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Quality of Life Research

, Volume 22, Issue 5, pp 939–950 | Cite as

How do doctors refer to patient-reported outcome measures (PROMS) in oncology consultations?

  • Joanne Greenhalgh
  • Purva Abhyankar
  • Serena McCluskey
  • Elena Takeuchi
  • Galina Velikova
Article

Abstract

Purpose

We conducted a secondary qualitative analysis of consultations between oncologists and their patients to explore how patient-reported outcome measures (PROMs) data were referred to in the process of (1) eliciting and exploring patients’ concerns; (2) making decisions about supportive treatment and (3) making decisions about chemotherapy and other systemic treatments.

Methods

We purposively sampled audio recordings of 18 consultations from the intervention arm and 4 from the attention control arm of a previous UK randomised controlled trial of the feedback of PROMs data to doctors (Velikova et al. in J Clin Oncol 22(4):714–724 [1]). We used a combination of content and conversation analysis to examine how opportunities for discussion of health-related quality of life issues are opened up or closed down within the consultation and explore why this may or may not lead to changes in patient management.

Findings

Explicit reference to the PROMs data provided an opportunity for the patient to clarify and further elaborate on the side effects of chemotherapy. High scores on the PROMs data were not explored further if the patient indicated they were not a problem or were not related to the cancer or chemotherapy. Symptomatic treatment was more often offered for problems like nausea, constipation, pain and depression but much less so for fatigue. Doctors discussed fatigue by providing a cause for the fatigue (e.g. the chemotherapy), presenting this as ‘something to be expected’, minimising its impact or moving on to another topic. Chemotherapy regimens were not changed on the basis of the PROMs data alone, but PROMs data were sometimes used to legitimise changes.

Conclusions

Explicit mention of PROMs data in the consultation may strengthen opportunities for patients to elaborate on their problems, but doctors may not always know how to do this. Our findings have informed the development of a training package to enable doctors to optimise their use of PROMs data within the consultation.

Keywords

Patient-reported outcome measures Consultation Qualitative Oncology Conversation analysis 

Notes

Acknowledgments

This study was funded as part of a Programme Grant from Cancer Research UK.

References

  1. 1.
    Velikova, G., Booth, L., Smith, A. B., Brown, P. M., Lynch, P., Brown, J. M., et al. (2004). Measuring quality of life in routine oncology practice improves communication and patient well being—a randomized controlled trial. Journal of Clinical Oncology, 22(4), 714–724.PubMedCrossRefGoogle Scholar
  2. 2.
    Black, N., & Jenkinson, C. (2009). Measuring patients’ experiences and outcomes. BMJ, 339, b2495.PubMedCrossRefGoogle Scholar
  3. 3.
    DoH. (2010). Equity and excellence: Liberating the NHS. London: DH.Google Scholar
  4. 4.
    Santana, M. J., Feeny, D., Johnson, J. A., McAlister, F. A., Kim, D., Weinkauf, J., et al. (2010). Assessing the use of health related quality of life measures in routine clinical care of lung-transplant patients. Quality of Life Research, 19, 371–379.PubMedCrossRefGoogle Scholar
  5. 5.
    Detmar, S. B., Muller, M. J., Schornagel, J. H., Wever, L. D., & Aaronson, N. K. (2002). Health related quality of life assessments and patient–physician communication. JAMA, 288(23), 3027–3034.PubMedCrossRefGoogle Scholar
  6. 6.
    Mathias, S. D., Fifer, S. K., Mazonson, P. D., Lubeck, D. P., Buesching, D. P., & Patrick, D. L. (1994). Necessary but not sufficient: The effect of screening and feedback on outcomes of primary care patients with untreated anxiety. Journal of General Internal Medicine, 9(11), 606–615.PubMedCrossRefGoogle Scholar
  7. 7.
    Dowrick, C. (1995). Does testing for depression influence diagnosis or management by general practitioners? Family Practice, 12(4), 461–465.PubMedCrossRefGoogle Scholar
  8. 8.
    Rubenstein, L. V., McCoy, J. M., Cope, D. W., Barrett, P. A., Hirsch, S. H., Messer, K. S., et al. (1995). Improving patient quality of life with feedback to physicians about functional status. Journal of General Internal Medicine, 10(11), 607–614.PubMedCrossRefGoogle Scholar
  9. 9.
    de Wit, M., Delemarre-van der Waal, H. A., Bokma, J. A., Haasnoot, K., Houdijk, M. C., Gemke, R. J., et al. (2008). Monitoring and discussing health related quality of life in adolescents with type 1 diabetes improves psychosocial well being. Diabetes Care, 31(8), 1521–1526.PubMedCrossRefGoogle Scholar
  10. 10.
    Greenhalgh, J. (2009). The applications of PROs in clinical practice: What are they, do they work and why? Quality of Life Research, 18(2009), 115–123.PubMedCrossRefGoogle Scholar
  11. 11.
    Valderas, J. M., Kotzeva, A., Espallargues, M., Guyatt, G., Ferrans, C. E., Halyard, M. Y., et al. (2008). The impact of measuring patient-reported outcomes in clinical practice: A systematic review of the literature. Quality of Life Research, 17(2), 179–193.PubMedCrossRefGoogle Scholar
  12. 12.
    Marshall, S., Haywood, K. L., & Fitzpatrick, R. (2006). Impact of patient-reported outcome measures on routine practice: A structured review. Journal of Evaluation in Clinical Practice, 12(5), 559–568.PubMedCrossRefGoogle Scholar
  13. 13.
    Greenhalgh, J., Long, A. F., & Flynn, R. (2005). The use of patient reported outcome measures in clinical practice: Lacking an impact or lacking a theory? Social Science and Medicine, 60, 833–843.PubMedCrossRefGoogle Scholar
  14. 14.
    Roter, D. (2000). The enduring and evolving nature of the patient–physician relationship. Patient Education and Counseling, 39(1), 5–15.PubMedCrossRefGoogle Scholar
  15. 15.
    Takeuchi, E. E., Keding, A., Awad, N., Hofmann, U., Campbell, L. J., Selby, P. J., et al. (2011). Impact of patient-reported outcomes in oncology: A longitudinal analysis of patient-physician communication. Journal of Clinical Oncology, 29(21), 2910–2917.PubMedCrossRefGoogle Scholar
  16. 16.
    Heritage, J., & Sorjonen, M. (1994). Constituting and maintaining activities across sequences: And prefacing as a feature of question design. Language in Society, 23, 1–29.CrossRefGoogle Scholar
  17. 17.
    Drew, P., Chatwin, J., & Collins, S. (2001). Conversation analysis: A method for research into interactions between patients and health care professionals. Health Expectations, 4, 58–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Heritage, J., & Maynard, D. W. (2006). Introduction: Analyzing interaction between doctors and patients in primary care encounters. In J. Heritage & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 1–21). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  19. 19.
    Charmaz, K. (2006). Constructing grounded theory. London: Sage.Google Scholar
  20. 20.
    Sacks, H., Schegloff, E. A., & Jefferson, G. (1974). A simplest systematics for the organisation of turn taking for conversation. Language, 50, 696–735.CrossRefGoogle Scholar
  21. 21.
    Heritage, J., & Robinson, J. D. (2006). The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication, 2, 89–102.CrossRefGoogle Scholar
  22. 22.
    Raymond, G. (2003). Grammar and social organization: Yes/no interrogatives and the structure of responding. American Sociological Review, 68, 939–967.CrossRefGoogle Scholar
  23. 23.
    McKevitt, C., & Wolfe, C. (2002). Quality of life: What, how, why? Quality in Aging: Policy, Practice and Research, 3(1), 13–19.Google Scholar
  24. 24.
    Gilbody, S. M., House, A. O., & Sheldon, T. A. (2002). Psychiatrists in the UK do not use outcomes measures. National survey. British Journal of Psychiatry, 180, 101–103.PubMedCrossRefGoogle Scholar
  25. 25.
    Bird, J., & Cohen-Cole, S. A. (1990). The three function model of the medical interview. Advances in Psychosomatic Medicine, 20, 65–88.PubMedGoogle Scholar
  26. 26.
    Donovan, J. L., Frankel, S. J., & Eyles, J. D. (1992). Assessing the need for health status measures. Journal of Epidemiology and Community Health, 47, 158–162.CrossRefGoogle Scholar
  27. 27.
    Mallinson, S. (2002). Listening to respondents: A qualitative assessment of the Short Form 36 health status questionnaire. Social Science and Medicine, 54, 11–21.PubMedCrossRefGoogle Scholar
  28. 28.
    Jenkinson, C., Peto, V., & Coulter, A. (1996). Making sense of ambiguity: Evaluation of internal reliability and face validity of the SF-36 questionnaire in women presenting with menorrhagia. Quality in Health Care, 5, 9–12.PubMedCrossRefGoogle Scholar
  29. 29.
    Rogers, M. S., & Todd, C. J. (2000). The ‘right kind’ of pain: Talking about symptoms in outpatient oncology consultations. Palliative Medicine, 14(4), 299–307.PubMedCrossRefGoogle Scholar
  30. 30.
    Collins, S., de Vogel-Voogt, E., Visser, A., & van der Heide, A. (2008). Presence, communication and treatment of fatigue and pain complaints in incurable cancer patients. Patient Education and Counseling, 72, 102–108.PubMedCrossRefGoogle Scholar
  31. 31.
    Curt, G. A., Breitbart, W., Cella, D., Groopman, J. E., Horning, S. J., Itri, L. M., et al. (2000). Impact of cancer-related fatigue on the lives of patients: New findings from the fatigue coalition. The Oncologist, 5, 353–360.PubMedCrossRefGoogle Scholar
  32. 32.
    Velikova, G., Awad, N., Coles-Gale, R., Wright, E. P., Brown, J. M., & Selby, P. J. (2008). The clinical value of quality of life assessment in oncology practice—a qualitative study of patient and physician views. Psycho-Oncology, 17(7), 690–698.PubMedCrossRefGoogle Scholar
  33. 33.
    Takeuchi, E. E., Harley, C., Shepherd, S., & Velikova, G. (2009). Cancer specialists’ views on assessing psychosocial issues in routine clinical practice. Psycho-Oncology, 18, 309.Google Scholar
  34. 34.
    Reuben, D. B., Borok, G. M., Wolde-Tsadik, G., Ershoff, D. H., Fishman, L. K., Ambrosini, V. L., et al. (1995). A randomized trial of comprehensive geriatric assessment in the care of hospitalized patients. New England Journal of Medicine, 332(20), 1345–1350.PubMedCrossRefGoogle Scholar
  35. 35.
    Greenhalgh, J., Flynn, R., Long, A. F., & Tyson, S. (2008). Tacit and encoded knowledge in the use of standardised outcome measures in multidisciplinary team decision making: A case study of in-patient neurorehabilitation. Social Science and Medicine, 67, 183–194.PubMedCrossRefGoogle Scholar
  36. 36.
    Detmar, S. B., Muller, M. J., Schornagel, J. H., Wever, L. D., & Aaronson, N. K. (2002). Role of health-related quality of life in palliative chemotherapy treatment decisions. Journal of Clinical Oncology, 20(4), 1056–1062.PubMedCrossRefGoogle Scholar
  37. 37.
    Tannenbaum, S. J. (1994). Knowing and acting in medical practice: The epistemological politics of outcomes research. Journal of Health Politics, Policy and Law, 19, 27–44.CrossRefGoogle Scholar
  38. 38.
    Ashley, L., Jones, H., Thomas, J., Forman, D., Newsham, A., Morris, E., et al. (2011). Integrating cancer survivors’ experiences into UK cancer registries: Design and development of the ePOCS system (electronic Patient-reported Outcomes from Cancer Survivors). British Journal of Cancer, 105(Suppl 1), S74–S81.PubMedCrossRefGoogle Scholar
  39. 39.
    Devlin, N. J., & Appleby, J. (2010). Getting the most out of PROMs: Putting health outcomes at the heart of decision making. London: The King’s Fund.Google Scholar
  40. 40.
    Pawson, R., & Tiley, N. (1997). Realistic evaluation. London: Sage.Google Scholar
  41. 41.
    Paul, G. L. (1967). Strategy of outcome research in psychotherapy. Journal of Consulting and Clinical Psychology, 31(12), 109–118.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Joanne Greenhalgh
    • 1
  • Purva Abhyankar
    • 2
  • Serena McCluskey
    • 3
  • Elena Takeuchi
    • 4
  • Galina Velikova
    • 4
  1. 1.School of Sociology and Social PolicyUniversity of LeedsLeedsUK
  2. 2.NMAHP Research UnitUniversity of StirlingStirlingUK
  3. 3.Centre for Health and Social Care Research, Human and Health Research BuildingUniversity of HuddersfieldHuddersfieldUK
  4. 4.St James’s Institute of OncologySt James’s HospitalLeedsUK

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