Electronic Patient-Reported Outcome Measures (ePROMs) Improve the Assessment of Underrated Physical and Psychological Symptom Burden among Oncological Inpatients

Warnecke, E; Comino, Maria Rosa Salvador; Kocol, Dilara; Hosters, Bernadette; Wiesweg, Marcel; Bauer, Sebastian; Welt, Anja; Heinzelmann, Anna; Müller, S. C.; Schüler, Martin; Teufel, Martin; Tewes, Mitra

doi:10.3390/cancers15113029

Cited by 8 publications

(2 citation statements)

References 36 publications

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“…After some refinement of this model, the next steps would be to develop an assessment battery to provide a profile of the patient and carer with respect to the three components and three phases of the model to aid in the implementation of palliative care that optimizes physical, psychological, social and spiritual quality of life outcomes. There are emerging assessment approaches that are specific to palliative care with respect to quality of life [54] and other aspects of palliative care [55] that could be adopted for use with this psychosocial integrative model. However, more work would be needed to integrate self-report measures with regard to satisfaction with the process of optimal matching of the need and provision of support, both from the patient's and carer's perspective.…”

Section: Future Directionsmentioning

confidence: 99%

Integration of Psychosocial Theory into Palliative Care: Implications for Care Planning and Early Palliative Care

Merluzzi,

Salamanca-Balen,

Philip

et al. 2024

Cancers

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Palliative care improves patients’ symptoms, quality of life and family satisfaction with caregiving, reduces hospital admissions and promotes alignment of medical care with the patient’s needs and goals. This article proposes the utility of integrating three psychosocial theories into standard palliative care with implications for care planning, early palliative care and optimizing quality of life. First, Control Theory focuses on the complex juxtaposition of promoting agency/empowerment in patients and carers and coping with often highly uncertain outcomes. Second, Optimal Matching Theory accounts for the alignment of need and provision of care to potentiate the quality of life effects of supportive care in a complex social process involving health care providers, patients and carers. Third, Hope Theory represents a dynamic process, which is marked by variation in the qualities of hope as the patient and carer confront challenges during palliative care. Future work will be translational in nature to adapt both assessment and interventions based on this theoretically driven augmentation of palliative care as well as to evaluate whether it provides a conceptual framework that has incremental utility in palliative care planning.

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Section: Future Directionsmentioning

confidence: 99%

Integration of Psychosocial Theory into Palliative Care: Implications for Care Planning and Early Palliative Care

Merluzzi,

Salamanca-Balen,

Philip

et al. 2024

Cancers

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“…A systematic approach to assessment and monitoring identifies more symptoms. 43 , 44 For both patients and HCPs, it is not always natural to express palliative care needs in words and to discuss them. 45 Patient-reported outcome measures (PROMS) can support HCPs in identifying symptoms and needs of patients and monitoring their severity.…”

Section: Care Content-related Barriersmentioning

confidence: 99%

Healthcare professionals’ perceived barriers in providing palliative care in primary care and nursing homes: a survey study

Kochems,

de Graaf,

Hesselmann

et al. 2023

Palliat�Care

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Background: Palliative care in primary care and nursing home settings is becoming increasingly important. A multidimensional palliative care approach, provided by a multiprofessional team, is essential to meeting patients’ and relatives’ values, wishes, and needs. Factors that hamper the provision of palliative care in this context have not yet been fully explored. Objectives: To identify the barriers to providing palliative care for patients at home or in nursing homes as perceived by healthcare professionals. Design: Cross-sectional survey study. Methods: A convenience sample of nurses, doctors, chaplains, and rehabilitation therapists working in primary care and at nursing homes in the Netherlands is used. The primary outcome is barriers, defined as statements with ⩾20% negative response. The survey contained 56 statements on palliative reasoning, communication, and multiprofessional collaboration. Data were analyzed using descriptive statistics. Results: In total, 249 healthcare professionals completed the survey (66% completion rate). The main barriers identified in the provision of palliative care were the use of measurement tools (43%), consultation of an expert (31%), estimation of life expectancy (29%), and documentation in the electronic health record (21% and 37%). In primary care, mainly organizational barriers were identified, whereas in nursing homes, most barriers were related to care content. Chaplains and rehabilitation therapists perceived the most barriers. Conclusion: In primary care and nursing homes, there are barriers to the provision of palliative care. The provision of palliative care depends on the identification of patients with palliative care needs and is influenced by individual healthcare professionals, possibilities for consultation, and the electronic health record. An unambiguous and systematic approach within the multiprofessional team is needed, which should be patient-driven and tailored to the setting.

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Determining the cut-off value for the Minimal Documentation System (MIDOS2) screening tool to initiate specialized palliative care based on patient’s subjective need for palliative support and symptom burden in inpatients with advanced cancer

Heinzelmann,

Tewes,

Müller

et al. 2024

J Cancer Res Clin Oncol

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Purpose The Minimal Documentation System (MIDOS2) is recommended as a systematic screening tool for assessing symptom burden and patient needs in advanced cancer patients. Given the absence of an optimal weighting of individual symptoms and a corresponding cut-off value, this study aims to determine a threshold based on inpatient’s subjective need for palliative support. Additionally, we investigate the correlation between symptom burden and subjective need for palliative support collected through a patient-reported outcome measure (PROM) with survival duration of less or more than one year. Methods Inpatients diagnosed with advanced solid cancer completed an electronic PROM, which included the MIDOS2 questionnaire among other tools. Differences in symptom burden were analysed between patients expressing subjective need for palliative support and those with survival of less or more than one year using ANOVA, Mann–Whitney-U Test, logistic regression, Pearson and Spearman correlation tests. Cut-off analyses were performed using a ROC curve. Youden-Index, sensitivity, and specificity measures were used as well. Results Between April 2020 and March 2021, 265 inpatients were included in the study. Using a ROC curve, the MIDOS2 analysis resulted in an Area under the curve (AUC) of 0.732, a corresponding cut-off value of eight points, a sensitivity of 76.36% and a specificity of 62.98% in assessing the subjective need for palliative support. The MIDOS2, with double weighting of the significant symptoms, showed a cut-off value of 14 points, achieving a sensitivity of 78.18% and a specificity of 72.38%. A total of 55 patients (20.8%) expressed a need for support from the palliative care team. This need was independent of the oncological tumour entity and increased among patients with a survival of less than one year. These patients reported significantly poorer physical (p < 0.001) or mental (p < 0.001) condition. Additionally, they reported higher intensities of pain (p = 0.002), depressive symptoms (p < 0.001), weakness (p < 0.001), anxiety (p < 0.001), and tiredness (p < 0.001). Conclusion Using the established MIDOS2 cut-off value with an adjusted double weighting in our study, a large proportion of inpatients may be accurately referred to SPC based on their subjective need for palliative support. Additionally, subjective reports of poor general, mental, and physical condition, as well as pain, depressive symptoms, weakness, anxiety, and tiredness, increase the subjective need for palliative support, particularly in patients with a survival prognosis of less than one year.

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Electronic Patient-Reported Outcome Measures (ePROMs) Improve the Assessment of Underrated Physical and Psychological Symptom Burden among Oncological Inpatients

Cited by 8 publications

References 36 publications

Integration of Psychosocial Theory into Palliative Care: Implications for Care Planning and Early Palliative Care

Integration of Psychosocial Theory into Palliative Care: Implications for Care Planning and Early Palliative Care

Healthcare professionals’ perceived barriers in providing palliative care in primary care and nursing homes: a survey study

Determining the cut-off value for the Minimal Documentation System (MIDOS2) screening tool to initiate specialized palliative care based on patient’s subjective need for palliative support and symptom burden in inpatients with advanced cancer

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