A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting

Abstract

BackgroundDespite growing interest and urges by leading experts for the routine collection of patient reported outcome (PRO) measures in all general care patients, and in particular cancer patients, there has not been an updated comprehensive review of the evidence regarding the impact of adopting such a strategy on patients, service providers and organisations in an oncologic setting.MethodsBased on a critical analysis of the three most recent systematic reviews, the current systematic review developed a six-method strategy in searching and reviewing the most relevant quantitative studies between January 2000 and October 2011 using a set of pre-determined inclusion criteria and theory-based outcome indicators. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to rate the quality and importance of the identified publications, and the synthesis of the evidence was conducted.ResultsThe 27 identified studies showed strong evidence that the well-implemented PROs improved patient-provider communication and patient satisfaction. There was also growing evidence that it improved the monitoring of treatment response and the detection of unrecognised problems. However, there was a weak or non-existent evidence-base regarding the impact on changes to patient management and improved health outcomes, changes to patient health behaviour, the effectiveness of quality improvement of organisations, and on transparency, accountability, public reporting activities, and performance of the health care system.ConclusionsDespite the existence of significant gaps in the evidence-base, there is growing evidence in support of routine PRO collection in enabling better and patient-centred care in cancer settings.

Feasibility and diagnostic accuracy of the Patient‐Reported Outcomes Measurement Information System (PROMIS) item banks for routine surveillance of sleep and fatigue problems in ambulatory cancer care

“…35,59 The integration of PROs in clinical work flow and its uptake in routine clinical care for management of patients is still in its infancy and little research attention has focused on key success factors of implementation of PROs in clinical care to as recommended by Greenhalgh and colleagues. 60 Our experience in Ontario, Canada supports the need for multifaceted implementation strategies that are tailored based on identified barriers in clinical care and use of change management coaching for facilitating uptake of PROs in the clinical encounter that are Accepted Article 20 informed by knowledge translation approaches. 61 Clinician attitudes that nothing can be done to change fatigue or sleep disturbances in the context of cancer treatment may influence the value they place on usefulness of this data in clinical care.…”

“…A number of systematic reviews have shown that feedback of PROMs data to clinicians may improve communication and the attention paid to symptoms but the effects on health outcomes remains uncertain. 60,61 This lack of an effect has been explained by the lack of attention paid to the complex processes involved to ensure integration of PROMs data in the clinical encounter and for use in clinical decision-making. 64 Attention to the use of knowledge translation Accepted Article 22 theories and strategies in the implementation and uptake of PROMs in clinical practice has been advised.…”

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

“…There are 16 reviews of the quantitative/randomised controlled trial (RCT) literature on the feedback of individual-level PROMs data 24,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] and one review currently in progress. 57 There is also one review of qualitative studies 58 and four mixed-method reviews.…”

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk oncology settings, 42,43,46,55 one review focused on use of PROMs as a means of screening for cancer-related distress 56 and two reviews focused on the use of PROMs feedback in palliative care settings. 59,60 One review focused on feedback of PROMs data to allied health professionals.…”

“…61 Three studies attempted to identify the 'barriers and facilitators' to PROMs feedback in clinical practice; 58,59,61 two reviews adopted a theory-driven approach to the review; 60,62 and one review combined a 'review of reviews' with existing conceptual frameworks of PROMs feedback, but focused on synthesising the quantitative evidence. 43 Thus, there is a large volume of literature examining the impact of individual PROMs feedback in clinical practice, and reviewers have dissected and grouped the literature in a number of different ways, for example by condition or by setting. Furthermore, even for those reviews that have focused on the same condition or setting, differences in search methods and in inclusion and exclusion criteria have resulted in these reviews including overlapping, but different, groups of studies.…”