMBERS CRD42018109843.
Collapse
Affiliation(s)
- Caroline Miller
- School of Health Sciences, University of East Anglia, Norwich, UK
- University Hospitals Birmingham NHS Foundation Trust, Physiotherapy Department, Queen Elizabeth Hospital, Birmingham, UK
| | - Jane Cross
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Dominic M Power
- The Birmingham Peripheral Nerve Injury Service, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | |
Collapse
|
23
|
Bhachu HK, Cockwell P, Subramanian A, Nirantharakumar K, Kyte D, Calvert M. Cross-sectional observation study to investigate the impact of risk-based stratification on care pathways for patients with chronic kidney disease: protocol paper. BMJ Open 2019; 9:e027315. [PMID: 31182446 PMCID: PMC6561412 DOI: 10.1136/bmjopen-2018-027315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care nephrology services. Estimated glomerular filtration rate (eGFR) is commonly used to guide timing of referrals and preparation of patients approaching renal replacement therapy. However, eGFR lacks sensitivity for progression to end-stage renal failure; as a consequence, the international guideline group, Kidney Disease: Improving Global Outcomes has recommended the use of a risk calculator. The validated Kidney Failure Risk Equation may enable increased precision for the management of patients with CKD; however, there is little evidence to date for the implication of its use in routine clinical practice. This study will aim to determine the impact of the Kidney Failure Risk Equation on the redesignation of patients with CKD in the UK for referral to secondary care, compared with NICE CKD guidance. METHOD AND ANALYSIS This is a cross-sectional population-based observational study using The Health Improvement Network database to identify the impact of risk-based designation for referral into secondary care for patients with CKD in the UK. Adult patients registered in primary care and active in the database within the period 1 January 2016 to 31 March 2017 with confirmed CKD will be analysed. The proportion of patients who meet defined risk thresholds will be cross-referenced with the current NICE guideline recommendations for referral into secondary care along with an evaluation of urinary albumin-creatinine ratio monitoring. ETHICS AND DISSEMINATION Approval was granted by The Health Improvement Network Scientific Review Committee (Reference number: 18THIN061). Study outcomes will inform national and international guidelines including the next version of the NICE CKD guideline. Dissemination of findings will also be through publication in a peer-reviewed journal, presentation at conferences and inclusion in the core resources of the Think Kidneys programme.
Collapse
Affiliation(s)
- Harjeet Kaur Bhachu
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | | | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre (BRC) in Inflammatory Diseases, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
24
|
Hjollund NHI, Valderas JM, Kyte D, Calvert MJ. Health Data Processes: A Framework for Analyzing and Discussing Efficient Use and Reuse of Health Data With a Focus on Patient-Reported Outcome Measures. J Med Internet Res 2019; 21:e12412. [PMID: 31115347 PMCID: PMC6547770 DOI: 10.2196/12412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/02/2019] [Accepted: 03/24/2019] [Indexed: 11/14/2022] Open
Abstract
The collection and use of patient health data are central to any kind of activity in the health care system. These data may be produced during routine clinical processes or obtained directly from the patient using patient-reported outcome (PRO) measures. Although efficiency and other reasons justify data availability for a range of potentially relevant uses, these data are nearly always collected for a single specific purpose. The health care literature reflects this narrow scope, and there is limited literature on the joint use of health data for daily clinical use, clinical research, surveillance, and administrative purposes. The aim of this paper is to provide a framework for discussing the efficient use of health data with a specific focus on the role of PRO measures. PRO data may be used at an individual patient level to inform patient care or shared decision making and to tailor care to individual needs or group-level needs as a complement to health record data, such as that on mortality and readmission, in order to inform service delivery and measure the real-world effectiveness of treatment. PRO measures may be used either for their own sake, to provide valuable information from the patient perspective, or as a proxy for clinical data that would otherwise not be feasible to collect. We introduce a framework to analyze any health care activity that involves health data. The framework consists of four data processes (patient identification, data collection, data aggregation and data use), further structured into two dichotomous dimensions in each data process (level: group vs patient; timeframe: ad hoc vs systematic). This framework is used to analyze various health activities with respect to joint use of data, considering the technical, legal, organizational, and logistical challenges that characterize each data process. Finally, we propose a model for joint use of health data with data collected during follow-up as a base. Demands for health data will continue to increase, which will further add to the need for the concerted use and reuse of PRO data for parallel purposes. Repeated and uncoordinated PRO data collection for the same patient for different purposes results in misuse of resources for the patient and the health care system as well as reduced response rates owing to questionnaire fatigue. PRO data can be routinely collected both at the hospital (from inpatients as well as outpatients) and outside of hospital settings; in primary or social care settings; or in the patient’s home, provided the health informatics infrastructure is in place. In the future, clinical settings are likely to be a prominent source of PRO data; however, we are also likely to see increased remote collection of PRO data by patients in their own home (telePRO). Data collection for research and quality surveillance will have to adapt to this circumstance and adopt complementary data capture methods that take advantage of the utility of PRO data collected during daily clinical practice. The European Union’s regulation with respect to the protection of personal data—General Data Protection Regulation—imposes severe restrictions on the use of health data for parallel purposes, and steps should be taken to alleviate the consequences while still protecting personal data against misuse.
Collapse
Affiliation(s)
- Niels Henrik Ingvar Hjollund
- Occupational Medicine, University Research Clinic, AmbuFlex/WestChronic, Aarhus University, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - José Maria Valderas
- University of Exeter Collaboration for Academic Primary Care, Health Services & Policy Research Group, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (South West Peninsula), University of Exeter, Exeter, United Kingdom
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom.,National Institute for Health Research Birmingham Biomedical Research Centre and National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Melanie Jane Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom.,National Institute for Health Research Birmingham Biomedical Research Centre and National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| |
Collapse
|
25
|
Anderson NE, Calvert M, Cockwell P, Dutton M, Kyte D. The Use of Patient-Reported Outcomes in Patients Treated With Maintenance Hemodialysis: A Perspective. Am J Kidney Dis 2019; 74:399-406. [PMID: 31031088 DOI: 10.1053/j.ajkd.2019.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/29/2019] [Indexed: 12/20/2022]
Abstract
There is increasing interest in the integration of patient-reported outcomes (PROs) into health care research and clinical practice for the benefit of patients with end-stage kidney disease receiving hemodialysis. In a research setting, PROs can be used as a patient-centered primary or secondary outcome in clinical studies. In routine care, PRO data may be used to support service delivery through benchmarking and audit or inform and enhance the care of the individual patient by improving patient-clinician communication. Despite evidence demonstrating the potential benefits of PROs and prioritization of these outcomes by patients, their use in kidney disease remains limited. Although there are significant methodological and operational challenges for the widespread integration of PROs, there is now consensus that this area should be at the forefront of clinical research and implementation science. We discuss the current use of PROs for patients with end-stage kidney disease receiving hemodialysis and identify a roadmap for increasing the evidence base and introducing PROs into mainstream clinical practice.
Collapse
Affiliation(s)
- Nicola Elizabeth Anderson
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom; NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Paul Cockwell
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Mary Dutton
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, United Kingdom; Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom; NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
26
|
Aiyegbusi OL, Kyte D, Cockwell P, Marshall T, Dutton M, Walmsley-Allen N, Slade A, McMullan C, Calvert M. Patient and Clinician Perspectives on Electronic Patient-Reported Outcome Measures in the Management of Advanced CKD: A Qualitative Study. Am J Kidney Dis 2019; 74:167-178. [PMID: 31003865 DOI: 10.1053/j.ajkd.2019.02.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
RATIONALE & OBJECTIVE Chronic kidney disease (CKD) can substantially affect patients' health-related quality of life. Electronic patient-reported outcome measures (ePROMs) may capture symptoms and health-related quality of life and assist in the management of CKD. This study explored patient and clinician views on the use of a renal ePROM system. STUDY DESIGN Qualitative study. SETTING & PARTICIPANTS 12 patients with stage 4 or 5 CKD (non-dialysis dependent); 22 clinicians (6 CKD community nurses, 1 clinical psychologist, 10 nephrologists, 3 specialist registrars, and 2 renal surgeons) in the United Kingdom. ANALYTICAL APPROACH Semi-structured interviews and focus group discussion during which patients received paper versions of the Kidney Disease Quality of Life-36 and the Integrated Patient Outcome Scale-Renal to exemplify the type of content that could be included in an ePROM. Thematic analysis of interview transcripts. RESULTS 4 themes were identified: (1) general opinions of PROMs, (2) potential benefits and applications of an ePROM system, (3) practical considerations for the implementation of ePROMs, and (4) concerns, barriers, and facilitators. Patients were willing to complete ePROMs on a regular basis as part of their care despite clinician concerns about patient burden. Patients assessed the questionnaires favorably. Clinicians suggested that the extent of adoption of renal ePROM systems in routine clinical settings should be based on evidence of significant impact on patient outcomes. Clinicians were concerned that an ePROM system may raise patient expectations to unrealistic levels and expose clinicians to the risk for litigation. Patients and clinicians identified potential benefits and highlighted issues and concerns that need to be addressed to ensure the successful implementation of the renal ePROM system. LIMITATIONS Transferability of the findings may be limited because only English-speaking participants were recruited to the study. CONCLUSIONS A renal ePROM system may play a supportive role in the routine clinical management of patients with advanced CKD if the concerns of clinicians and patients can be sufficiently addressed.
Collapse
Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University Hospitals, Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Paul Cockwell
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Tom Marshall
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Mary Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Natalie Walmsley-Allen
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Anita Slade
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| |
Collapse
|
27
|
Retzer A, Turner GM, Slade A, Kyte D, McMullan C, Jones L, Belli A, Calvert M. Electronic patient reported outcomes to support care of patients with traumatic brain injury: PRiORiTy study qualitative protocol. BMJ Open 2019; 9:e024617. [PMID: 30782736 PMCID: PMC6352873 DOI: 10.1136/bmjopen-2018-024617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/11/2018] [Accepted: 12/07/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) represents a major health and socioeconomic problem internationally. The expansive nature of injuries results in a heterogeneous population. The degree and type of long-term impacts following TBI and improvement following injury are highly variable. The use of electronic Patient Reported Outcomes Measures (ePROMs) could help identify residual impacts of TBI and support patient management and care. The Patient Reported Outcomes Research in Trauma study is a qualitative study exploring the long-term symptoms and impacts that are experienced by those with TBI and the potential utility of an ePROM platform to collect real-time information on patient symptoms and quality of life to inform treatment and identify support needs. METHODS AND ANALYSIS Semi-structured telephone and face-to-face interviews will be conducted with approximately 30-40 individuals recruited from five groups: (1) people with TBI; (2) carers and relatives of individuals with TBI; (3) TBI healthcare professionals; (4) researchers and (5) third sector staff members and volunteers working with those with TBI. Data will be analysed using directed thematic analysis employing an iterative coding frame that will be modified as analysis progresses. Intercoder triangulation will be employed to enhance credibility. ETHICS AND DISSEMINATION This study was approved by the West Midlands-Black Country Research Ethics Committee (Ref: 18/WM/0033). Findings will be disseminated via conference presentations, peer-reviewed journals, social media (@CPROR_UoB; http://www.birmingham.ac.uk/cpror) and the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre.
Collapse
Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Grace M Turner
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Laura Jones
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Antonio Belli
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham
| |
Collapse
|
28
|
Affiliation(s)
- Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, and NIHR, Birmingham Biomedical Research Centre, University of Birmingham B15 2TT UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, and NIHR, Birmingham Biomedical Research Centre, University of Birmingham B15 2TT UK
| | - Gary Price
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, and NIHR, Birmingham Biomedical Research Centre, University of Birmingham B15 2TT UK
| | - Jose M Valderas
- NIHR PenCLAHRC and Institute for Health Services Research, University of Exeter Medical School, St Luke's Campus, St Leonards, Exeter EX1 2LU, UK
| | - Niels Henrik Hjollund
- AmbuFlex/WestChronic, Regional Hospital West Jutland, Herning, Denmark, and Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
29
|
Kaur G, Kyte D, Reeve BB, Basch E, Calvert M. Patient-reported outcome monitoring in a routine paediatric oncology setting: challenges and opportunities. Lancet Oncol 2019; 20:19-20. [DOI: 10.1016/s1470-2045(18)30785-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022]
|
30
|
Anderson NE, Calvert M, Cockwell P, Dutton M, Aiyegbusi OL, Kyte D. Using patient-reported outcome measures (PROMs) to promote quality of care in the management of patients with established kidney disease requiring treatment with haemodialysis in the UK (PROM-HD): a qualitative study protocol. BMJ Open 2018; 8:e021532. [PMID: 30373779 PMCID: PMC6224733 DOI: 10.1136/bmjopen-2018-021532] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Patients undergoing haemodialysis (HD) for end-stage kidney disease often report a poor quality of life (QoL) and identify that improving QoL has a higher priority for them than improvements in long-term survival. Research suggests that regular collection and usage of patient-reported outcome measures (PROMs) in patients with chronic conditions may reduce hospitalisation, improve QoL and overall survival. In the UK, despite increased use within research settings, PROMs have not been introduced into the routine clinical care for patients undergoing HD.We report the protocol for 'Using patient reported outcome measures (PROMs) to promote quality of care in the management of patients with established kidney disease requiring treatment with haemodialysis in the UK-PROM-HD'. The study aim is to investigate the methodological basis for the use of routine PROMs assessment, particularly using electronic formats (ePROMs) within clinical and research settings, to maximise the potential of PROM use in the management of the care of this patient group. METHODS AND ANALYSIS The project will use qualitative methodology to explore, by thematic analysis, the views, perceptions and experiences of patients receiving HD and members of the HD multidisciplinary team regarding the collection and use of PROMs in routine clinical care, particularly ePROMs. This will involve interviews with up to 30 patients or until saturation is achieved and three focus group sessions with approximately 18 members of the clinical team delivering care to this patient group, which will be interpreted broadly to include both professional and non-professional staff.
Collapse
Affiliation(s)
- Nicola Elzabeth Anderson
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Mary Dutton
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Derek Kyte
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
31
|
Kyte D, Bishop J, Brettell E, Calvert M, Cockwell P, Dutton M, Eddington H, Hadley G, Ives NJ, Jackson LJ, Stringer S, Valente M. Use of an electronic patient-reported outcome measure in the management of patients with advanced chronic kidney disease: the RePROM pilot trial protocol. BMJ Open 2018; 8:e026080. [PMID: 30373785 PMCID: PMC6224762 DOI: 10.1136/bmjopen-2018-026080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) affects up to 16% of adults in the UK. Patient quality of life is particularly reduced in end-stage renal disease and is strongly associated with increased hospitalisation and mortality. Thus, accurate and responsive healthcare is a key priority. Electronic patient-reported outcome measures (ePROMs) are online questionnaires which ask patients to self-rate their health status. Evidence in oncology suggests that the use of ePROM data within routine care, alongside clinical information, may enhance symptom management and improve patient outcomes. However, National Health Service (NHS)-based ePROM research in CKD is lacking. This pilot trial will assess the feasibility of undertaking a full-scale randomised controlled trial (RCT) in patients with CKD within the NHS. METHODS AND ANALYSIS The renal ePROM pilot trial is an investigator-led single-centre, open-label, two-arm randomised controlled pilot trial of 66 participants ≥18 years with advanced CKD. Participants will be randomised to receive either usual care or usual care supplemented with an ePROM intervention. Participants within the intervention arm will be asked to submit monthly self-reports of their health status using the ePROM system. The system will provide tailored information to patients in response to each report and notify the clinical team of patient deterioration. The renal clinical team will monitor for ePROM notifications and will respond with appropriate action, in line with standard clinical practice. Measures of study feasibility, participant quality of life and CKD severity will be completed at 3 monthly intervals. Health economic outcomes will be assessed. Clinicians will record treatment decision-making. Acceptability and feasibility of the protocol will be assessed alongside outcome measure and intervention compliance rates. Qualitative process evaluation will be conducted. ETHICS AND DISSEMINATION The findings will inform the design of a full-scale RCT and the results will be submitted for publication in peer-reviewed journals. The study has ethical approval. TRIAL REGISTRATION NUMBERS ISRCTN12669006; Pre-results.
Collapse
Affiliation(s)
- Derek Kyte
- Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mary Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Eddington
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gabby Hadley
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natalie J Ives
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Stephanie Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Marie Valente
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
32
|
Aiyegbusi OL, Kyte D, Cockwell P, Marshall T, Dutton M, Walmsley-Allen N, Auti R, Calvert M. Development and usability testing of an electronic patient-reported outcome measure (ePROM) system for patients with advanced chronic kidney disease. Comput Biol Med 2018; 101:120-127. [DOI: 10.1016/j.compbiomed.2018.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 12/22/2022]
|
33
|
Isa F, Turner GM, Kaur G, Kyte D, Slade A, Pankhurst T, Kerecuk L, Keeley T, Ferguson J, Calvert M. Patient-reported outcome measures used in patients with primary sclerosing cholangitis: a systematic review. Health Qual Life Outcomes 2018; 16:133. [PMID: 29976215 PMCID: PMC6034220 DOI: 10.1186/s12955-018-0951-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary Sclerosing Cholangitis (PSC) is a rare chronic, cholestatic liver condition in which patients can experience a range of debilitating symptoms. Patient reported outcome measures (PROMs) could provide a valuable insight into the impact of PSC on patient quality of life and symptoms. A previous review has been conducted on the quality of life instruments used in liver transplant recipients. However, there has been no comprehensive review evaluating PROM use or measurement properties in PSC patients' to-date. The aim of the systematic review was to: (a) To identify and categorise which PROMs are currently being used in research involving the PSC population (b) To investigate the measurement properties of PROMs used in PSC. METHODS A systematic review of Medline, EMBASE and CINAHL, from inception to February 2018, was undertaken. The methodological quality of included studies was assessed using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) checklist. RESULTS Thirty-seven studies were identified, which included 36 different PROMs. Seven PROMs were generic, 10 disease-specific, 17 symptom-specific measures and 2 measures on dietary intake. The most common PROMs were the Short form-36 (SF-36) (n = 15) and Chronic liver disease questionnaire (CLDQ) (n = 6). Only three studies evaluated measurement properties, two studies evaluated the National Institute of Diabetes Digestive and Kidney Diseases Liver Transplant (NIDDK-QA) and one study evaluated the PSC PRO; however, according to the COSMIN guidelines, methodological quality was poor for the NIDDK-QA studies and fair for the PSC PRO study. CONCLUSION A wide variety of PROMs have been used to assess health-related quality of life and symptom burden in patients with PSC; however only two measures (NIDDK-QA and PSC PRO) have been formally validated in this population. The newly developed PSC PRO requires further validation in PSC patients with diverse demographics, comorbidities and at different stages of disease; however this is a promising new measure with which to assess the impact of PSC on patient quality of life and symptoms.
Collapse
Affiliation(s)
- Fatima Isa
- Public Health England, 5 St Philips Place, Birmingham, B3 2PW UK
| | - Grace M. Turner
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Geetinder Kaur
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Anita Slade
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, B15 2TT UK
| | | | | | - Thomas Keeley
- PAREXEL International, Evergreen House North, 160 Euston Road, London, NW1 2DX UK
| | - James Ferguson
- NIHR Birmingham Biomedical Research Centre, Birmingham, B15 2TT UK
- University Hospital Birmingham, Birmingham, B15 2TH UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, B15 2TT UK
| |
Collapse
|
34
|
Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Adam Glaser
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
| | - Richard Stephens
- Consumer Forum, National Cancer Research Institute (NCRI), London, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
35
|
Slade A, Isa F, Kyte D, Pankhurst T, Kerecuk L, Ferguson J, Lipkin G, Calvert M. Patient reported outcome measures in rare diseases: a narrative review. Orphanet J Rare Dis 2018; 13:61. [PMID: 29688860 PMCID: PMC5914068 DOI: 10.1186/s13023-018-0810-x] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/16/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rare diseases can lead to a significant reduction in quality of life for patients and their families. Ensuring the patients voice is central to clinical decision making is key to delivering, evaluating and understanding the efficacy of therapeutic interventions. Patient reported outcome measures (PROMs) are used to capture the patient's views about their health status and facilitate our understanding of the impact of these diseases and their treatments on patient's quality of life and symptoms. MAIN TEXT This review explores some of the current issues around the utilisation of PROMs in rare diseases, including small patient populations and dearth of valid PROMs. Difficulties in validating new or current PROMs for use in clinical trials and research are discussed. The review highlights potential solutions for some of the issues outlined in the review and the implementation of PROMs in research and clinical practice are discussed. CONCLUSION Patient input throughout the development of PROMs including qualitative research is essential to ensure that outcomes that matter to people living with rare disease are appropriately captured. Given the large number of rare diseases, small numbers of patients living with each condition and the cost of instrument development, creative and pragmatic solutions to PROM development and use may be necessary. Solutions include qualitative interviews, modern psychometrics and resources such as item banking and computer adaptive testing. Use of PROMs in rare disease research and clinical practice offers the potential to improve patient care and clinical outcomes.
Collapse
Affiliation(s)
- Anita Slade
- Centre for Patient Reported Outcome Research, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Birmingham Health Partners, Birmingham, UK.
| | | | - Derek Kyte
- Centre for Patient Reported Outcome Research, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tanya Pankhurst
- Centre for Patient Reported Outcome Research, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK
- University Hospital Birmingham, Birmingham, UK
| | - Larissa Kerecuk
- Centre for Patient Reported Outcome Research, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK
- Birmingham Childrens and Womens Hospital, Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Ferguson
- Centre for Patient Reported Outcome Research, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK
- University Hospital Birmingham, Birmingham, UK
| | - Graham Lipkin
- Centre for Patient Reported Outcome Research, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK
- University Hospital Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
36
|
Mercieca-Bebber R, Calvert M, Kyte D, Stockler M, King MT. The administration of patient-reported outcome questionnaires in cancer trials: Interviews with trial coordinators regarding their roles, experiences, challenges and training. Contemp Clin Trials Commun 2018; 9:23-32. [PMID: 29696221 PMCID: PMC5898562 DOI: 10.1016/j.conctc.2017.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/10/2017] [Accepted: 11/22/2017] [Indexed: 11/24/2022] Open
Abstract
AIMS To explore cancer trial coordinators' roles and challenges in administering patient-reported outcome (PRO) questionnaires, and establish what PRO-specific training and guidance they received and needed. METHODS Eligible cancer trial coordinators experienced with PRO assessment from approved Australian sites participated in an audio-recorded, semi-structured interview (transcribed verbatim). Recruitment continued until data saturation. Transcripts underwent content analysis. RESULTS Twenty coordinators participated (professional training: nursing (n = 12), science/research (n = 4), both (n = 4)). PRO administration formed a minor component of most (85%) coordinators' roles. PRO administration challenges included managing 'English second language' participants, participants' companions who attempted to complete questionnaires, burdensome questionnaires, and balancing their duty of care against trial requirements. Coordinators reported inconsistencies in PRO administration, which appeared to arise as a result of confusion and inconsistent or contradictory PRO training. Inconsistencies concerned whether/when they explained the purpose of PRO assessment, which participants they approached to complete PROs, and whether they used PRO trial data to inform care.Coordinators received PRO training from various sources; most commonly study-specific start-up meetings (45%) or from colleagues (30%). Two received no PRO-specific training. Despite the challenges reported, many (55%) felt they did not need further PRO training. CONCLUSION Trial coordinators receive inconsistent PRO-specific training and are often unclear how to prioritise different aspects of data quality when faced with everyday challenges, leading to inconsistent methods, missing data, poor quality data, and even bias. Agreement on how coordinators should prioritise the requirements of PRO studies is a necessary pre-requisite for the development of much-needed, consensus-based PRO administration guidelines.
Collapse
Affiliation(s)
- Rebecca Mercieca-Bebber
- Central Clinical School, Sydney Medical School, University of Sydney, NSW 2006, Australia
- Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, NSW 2006, Australia
- NHMRC Clinical Trials Centre, University of Sydney, NSW 2006, Australia
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Derek Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Martin Stockler
- NHMRC Clinical Trials Centre, University of Sydney, NSW 2006, Australia
| | - Madeleine T. King
- Central Clinical School, Sydney Medical School, University of Sydney, NSW 2006, Australia
- Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, NSW 2006, Australia
| |
Collapse
|
37
|
Calvert M, Kyte D, Mercieca-Bebber R, Slade A, Chan AW, King MT, Hunn A, Bottomley A, Regnault A, Chan AW, Ells C, O'Connor D, Revicki D, Patrick D, Altman D, Basch E, Velikova G, Price G, Draper H, Blazeby J, Scott J, Coast J, Norquist J, Brown J, Haywood K, Johnson LL, Campbell L, Frank L, von Hildebrand M, Brundage M, Palmer M, Kluetz P, Stephens R, Golub RM, Mitchell S, Groves T. Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols: The SPIRIT-PRO Extension. JAMA 2018; 319:483-494. [PMID: 29411037 DOI: 10.1001/jama.2017.21903] [Citation(s) in RCA: 452] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Patient-reported outcome (PRO) data from clinical trials can provide valuable evidence to inform shared decision making, labeling claims, clinical guidelines, and health policy; however, the PRO content of clinical trial protocols is often suboptimal. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was published in 2013 and aims to improve the completeness of trial protocols by providing evidence-based recommendations for the minimum set of items to be addressed, but it does not provide PRO-specific guidance. Objective To develop international, consensus-based, PRO-specific protocol guidance (the SPIRIT-PRO Extension). Design, Setting, and Participants The SPIRIT-PRO Extension was developed following the Enhancing Quality and Transparency of Health Research (EQUATOR) Network's methodological framework for guideline development. This included (1) a systematic review of existing PRO-specific protocol guidance to generate a list of potential PRO-specific protocol items (published in 2014); (2) refinements to the list and removal of duplicate items by the International Society for Quality of Life Research (ISOQOL) Protocol Checklist Taskforce; (3) an international stakeholder survey of clinical trial research personnel, PRO methodologists, health economists, psychometricians, patient advocates, funders, industry representatives, journal editors, policy makers, ethicists, and researchers responsible for evidence synthesis (distributed by 38 international partner organizations in October 2016); (4) an international Delphi exercise (n = 137 invited; October 2016 to February 2017); and (5) consensus meeting (n = 30 invited; May 2017). Prior to voting, consensus meeting participants were informed of the results of the Delphi exercise and given data from structured reviews evaluating the PRO protocol content of 3 defined samples of trial protocols. Results The systematic review identified 162 PRO-specific protocol recommendations from 54 sources. The ISOQOL Taskforce (n = 21) reduced this to 56 items, which were considered by 138 international stakeholder survey participants and 99 Delphi panelists. The final wording of the SPIRIT-PRO Extension was agreed on at a consensus meeting (n = 29 participants) and reviewed by external group of experts during a consultation period. Eleven extensions and 5 elaborations to the SPIRIT 2013 checklist were recommended for inclusion in clinical trial protocols in which PROs are a primary or key secondary outcome. Extension items focused on PRO-specific issues relating to the trial rationale, objectives, eligibility criteria, concepts used to evaluate the intervention, time points for assessment, PRO instrument selection and measurement properties, data collection plan, translation to other languages, proxy completion, strategies to minimize missing data, and whether PRO data will be monitored during the study to inform clinical care. Conclusions and Relevance The SPIRIT-PRO guidelines provide recommendations for items that should be addressed and included in clinical trial protocols in which PROs are a primary or key secondary outcome. Improved design of clinical trials including PROs could help ensure high-quality data that may inform patient-centered care.
Collapse
Affiliation(s)
- Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Derek Kyte
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Rebecca Mercieca-Bebber
- Sydney Medical School, Faculty of Medicine and School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Anita Slade
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madeleine T King
- Sydney Medical School, Faculty of Medicine and School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | | | - Andrew Bottomley
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | | | - An-Wen Chan
- University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Ells
- Panel on Research Ethics, Toronto, Ontario, Canada
| | - Daniel O'Connor
- Medicines and Healthcare Products Regulatory Agency, London, England
| | | | | | | | | | | | - Gary Price
- Patient Partner, Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | | | | | - Jane Scott
- Janssen Global Services, Johnson and Johnson, High Wycombe, England
| | | | | | | | | | | | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, England
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, DC
| | - Maria von Hildebrand
- Patient Partner, Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | | | | | - Paul Kluetz
- US Food and Drug Administration, Silver Spring, Maryland
| | - Richard Stephens
- National Cancer Research Institute Consumer Forum, London, England
| | | | | | | |
Collapse
|
38
|
Retzer A, Keeley T, Ahmed K, Armes J, Brown JM, Calman L, Copland C, Efficace F, Gavin A, Glaser A, Greenfield DM, Lanceley A, Taylor RM, Velikova G, Brundage M, Mercieca-Bebber R, King MT, Calvert M, Kyte D. Evaluation of patient-reported outcome protocol content and reporting in UK cancer clinical trials: the EPiC study qualitative protocol. BMJ Open 2018; 8:e017282. [PMID: 29431123 PMCID: PMC5829743 DOI: 10.1136/bmjopen-2017-017282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are increasingly included within cancer clinical trials. If appropriately collected, analysed and transparently reported, these data might provide invaluable evidence to inform patient care. However, there is mounting indication that the design and reporting of PRO data in cancer trials may be suboptimal. This programme of research will establish via three interlinked studies whether these findings are applicable to UK cancer trials, and if so, how to best enhance the way PROs are assessed, managed and reported in clinical trials. This study will explore with key stakeholders factors that influence optimal PRO protocol content, implementation and reporting and make recommendations for training and guidance. METHODS AND ANALYSIS Semistructured interviews will be conducted with members of key stakeholder groups. The purposive sample of up to 48 participants will include: (1) trial chief investigators, trial management group members, statisticians and research nurses of cancer trials including primary or secondary PRO recruited via the National Cancer Research Institute (NCRI) Clinical Studies Group and Consumer Liaison Group and the UK Clinical Research Collaboration Registered UK Clinical Trial Unit Network; (2) NCRI Consumer Liaison Group members; (3) international experts in PRO oncology trial design; and (4) journal editors and funding bodies. Data will be analysed using directed thematic analysis employing a coding frame and modified as analysis progresses. Formal triangulation of coding and member checking will be employed to enhance credibility. ETHICS AND DISSEMINATION This study was approved by the University of Birmingham Ethics Committee (Ref: ERN_17-0085). Findings will be disseminated via conference presentations, peer-reviewed journals, patient groups and social media (@CPROR_UoB; http://www.birmingham.ac.uk/cpror). PROSPERO REGISTRATION NUMBER CRD42016036533.
Collapse
Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Khaled Ahmed
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Julia M Brown
- UKCRC Registered CTU Network, University of Leeds, Leeds, UK
| | - Lynn Calman
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Chris Copland
- NCRI Psychosocial Oncology and Survivorship CSG, York, UK
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Anna Gavin
- N. Ireland Cancer Registry, Queen’s University Belfast, Centre for Public Health, Belfast, UK
| | - Adam Glaser
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
| | | | - Anne Lanceley
- UCL EGA Institute for Women’s Health, University College London, London, UK
| | - Rachel M Taylor
- Cancer Division, University College Hospitals NHS Foundation Trust, London, UK
| | - Galina Velikova
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
- Patient Centred Outcomes Group: Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Michael Brundage
- Queen’s Department of Oncology School of Medicine, Queen’s University Cancer Research Institute, Kingston, Ontario, Canada
| | - Rebecca Mercieca-Bebber
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Psycho-Oncology Cooperative Research Group, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Madeleine T King
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Psycho-Oncology Cooperative Research Group, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
39
|
Williams FR, Vallance A, Faulkner T, Towey J, Kyte D, Durman S, Johnson J, Holt A, Perera MT, Ferguson J, Armstrong MJ. Home-based exercise therapy in patients awaiting liver transplantation: protocol for an observational feasibility trial. BMJ Open 2018; 8:e019298. [PMID: 29358444 PMCID: PMC5781094 DOI: 10.1136/bmjopen-2017-019298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Liver disease is the third most common cause of premature mortality in the UK. Liver failure accelerates frailty, resulting in skeletal muscle atrophy, functional decline and an associated risk of liver transplant waiting list mortality. However, there is limited research investigating the impact of exercise on patient outcomes pre and post liver transplantation. The waitlist period for patients listed for liver transplantation provides a unique opportunity to provide and assess interventions such as prehabilitation. METHODS AND ANALYSIS This study is a phase I observational study evaluating the feasibility of conducting a randomised control trial (RCT) investigating the use of a home-based exercise programme (HBEP) in the management of patients awaiting liver transplantation. Twenty eligible patients will be randomly selected from the Queen Elizabeth University Hospital Birmingham liver transplant waiting list. Participants will be provided with an individually tailored 12-week HBEP, including step targets and resistance exercises. Activity trackers and patient diaries will be provided to support data collection. For the initial 6 weeks, telephone support will be given to discuss compliance with the study intervention, achievement of weekly targets, and to address any queries or concerns regarding the intervention. During weeks 6-12, participants will continue the intervention without telephone support to evaluate longer term adherence to the study intervention. On completing the intervention, all participants will be invited to engage in a focus group to discuss their experiences and the feasibility of an RCT. ETHICS AND DISSEMINATION The protocol is approved by the National Research Ethics Service Committee North West - Greater Manchester East and Health Research Authority (REC reference: 17/NW/0120). Recruitment into the study started in April 2017 and ended in July 2017. Follow-up of participants is ongoing and due to finish by the end of 2017. The findings of this study will be disseminated through peer-reviewed publications and international presentations. In addition, the protocol will be placed on the British Liver Trust website for public access. TRIAL REGISTRATION NUMBER NCT02949505; Pre-results.
Collapse
Affiliation(s)
- Felicity Rhian Williams
- Department of Physiotherapy, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Alice Vallance
- Department of Physiotherapy, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Thomas Faulkner
- Department of Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Jennifer Towey
- Department of Dietetics, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Jill Johnson
- Department of Dietetics, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Andrew Holt
- Liver Transplant and Hepatobiliary Pancreatic Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - M Thamara Perera
- Liver Transplant and Hepatobiliary Pancreatic Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - James Ferguson
- Liver Transplant and Hepatobiliary Pancreatic Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Matthew James Armstrong
- Liver Transplant and Hepatobiliary Pancreatic Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| |
Collapse
|
40
|
Mercieca-Bebber R, Friedlander M, Calvert M, Stockler M, Kyte D, Kok PS, King MT. A systematic evaluation of compliance and reporting of patient-reported outcome endpoints in ovarian cancer randomised controlled trials: implications for generalisability and clinical practice. J Patient Rep Outcomes 2017; 1:5. [PMID: 29757300 PMCID: PMC5934909 DOI: 10.1186/s41687-017-0008-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/07/2017] [Indexed: 11/26/2022] Open
Abstract
Background This study aimed to evaluate the patient-reported outcome (PRO) content of ovarian cancer randomised-controlled trial (RCT) publications, describe PRO compliance, and explore potential relationships among these and completeness of PRO protocol content. Methods Publications of Phase III ovarian cancer RCTs with PRO endpoints were identified by Medline and Cochrane systematic search: January 2000 to February 2016. Two reviewers determined the number of Consolidated Standards of Reporting Trials (CONSORT)-PRO Extension items addressed in publications. Compliance rates (defined as the proportion of participants included in the principal PRO analysis, of those from whom PRO assessments were expected) were extracted. The relationship between CONSORT-PRO score and compliance rates was explored using scatter plots. Additionally CONSORT-PRO score and PRO compliance rates respectively were compared with corresponding PRO protocol scores obtained from a previous study. Results Thirty-six eligible RCTs (n = 33 with secondary PRO endpoint) were identified and analysed. The average number of CONSORT-PRO items addressed in publications was 6.7 (48%; Range 0–13.5/14). Three RCTs did not report PRO results; in 1 case due to poor compliance. Some compliance information was reported in 26 RCTs, but was considered complete for only 10 (28%) RCTs. Compliance rates were poor overall, ranging from 59 to 83%; therefore missing PRO data from 17 to 41% of participants in these trials could have been avoided. Of the 26 (73%) RCTs for which PRO protocol completeness scores were available, 6 RCTs reported complete compliance information and the 3 of these RCTs with highest PRO compliance had highest protocol checklist scores. Conclusions Few RCTs reported PRO compliance information in a manner enabling assessment of the generalisability of PRO results. This information is particularly important in RCTs of advanced ovarian cancer because it is important to be able to determine if missing data was due to worsening illness compared to methodological issues. Poor compliance appeared related to poor PRO protocol content, and in one case prevented PRO results from being reported, highlighting the need to address compliance strategies in the protocol. Adhering to protocol and CONSORT-PRO reporting guidance should improve PRO implementation and reporting respectively in ovarian cancer RCTs and allow results to meaningfully inform clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s41687-017-0008-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rebecca Mercieca-Bebber
- 1Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW Australia.,2Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, Sydney, NSW Australia
| | - Michael Friedlander
- 3NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW Australia.,Australian New Zealand Gynecological Oncology Group (ANZGOG), Camperdown, NSW Australia
| | - Melanie Calvert
- 5Centre for Patient-Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Martin Stockler
- 3NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW Australia.,Australian New Zealand Gynecological Oncology Group (ANZGOG), Camperdown, NSW Australia
| | - Derek Kyte
- 5Centre for Patient-Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Peey-Sei Kok
- 3NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW Australia.,Australian New Zealand Gynecological Oncology Group (ANZGOG), Camperdown, NSW Australia
| | - Madeleine T King
- 1Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW Australia.,2Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, Sydney, NSW Australia.,Australian New Zealand Gynecological Oncology Group (ANZGOG), Camperdown, NSW Australia
| |
Collapse
|
41
|
Aiyegbusi OL, Kyte D, Cockwell P, Marshall T, Dutton M, Slade A, Marklew N, Price G, Verdi R, Waters J, Sharpe K, Calvert M. Using Patient-Reported Outcome Measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney disease (PRO-trACK project): a mixed-methods project protocol. BMJ Open 2017; 7:e016687. [PMID: 28667225 PMCID: PMC5726096 DOI: 10.1136/bmjopen-2017-016687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Advanced chronic kidney disease (CKD) has a major effect on the quality of life and health status of patients and requires accurate and responsive management. The use of electronic patient-reported outcome measures (ePROMs) could assist patients with advanced pre-dialysis CKD, and the clinicians responsible for their care, by identifying important changes in symptom burden in real time. We report the protocol for 'Using Patient-Reported Outcome measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney Disease' (PRO-trACK) project, which will explore the feasibility and validity of an ePROM system for use in patients with advanced CKD. METHODS AND ANALYSIS The project will use a mixed-methods approach in three studies: (1) usability testing of the ePROM system involving up to 30 patients and focusing on acceptability and technical performance/stability; (2) ascertaining the views of patient and clinician stakeholders on the optimal use and administration of the CKD ePROM system-this will involve qualitative face-to-face/telephone interviewing with up to 30 patients or until saturation is achieved, focus groups with up to 15 clinical staff, management and IT team members; (3) psychometric assessment of the system, within a cohort of at least 180 patients with advanced CKD, to establish the measurement properties of the ePROM. ETHICS AND DISSEMINATION This project was approved by the West Midlands Edgbaston Research Ethics Committee (Reference 17/WM/0010) and received Health Research Authority (HRA) approval on 24 February 2017.The findings from this project will be provided to clinicians at the Department of Renal Medicine, Queen Elizabeth Hospitals, Birmingham (QEHB), NHS England, presented at conferences and to the Kidney Patients' Association, British Kidney Patient Association and the British Renal Society. Articles based on the findings will be written and submitted for publication in peer-reviewed journals.
Collapse
Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Tom Marshall
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mary Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Neil Marklew
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Rav Verdi
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Judi Waters
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Keeley Sharpe
- Patient Advisory Group Member, Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
42
|
Aiyegbusi OL, Kyte D, Cockwell P, Marshall T, Gheorghe A, Keeley T, Slade A, Calvert M. Measurement properties of patient-reported outcome measures (PROMs) used in adult patients with chronic kidney disease: A systematic review. PLoS One 2017. [PMID: 28636678 PMCID: PMC5479575 DOI: 10.1371/journal.pone.0179733] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) can provide valuable information which may assist with the care of patients with chronic kidney disease (CKD). However, given the large number of measures available, it is unclear which PROMs are suitable for use in research or clinical practice. To address this we comprehensively evaluated studies that assessed the measurement properties of PROMs in adults with CKD. Methods Four databases were searched; reference list and citation searching of included studies was also conducted. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to appraise the methodological quality of the included studies and to inform a best evidence synthesis for each PROM. Results The search strategy retrieved 3,702 titles/abstracts. After 288 duplicates were removed, 3,414 abstracts were screened and 71 full-text articles were retrieved for further review. Of these, 24 full-text articles were excluded as they did not meet the eligibility criteria. Following reference list and citation searching, 19 articles were retrieved bringing the total number of papers included in the final analysis to 66. There was strong evidence supporting internal consistency and moderate evidence supporting construct validity for the Kidney Disease Quality of Life-36 (KDQOL-36) in pre-dialysis patients. In the dialysis population, the KDQOL-Short Form (KDQOL-SF) had strong evidence for internal consistency and structural validity and moderate evidence for test-retest reliability and construct validity while the KDQOL-36 had moderate evidence of internal consistency, test-retest reliability and construct validity. The End Stage Renal Disease-Symptom Checklist Transplantation Module (ESRD-SCLTM) demonstrated strong evidence for internal consistency and moderate evidence for test-retest reliability, structural and construct validity in renal transplant recipients. Conclusions We suggest considering the KDQOL-36 for use in pre-dialysis patients; the KDQOL-SF or KDQOL-36 for dialysis patients and the ESRD-SCLTM for use in transplant recipients. However, further research is required to evaluate the measurement error, structural validity, responsiveness and patient acceptability of PROMs used in CKD.
Collapse
Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail:
| | - Paul Cockwell
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Tom Marshall
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | | | - Anita Slade
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| |
Collapse
|
43
|
Kyte D, Cockwell P, Lencioni M, Skrybant M, Hildebrand MV, Price G, Squire K, Webb S, Brookes O, Fanning H, Jones T, Calvert M. Reflections on the national patient-reported outcome measures (PROMs) programme: Where do we go from here? J R Soc Med 2017; 109:441-445. [PMID: 27923896 DOI: 10.1177/0141076816677856] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Derek Kyte
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham B15 2TT, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Paul Cockwell
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TT, UK.,Institute of Inflammation and Aging, University of Birmingham B15 2TT, UK
| | - Mauro Lencioni
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Maria von Hildebrand
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Gary Price
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Katie Squire
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Shena Webb
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Olivia Brookes
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Hilary Fanning
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Tim Jones
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Melanie Calvert
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham B15 2TT, UK .,Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| |
Collapse
|
44
|
Jesky MD, Dutton M, Dasgupta I, Yadav P, Ng KP, Fenton A, Kyte D, Ferro CJ, Calvert M, Cockwell P, Stringer SJ. Health-Related Quality of Life Impacts Mortality but Not Progression to End-Stage Renal Disease in Pre-Dialysis Chronic Kidney Disease: A Prospective Observational Study. PLoS One 2016; 11:e0165675. [PMID: 27832126 PMCID: PMC5104414 DOI: 10.1371/journal.pone.0165675] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/14/2016] [Indexed: 12/19/2022] Open
Abstract
Background Chronic kidney disease (CKD) is associated with reduced health-related quality of life (HRQL). However, the relationship between pre-dialysis CKD, HRQL and clinical outcomes, including mortality and progression to end-stage renal disease (ESRD) is unclear. Methods All 745 participants recruited into the Renal Impairment In Secondary Care study to end March 2014 were included. Demographic, clinical and laboratory data were collected at baseline including an assessment of HRQL using the Euroqol EQ-5D-3L. Health states were converted into an EQ-5Dindex score using a set of weighted preferences specific to the UK population. Multivariable Cox proportional hazards regression and competing risk analyses were undertaken to evaluate the association of HRQL with progression to ESRD or all-cause mortality. Regression analyses were then performed to identify variables associated with the significant HRQL components. Results Median eGFR was 25.8 ml/min/1.73 m2 (IQR 19.6–33.7ml/min) and median ACR was 33 mg/mmol (IQR 6.6–130.3 mg/mmol). Five hundred and fifty five participants (75.7%) reported problems with one or more EQ-5D domains. When adjusted for age, gender, comorbidity, eGFR and ACR, both reported problems with self-care [hazard ratio 2.542, 95% confidence interval 1.222–5.286, p = 0.013] and reduced EQ-5Dindex score [hazard ratio 0.283, 95% confidence interval 0.099–0.810, p = 0.019] were significantly associated with an increase in all-cause mortality. Similar findings were observed for competing risk analyses. Reduced HRQL was not a risk factor for progression to ESRD in multivariable analyses. Conclusions Impaired HRQL is common in the pre-dialysis CKD population. Reduced HRQL, as demonstrated by problems with self-care or a lower EQ-5Dindex score, is associated with a higher risk for death but not ESRD. Multiple factors influence these aspects of HRQL but renal function, as measured by eGFR and ACR, are not among them.
Collapse
Affiliation(s)
- Mark D. Jesky
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Mary Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Indranil Dasgupta
- Renal Unit, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Punit Yadav
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Khai Ping Ng
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Anthony Fenton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Derek Kyte
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Charles J. Ferro
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Melanie Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stephanie J. Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
45
|
Aiyegbusi OL, Kyte D, Cockwell P, Marshall T, Keeley T, Gheorghe A, Calvert M. Measurement properties of patient-reported outcome measures (PROMs) used in adult patients with chronic kidney disease: a systematic review protocol. BMJ Open 2016; 6:e012014. [PMID: 27733411 PMCID: PMC5073911 DOI: 10.1136/bmjopen-2016-012014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with symptoms that can significantly reduce the quality of life (QoL) of patients. Patient-reported outcome measures (PROMs) may facilitate the assessment of the impact of disease and treatment on the QoL, from a patient perspective. PROMs can be used in research and routine clinical practice. METHODS AND ANALYSIS A systematic review of studies evaluating the measurement properties of PROMs in adults with CKD will be conducted. MEDLINE, EMBASE, PsycINFO and CINAHL Plus will be systematically searched from inception. Hand searching of reference lists and citations of included studies will be carried out. 2 reviewers will independently screen the titles and abstracts of all the studies retrieved during the systematic search to determine their eligibility. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist will be used to appraise the methodological quality of the selected studies following the full-text review. Data on the study population, questionnaire characteristics and measurement properties will be extracted from the selected papers. Finally, a narrative synthesis of extracted data will be undertaken. ETHICS AND DISSEMINATION Ethical permissions are not required for this study as data from published research articles will be used. Findings will be disseminated through publication in a peer-reviewed journal and presented at conferences. This systematic review will provide a comprehensive assessment of the measurement properties of PROMs currently available for use in adult patients with CKD and present evidence which may inform the selection of measures for use in research and clinical practice. TRIAL REGISTRATION NUMBER CRD42016035554.
Collapse
Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Tom Marshall
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Thomas Keeley
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adrian Gheorghe
- Oxford Policy Management Ltd, Level 3 Clarendon Centre, Oxford, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
46
|
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) collected in clinical trials should be administered in a standardised way across sites and routinely screened for avoidable missing data in order to maximise data quality/minimise risk of bias. Recent qualitative findings, however, have raised concerns about the consistency of PROM administration in UK trials. The purpose of this study was to determine the generalisability of these findings across the wider community of trial personnel. DESIGN Online cross-sectional survey. SETTING Participants were recruited from 55 UK Clinical Research Collaboration Registered Clinical Trials Units and 19 Comprehensive Local Research Networks. PARTICIPANTS Research nurses, data managers/coordinators, trial managers and chief/principal investigators involved in clinical trials collecting PROMs. ANALYSIS We undertook descriptive analyses of the quantitative data and directed thematic analysis of free-text comments. Factors associated with the management of missing PRO data were explored using logistic regression. RESULTS Survey data from 767 respondents supported the generalisability of qualitative study findings, suggesting inconsistencies in PROM administration with regard to: the level of assistance given to trial participants; the timing of PROM completion in relation to the clinical consultation; and the management of missing data. Having ≥10 years experience in a research role was significantly associated with the appropriate management of missing PROM data (OR 2.26 (95% CI 1.06 to 4.82), p=0.035). There was a consensus that more PROM guidance was needed in future trials and agreement between professional groups about the necessary components. CONCLUSIONS There are inconsistencies in the way PROMs are administered by trial staff. Such inconsistencies may reduce the quality of data and have the potential to introduce bias. There is a need for improved guidance in future trials that support trial personnel in conducting optimal PROM data collection to inform patient care.
Collapse
Affiliation(s)
- Derek Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Ives
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
47
|
Ahmed K, Kyte D, Keeley T, Efficace F, Armes J, Brown JM, Calman L, Copland C, Gavin A, Glaser A, Greenfield DM, Lanceley A, Taylor R, Velikova G, Brundage M, Mercieca-Bebber R, King MT, Calvert M. Systematic evaluation of patient-reported outcome (PRO) protocol content and reporting in UK cancer clinical trials: the EPiC study protocol. BMJ Open 2016; 6:e012863. [PMID: 27655263 PMCID: PMC5051436 DOI: 10.1136/bmjopen-2016-012863] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Emerging evidence suggests that patient-reported outcome (PRO)-specific information may be omitted in trial protocols and that PRO results are poorly reported, limiting the use of PRO data to inform cancer care. This study aims to evaluate the standards of PRO-specific content in UK cancer trial protocols and their arising publications and to highlight examples of best-practice PRO protocol content and reporting where they occur. The objective of this study is to determine if these early findings are generalisable to UK cancer trials, and if so, how best we can bring about future improvements in clinical trials methodology to enhance the way PROs are assessed, managed and reported. HYPOTHESIS Trials in which the primary end point is based on a PRO will have more complete PRO protocol and publication components than trials in which PROs are secondary end points. METHODS AND ANALYSIS Completed National Institute for Health Research (NIHR) Portfolio Cancer clinical trials (all cancer specialities/age-groups) will be included if they contain a primary/secondary PRO end point. The NIHR portfolio includes cancer trials, supported by a range of funders, adjudged as high-quality clinical research studies. The sample will be drawn from studies completed between 31 December 2000 and 1 March 2014 (n=1141) to allow sufficient time for completion of the final trial report and publication. Two reviewers will then review the protocols and arising publications of included trials to: (1) determine the completeness of their PRO-specific protocol content; (2) determine the proportion and completeness of PRO reporting in UK Cancer trials and (3) model factors associated with PRO protocol and reporting completeness and with PRO reporting proportion. ETHICS AND DISSEMINATION The study was approved by the ethics committee at University of Birmingham (ERN_15-0311). Trial findings will be disseminated via presentations at local, national and international conferences, peer-reviewed journals and social media including the CPROR twitter account and UOB departmental website (http://www.birmingham.ac.uk/cpro0r). TRIAL REGISTRATION NUMBER PROSPERO CRD42016036533.
Collapse
Affiliation(s)
- Khaled Ahmed
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Thomas Keeley
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Jo Armes
- King's College London, London, UK
| | - Julia M Brown
- UKCRC Registered CTU Network, University of Leeds, Leeds, UK
| | - Lynn Calman
- Department of Heath Sciences, University of Southhampton, Southampton, UK
| | - Chris Copland
- NCRI Psychosocial Oncology andSurvivorship CSG Consumer member, York, UK
| | - Anna Gavin
- Queen's University Belfast, Centre for Public Health, Belfast, UK
| | - Adam Glaser
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
| | | | - Anne Lanceley
- University College London, UCL EGA Institute for Women's Health, London, UK
| | - Rachel Taylor
- University College London Hospital (UCLH), London, UK
| | | | - Michael Brundage
- Queen's Department of Oncology School of Medicine, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Rebecca Mercieca-Bebber
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Faculties of Science and Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Madeleine T King
- Faculties of Science and Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
48
|
Mercieca-Bebber R, Friedlander M, Kok PS, Calvert M, Kyte D, Stockler M, King MT. The patient-reported outcome content of international ovarian cancer randomised controlled trial protocols. Qual Life Res 2016; 25:2457-2465. [PMID: 27294435 DOI: 10.1007/s11136-016-1339-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) provide the patient's perspective of the impact of treatment. Evidence suggests that PRO content of randomised controlled trials (RCTs) protocols is generally sub-optimal. This study aimed to describe and evaluate the PRO-specific content of ovarian cancer RCT protocols. METHODS Published, phase III, ovarian cancer RCTs with PRO endpoints were identified following a systematic search of Medline and Cochrane databases (Jan 2000 to Feb 2016). Corresponding RCT protocols were downloaded (if published) or obtained by contacting authors. Two investigators independently assessed adherence of PRO-specific content of included protocols to a checklist of 58 recommended PRO protocol items currently being developed by the International Society for Quality of Life Research. Discrepancies were resolved with a third investigator. RESULTS Of 41 eligible trials identified, 26 protocols were assessed (developed 1995-2010). We were unable to obtain the remaining 15 protocols. Protocols addressed a mean of 28 % PRO checklist items (range 8-66 %). Fifteen (58 % of assessed protocols) provided a rationale for PRO assessment, 8 (31 %) described a PRO objective, 24 (92 %) included a PRO assessment schedule, but only 6 (23 %) justified timing of PRO assessments. Twelve protocols (46 %) provided staff data collection instructions, 4 (15 %) included plans for monitoring PRO compliance, and 16 (62 %) included a PRO analysis plan. CONCLUSIONS On average, protocols addressed less than one-third of PRO protocol checklist items. In some cases, key guidance regarding PRO administration was lacking, which may lead to inconsistent and sub-optimal PRO methodology. Efforts are needed to improve PRO protocol content in cancer trials.
Collapse
Affiliation(s)
- Rebecca Mercieca-Bebber
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia. .,Quality of Life Office, Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, Sydney, NSW, 2006, Australia.
| | - Michael Friedlander
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia.,Australian New Zealand Gynecological Oncology Group (ANZGOG), Camperdown, NSW, 2050, Australia
| | - Peey-Sei Kok
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia.,Australian New Zealand Gynecological Oncology Group (ANZGOG), Camperdown, NSW, 2050, Australia
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Martin Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Madeleine T King
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia.,Quality of Life Office, Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, Sydney, NSW, 2006, Australia.,Australian New Zealand Gynecological Oncology Group (ANZGOG), Camperdown, NSW, 2050, Australia
| |
Collapse
|
49
|
Kyte D, Ives J, Draper H, Calvert M. Management of Patient-Reported Outcome (PRO) Alerts in Clinical Trials: A Cross Sectional Survey. PLoS One 2016; 11:e0144658. [PMID: 26785084 PMCID: PMC4718453 DOI: 10.1371/journal.pone.0144658] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022] Open
Abstract
Background Assessment of patient-reported outcomes (PROs) provides valuable information to inform patient-centered care, but may also reveal ‘PRO alerts’: psychological distress or physical symptoms that may require an immediate response. Ad-hoc management of PRO alerts in clinical trials may result in suboptimal patient care or potentially bias trial results. To gain greater understanding of current practice in PRO alert management we conducted a national survey of personnel involved in clinical trials with a PRO endpoint. Methods and Findings We conducted a national cross-sectional survey of 767 UK-based research nurses, data managers/coordinators, trial managers and chief/principal investigators involved in clinical trials using PROs. Respondents were self-selected volunteers from a non-randomised sample of eligible individuals recruited via 55 UK Clinical Research Collaboration Registered Clinical Trials Units and 19 Comprehensive Local Research Networks. Questions centred on the proportion of trial personnel encountering alerts, how staff responded to PRO alerts and whether current guidance was deemed sufficient to support research personnel. We undertook descriptive analyses of the quantitative data and directed thematic analysis of free-text comments. 20% of research nurses did not view completed PRO questionnaires and were not in a position to discover alerts, 39–50% of the remaining respondent group participants reported encountering PRO alerts. Of these, 83% of research nurses and 54% of data managers/trial coordinators reported taking action to assist the trial participant, but less than half were able to record the intervention in the trial documentation. Research personnel reported current PRO alert guidance/training was insufficient. Conclusions Research personnel are intermittently exposed to PRO alerts. Some intervene to help trial participants, but are not able to record this intervention in the trial documentation, risking co-intervention bias. Other staff do not check PRO information during the trial, meaning alerts may remain undiscovered, or do not respond to alerts if they are inadvertently encountered; both of which may impact on patient safety. Guidance is needed to support PRO alert management that protects the interests of trial participants whilst avoiding potential bias.
Collapse
Affiliation(s)
- Derek Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Ives
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| |
Collapse
|
50
|
Soundy A, Rosenbaum S, Elder T, Kyte D, Stubbs B, Hemmings L, Roskell C, Collett J, Dawes H. The Hope and Adaptation Scale (HAS): Establishing Face and Content Validity. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojtr.2016.42007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|