Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: main results of a cluster preference randomised controlled trial

Abstract

Purpose The patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL). Methods A pragmatic cluster preference randomised control trial with 15 consultants, 8 ‘using’ and 7 ‘not using’ the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible. Results Consultants saw a median (inter-quartile range) 16 (13–26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (− 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time. Conclusion This novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.

An Economic Evaluation Supported by Qualitative Data About the Patient Concerns Inventory (PCI) versus Standard Treatment Pathway in the Management of Patients with Head and Neck Cancer

“…Clinical-effectiveness results of the PCI intervention are published elsewhere [ 12 ] (see Appendix 1 for the summary) and indicated that length of the consultation time had a tendency to reduce with subsequent use of the PCI in comparison with the non-PCI group.…”

“…The list serves to guide the outpatient consultation and covers a range of symptoms and potential problems patients may face after treatment. It has been shown to be feasible in routine consultations [ 11 , 12 ] and for wider adoption across a cancer network [ 13 ]. The PCI is freely available online ( http://www.patient-concerns-inventory.co.uk ).…”

Health related quality of life and patient concerns in patients with osteoradionecrosis

“…(17) Patients appreciate the opportunity to raise their issues, and inclusion of the PCI is a low-cost intervention which in a randomised trial setting has indicated improvements in QOL and socio-emotional dysfunction. (18) The UW-QOL version 4 consists of 12 domains scaled from 0 (worst) to 100 (best) according to response hierarchy. (16) UW-QOL domains are presented within two subscales, physical function and social-emotional function with each subscale score being the mean of six domain scores.…”

Which Head and Neck Cancer Patients Are Most at Risk of High Levels of Fear of Cancer Recurrence

“…A systematic review and content comparison of unmet needs self-report measures favored the PCI over 13 other tools (Shunmugasundaram et al, 2019). In a randomized trial the PCI has been shown to be a low-cost intervention which is feasible in routine clinical practice and is associated with a positive effect on QoL and socio-emotional dysfunction (Rogers et al, 2020).…”

“…Although the PCI can help to identify the frequency of FCR (Rogers et al, 2010a;Kanatas et al, 2012;Ghazali et al, 2013), thus far specific details of which kind of patient is most at risk are lacking. The PCI randomized trial (Rogers et al, 2020) has given an opportunity to evaluate in much greater depth the issue of FCR and this is of particular merit as the trial is based in standard practice and involved 15 consultant HNC surgeons. Hence, the aim of this study is to describe the demographic background and clinical characteristics for those HCN patients who indicate a high level of FCR in their review consultation.…”