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Patient-reported outcome use in oncology: a systematic review of the impact on patient-clinician communication

Abstract

Purpose

Patient-reported outcomes (PROs) are an increasingly popular tool to optimize care and bridge the gap between patient experience and clinician understanding. The aim of this review was to identify mechanisms through which PROs facilitate patient-clinician communication in the adult oncology population.

Methods

We conducted a systematic review of the published literature using the following data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Cab Direct, and CDSR. Studies included in this review reported on the outcomes of PRO use, used PROs as an intervention and not as a study outcome measurement tool, included cancer patients or survivors as study participants, and analyzed patient-clinician communication.

Results

We identified 610 unique records, of which 43 publications met the inclusion and exclusion criteria. Synthesis of the reviewed studies provided evidence of the usefulness of PROs in facilitating patient-clinician communication on a variety of topics. We identified mechanisms though which PROs influenced patient-clinician communication to include increasing symptom awareness, prompting discussion, streamlining consultations, and facilitating inter-professional communication. Barriers to PRO use in communication improvement include technical problems impeding its administration and completion, compliance issues due to lack of incentive or forgetfulness, and use of PROs that do not appropriately assess issues relevant to the patient. Facilitators include increased education on PRO use, using PRO tools that patients find more acceptable, and providing patient data summaries in an easily accessible format for clinicians.

Conclusions

Our review suggests that PROs facilitate patient-clinician communication through various mechanisms that could perhaps contribute to improvements in symptom management and survival. The impact of PROs on clinical outcomes, however, remains poorly studied.

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Acknowledgements

We thank Katherine Miller (UBC), for her contributions to creating and editing the search strategy used in this review.

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Corresponding author

Correspondence to R. A. Olson.

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The authors declare that they have no conflicts of interest.

Appendix. Search strategy

Appendix. Search strategy

CDSR was searched using the OvidSP interface on August 8, 2016, for publications prior to July 2016, with an adult population and published in English.

1 cancer*.ab,ti.

2 tumo?r.ab,ti.

3 neoplasm*.ab,ti.

4 oncolog*.ab,ti.

5 carcinoma*.ab,ti.

6 lymphoma*.ab,ti.

7 sarcoma*.ab,ti.

8 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7.

9 PROM.

10 PROMIS.

11 PROMs.

12 patient reported outcome*.

13 (self or patient*) adj1 (questionnaire* or report*).

14 9 OR 10 OR 11 OR 12 OR 13.

15 communicat*.

16 (patient* adj6 (provider* or physician* or clinician* or nurse* or oncologist*) adj6 (interaction* or communication* or discuss*)).mp.

17 15 OR 16.

#18 8 and 14 and 17.

CINAHL was searched using the EBSCO interface on July 14, 2016, for publications prior to July 2016.

1 cancer*.

2 tumo?r.

3 carcinoma*.

4 lymphoma*.

5 sarcoma*.

6 (MH “Neoplasms+”).

7 (MH “Oncology+”).

8 (MH “Cancer Patients”).

9 (MH “Cancer Survivors”).

10 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9.

11 PROM.

12 PROMIS.

13 Patient reported outcome.

14 self N1 report N1 questionnaire.

15 (MH “Outcome Assessment”).

16 (MM “Questionnaires+”).

17 (MM “Scales”).

18 (MM “Severity of Illness Indices”).

19 (MM “Short Form-36 Health Survey”).

20 (MM “Self Report”).

21 S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21.

22 communication.

23 (MH “Communication+”).

24 (MH “Physician-Patient Relations”) OR (MH “Nurse-Patient Relations”).

25 (patient* N2 (provider* or physician* or clinician* or nurse* or oncologist*) N2 (interaction* or communication* or discuss*)).

26 S22 OR S23 OR S24 OR S25.

27 S10 AND S21 AND S26.

28 Limit 27 by english, all adult.

EMBASE was searched using the OvidSp interface on July 14, 2016, for publications prior to July 2016.

1 cancer*.ab,ti.

2 tumo?r.ab,ti.

3 carcinoma*.ab,ti.

4 lymphoma*.ab,ti.

5 sarcoma*.ab,ti.

6 neoplasm*.ab,ti.

7 oncolog*.ab,ti.

8 Oncology/.

9 Cancer Patient/.

10 Neoplasm/.

11 or/ 1–10.

12 PROM.

13 PROMs.

14 PROMIS.

15 patient reported outcome*.

16 patient* outcome* measure*.

17 self report adj1 (questionnaire or measure).

18 Health Assessment/.

19 Exp *Questionnaire/.

20 *Self Report/.

21 Exp *Health Survey/.

22 or/ 12–21.

23 (patient* adj2 (provider* or physician* or clinician* or nurse* or oncologist*) adj2 (interaction* or communication* or discuss*)).mp.

24 Nurse Patient Relationship/.

25 Doctor Patient Relation/.

26 Interpersonal Communication/.

27 communication.mp.

28 or/ 23–28.

29 11 and 22 and 28

30 limit 29 to (adult <18 to 64 years > or aged <65+ years>).

31 limit 30 to (human and english language).

MEDLINE was searched using the OvidSp interface on July 14, 2016, for publications prior to July 2016.

1 cancer*.ab,ti.

2 tumo?r.ab,ti.

3 carcinoma*.ab,ti.

4 lymphoma*.ab,ti.

5 sarcoma*.ab,ti.

6 neoplasm*.ab,ti.

7 oncolog*.ab,ti.

8 Exp Neoplasms/.

9 Exp Medical Oncology/.

10 or/ 1–9.

11 PROM.

12 PROMs.

13 PROMIS.

14 patient reported outcome*.

15 patient* outcome* measure*.

16 self report adj1 (questionnaire or measure).

17 Exp *Health Status Indicators/.

18 *Questionnaires/.

19 *Psychometrics/.

20 Self Report/.

21 Health Surveys/.

22 or/ 11–21.

23 Communication/ or communication.mp.

24 (patient* adj2 (provider* or physician* or clinician* or nurse* or oncologist*) adj2 (interaction* or communication* or discuss*)).mp.

25 Exp Professional-Patient Relations.

26 or/ 23–25.

27 and/ 10,22,26.

28 limit 27 to english.

29 limit 28 to human.

30 limit 29 to “all adult (19 plus years)”.

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Yang, L.Y., Manhas, D.S., Howard, A.F. et al. Patient-reported outcome use in oncology: a systematic review of the impact on patient-clinician communication. Support Care Cancer 26, 41–60 (2018). https://doi.org/10.1007/s00520-017-3865-7

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Keywords

  • Oncology
  • Patient-reported outcomes
  • Patient-reported outcome measures
  • Barriers to use
  • Physician-patient communication
  • Systematic review