Quality of Life Research

, Volume 25, Issue 11, pp 2833–2843 | Cite as

The development and acceptability of symptom management quality improvement reports based on patient-reported data: an overview of methods used in PROSSES

  • Alyssa Troeschel
  • Tenbroeck Smith
  • Kathleen Castro
  • Katherine Treiman
  • Joseph Lipscomb
  • Ryan M. McCabe
  • Steven Clauser
  • Eliot L. Friedman
  • Patricia D. Hegedus
  • Kenneth Portier



Patient experiences with symptom care need to be assessed and documented to ensure successful management of cancer-related symptoms. This paper details one method for creating symptom management quality improvement (SMQI) reports, including case-mix adjustment of patient-reported measures. Qualitative data regarding the acceptability of these reports at participating cancer centers (CCs) are also provided.


Data were collected from 2226 patients treated at 16 CCs via mailed/Web questionnaires. Twelve items assessing patient perceptions of symptom management—pain, fatigue, emotional distress—served as key quality indicators. Medico-demographic variables suitable for case-mix adjustment were selected using an index score combining predictive power and heterogeneity across CCs. SMQI reports were designed with staff feedback and produced for each CC, providing crude and adjusted CC-specific rates, along with study-wide rates for comparison purposes.


Cancer type and participant educational level were selected for case-mix adjustment based upon high index scores. The Kendall rank correlation coefficient showed that case-mix adjustments changed the ranking of CCs on the key quality indicators (% Δ rank range: 5–22 %). The key quality indicators varied across CCs (all p < 0.02). SMQI reports were well received by CC staff, who described plans to share them with key personnel (e.g., cancer committee, navigator).


This paper provides one method for creating hospital-level SMQI reports, including case-mix adjustment. Variation between CCs on key quality indicators, even after adjustment, suggested room for improvement. SMQI reports based on patient-reported data can inform and motivate efforts to improve care through professional/patient education and applying standards of care.


Cancer Patient-reported outcomes Quality improvement reports Case-mix adjustment Symptom management 



The authors are grateful for the contributions of the patients and clinicians who participated in this study. We appreciate contributions from the PROSSES Study Group: M Sitki Copur, MD, FACP; Kendra E. Johnson, MPH, CTR; Kevin Yiee, MD, MPH; Patricia Swanson, BSN; Kristi Olesen, BSBA; Mildred Nunez Jones, CTR, BA; Michaela Sherbeck, RN, BSN, OCN, CCR. We thank Rose Menton and Lance Grove for their data collection from St. Joseph- Towson; Andrew Salner, Susan Wright and Donna Handley from Hartford Hospital; James Bearden and Lucy Gansauer from Spartanburg Regional Hospital; Craig Schulz and Nichole Nikolic from Columbia St. Mary; David Hanson, Renea Duffin, and Linda Lee from Our Lady of the Lake Regional Medical Center; John Schallenkamp, Jo Duszkiewicz and Sarah Porter-Osen from Billings Clinic; Jay Harness and Pam Hockett from St. Joseph’s Hospital- Orange; and Debbie Salas-Lopez, Suresh Nair and Keith Weinhold from Lehigh Valley Hospital. Deborah Hill, from Leidos Biomedical Research, Inc. and Connie Hobbs, from RTI International, provided important study-related communication and administration tasks. We also acknowledge Kevin Stein, Elizabeth Ward, Otis Brawley and the American Cancer Society Mission Outcomes Committee for strategic advice.


This project has been funded by the American Cancer Society Intramural Research Department and with Federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. The content of this publication does not necessarily reflect the views of policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11136_2016_1305_MOESM1_ESM.docx (39 kb)
Supplementary material 1 (DOCX 38 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Alyssa Troeschel
    • 1
  • Tenbroeck Smith
    • 1
  • Kathleen Castro
    • 2
  • Katherine Treiman
    • 3
  • Joseph Lipscomb
    • 4
  • Ryan M. McCabe
    • 5
  • Steven Clauser
    • 6
  • Eliot L. Friedman
    • 7
  • Patricia D. Hegedus
    • 8
  • Kenneth Portier
    • 1
  1. 1.Intramural Research DepartmentAmerican Cancer SocietyAtlantaUSA
  2. 2.Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  3. 3.Research Triangle InstituteResearch Triangle ParkDurhamUSA
  4. 4.Rollins School of Public Health and Winship Cancer InstituteEmory UniversityAtlantaUSA
  5. 5.American College of SurgeonsChicagoUSA
  6. 6.Patient-Centered Outcomes Research InstituteWashingtonUSA
  7. 7.Lehigh Valley Health NetworkAllentownUSA
  8. 8.Gibbs Cancer Center and Research InstituteSpartanburgUSA

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