Design and feasibility of integrating personalized PRO dashboards into prostate cancer care

Hartzler, Andrea L.; Izard, Jason; Dalkin, Bruce L.; Mikles, Sean P.; Gore, John L.

doi:10.1093/jamia/ocv101

Cited by 62 publications

(66 citation statements)

References 61 publications

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“…The findings from this study can inform the presentation of PRO results at the individual clinic, institutional, or even electronic health record vendor level. They may also inform the development of standards for individual patient PRO data presentation, along with other, smaller studies that have investigated this question …”

Section: Discussionmentioning

confidence: 99%

What do these scores mean? Presenting patient‐reported outcomes data to patients and clinicians to improve interpretability

Snyder

Smith

Bantug

et al. 2017

Cancer

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Background Patient-reported outcomes (PROs) (e.g., symptoms, functioning) can inform patient management. However, patients and clinicians often have difficulty interpreting score meaning. We tested approaches for presenting PRO data to improve interpretability. Methods This mixed-methods study included an internet survey of cancer patients/survivors, oncology clinicians, and PRO researchers circulated via snowball sampling, plus individual in-person interviews. Clinical importance was conveyed using three approaches (presented in random order): normal score range shaded green, red-circled concerning scores, and threshold-line indicating normal vs. concerning scores. Versions also tested two approaches to score directionality: higher=more (better for function, worse for symptoms) and higher=better for both function and symptoms. Qualitative data from online comments and in-person interviews supplemented quantitative results on interpretation accuracy, clarity, and the “most useful” format. Results The survey included 1113 respondents: 627 survivors, 236 clinicians, and 250 researchers, plus 10 patient and 10 clinician purposively-sampled interviewees. Interpretation accuracy ranged from 53%–100%. Formats where higher=better were interpreted more accurately versus higher=more (OR=1.30; 95% CI=1.07–1.58), and were more likely to be rated “very”/“somewhat” clear (OR=1.39; 95% CI 1.13–1.70) and “very” clear (OR=1.36; 95% CI 1.18–1.58). Red-circles were interpreted more accurately than green-shading when the first format seen (OR=1.29; 95% CI=1.00–1.65). Threshold-line formats were more likely to be rated “very” clear than green-shading (OR=1.43; 95% CI=1.19–1.71) and red-circles (OR=1.22, 95% CI=1.02–1.46). Threshold-lines were most often selected as “most useful.” Conclusions These results support presenting PRO data with higher=better directionality and threshold-lines indicating normal vs. concerning scores.

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Section: Discussionmentioning

confidence: 99%

What do these scores mean? Presenting patient‐reported outcomes data to patients and clinicians to improve interpretability

Snyder

Smith

Bantug

et al. 2017

Cancer

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“…Yet it is increasingly recognized that PROMS should also be discussed with patients in routine medical encounters. 42,64,73 Such use has been theorized to (a) increase patients' motivation to complete PROMs 60 ; (b) improve management and monitoring of patients' problems 25,[74][75][76] ; (c) improve doctor-patient communication 25,77 ; and (d) improve SDM and informed patient decisions .. 39,40,42,74 PROMs are typically made available in the medical encounter through electronic health records and dashboards, 78,79 displaying individual, N = 1, PROMs scores of patients over time. There is not much experience yet on the merits of using PROMs in medical encounters, but the mere collection of PROMs is known to increase awareness of patients' concerns 80,81 and to enhance patient-provider communication.…”

Section: Use Of Proms In Medical Encounters With Patientsmentioning

confidence: 99%

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Damman

Jani

Jong

et al. 2019

Evaluation Clinical Practice

113

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Background The recent emphasis on value‐based health care (VBHC) is thought to provide new opportunities for shared decision‐making (SDM) in the Netherlands, especially when using patient‐reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. Aim To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. Approach Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. Results The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. Conclusion Successful implementation of SDM within VBHC initiatives may not be self‐evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time‐consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.

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“…Dashboards can quickly communicate information about decision alternatives by presenting factors which might matter to make decisions for its end users. In the context of VBHC, the use of the dashboard to display different health outcomes and costs can help health workers to provide better care [17]- [19] and make more value-driven decisions. Furthermore, it would let patients see various treatments' outcomes/costs (value), and it allows them to see their short and long-term health status in a user-friendly format.…”

Section: Dashboard In Value-based Healthcarementioning

confidence: 99%

“…Furthermore, it would let patients see various treatments' outcomes/costs (value), and it allows them to see their short and long-term health status in a user-friendly format. Consequently, the use of dashboards can increase patients' satisfaction, selfefficacy and involvement in decision making (decisions concern to treatments types and follow up care) [4], [17], [19]- [21]. Guided by the VBHC principle, the design and use of information technology and decision aid tools, such as dashboards need to support the following elements.…”

Section: Dashboard In Value-based Healthcarementioning

confidence: 99%

Investigating Analytics Dashboards’ Support for the Value-based Healthcare Delivery Model

Mashinchi¹,

Ojo²,

Sullivan³

2020

Proceedings of the Annual Hawaii International Conference on System Sciences

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Improving the value of care is one of the essential aspects of Value-Based Healthcare (VBHC) model today. VBHC is a new HC delivery model which is centered on patient health outcomes and improvements. There is anecdotal evidence that the use of decision aid tools like dashboards can play a significant role in the successful implementation of VBHC models. However, there has been little or no systematic studies and reviews to establish the extent to which analytics dashboards are used to support patient care in a VBHC delivery context. This paper bridges this knowledge gap through a systematic review of the existing literature on dashboards in the HC domain. Our study reveals dashboard capabilities as an enabling tool for value improvements and provides insight into the design of dashboards. This study concludes by highlighting a few gaps, question, and need for research in the future.The need for HC services is rising due to growing global demand and population, the burden of increasingly complicated chronic disease [8]. With

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Design and feasibility of integrating personalized PRO dashboards into prostate cancer care

Abstract: PRO dashboards are a promising approach for integrating patient-generated data into prostate cancer care. Informed by human-centered design principles, this work establishes guidance on dashboard content, tailoring, and clinical use that patients and providers find meaningful.

Cited by 62 publications

References 61 publications

What do these scores mean? Presenting patient‐reported outcomes data to patients and clinicians to improve interpretability

What do these scores mean? Presenting patient‐reported outcomes data to patients and clinicians to improve interpretability

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Investigating Analytics Dashboards’ Support for the Value-based Healthcare Delivery Model

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