PRO-ONKO—selection of patient-reported outcome assessments for the clinical use in cancer patients—a mixed-method multicenter cross-sectional exploratory study
Cancer patients frequently suffer from multiple symptoms often impairing functional status and health-related quality of life (HRQOL). A comprehensive assessment including patient-reported outcomes (PROs) is recommended to enable individualized supportive care. However, PRO assessments are still not part of routine clinical practice. Therefore, this project aimed to compile an item pool from validated assessment instruments to facilitate the use of PROs for clinical decision-making in oncology clinics.
This qualitative dominant mixed-method cross-sectional exploratory study was carried out in four centers and comprised two stages. Stage I: Six interdisciplinary focus groups were conducted to choose questionnaires meeting particular clinical requirements. Stage II: Adult patients with heterogeneous cancer diagnoses, receiving in- or out-patient treatment were asked to participate and complete the chosen questionnaires (participation 71/74). Resulting PROs were compared with clinical records. Health care professionals (HCPs) and patients rated the usefulness for routine clinical practice.
The European Organisation of Research and Treatment of Cancer (EORTC) QLQ-C30 and Distress Thermometer were chosen for screening and M.D. Anderson Symptom Inventory (MDASI) and EORTC single items for monitoring. Comparison of n = 88 PRO assessments with clinical records showed consistent documentation of side effects like fever and emesis. Symptoms like fatigue, sadness, or sleep disturbance were not documented regularly in the medical records but captured by PRO assessments. Patients and HCPs judged the chosen questionnaires and electronic data collection as useful.
Future studies should examine how PROs can complement or substitute routine documentation in order to achieve standardized assessment and documentation during the treatment process in different settings and examine possible benefits for patients.
KeywordsPatient-reported outcomes Cancer Quality of life Screening Monitoring Supportive therapy
- 8.Reeve BB et al (2014) Recommended patient-reported core set of symptoms to measure in adult cancer treatment trials. J Natl Cancer Inst 106(7)Google Scholar
- 11.Kotronoulas G et al (2014) What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol 32(14):1480–1501CrossRefPubMedGoogle Scholar
- 18.Chung AE, Basch EM (2015) Incorporating the patient’s voice into electronic health records through patient-reported outcomes as the “Review of Systems”. J Am Med Inform AssocGoogle Scholar
- 21.NCCN (2013) Distress management. Available from: http://www.oralcancerfoundation.org/treatment/pdf/distress.pdf
- 22.EHA (2012) Guidelines. Patient reported outcomes in hematology. Genua: forum service editoreGoogle Scholar
- 23.NCCN (2014) Cancer-related fatigue. Available from: https://s3.amazonaws.com/pfizerpro.com/fixtures/oncology/docs/NCCNFatigueGuidelines.pdf
- 24.Santana MJ et al (2015) Training clinicians in how to use patient-reported outcome measures in routine clinical practice. Qual Life ResGoogle Scholar
- 27.Howell D et al (2015) Patient-reported outcomes in routine cancer clinical practice: a scoping review of use, impact on health outcomes, and implementation factors. Ann OncolGoogle Scholar
- 32.Howell D et al (2012) Psychosocial health care needs assessment of adult cancer patients: a consensus-based guideline. Support Care CancerGoogle Scholar
- 35.Mayring P (2000) Qualitative content analysis [28 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research 1(2) Art. 20Google Scholar
- 38.Schaeffeler N et al (2015) Assessing the need for psychooncological support: screening instruments in combination with patients’ subjective evaluation may define psychooncological pathways. PsychooncologyGoogle Scholar
- 42.Brundage MD et al (2015) Communicating patient-reported outcome scores using graphic formats: results from a mixed-methods evaluation. Qual Life ResGoogle Scholar