Integration of clinical and patient-reported outcomes in surgical oncology

Macefield, Rhiannon; Avery, Kerry; Blazeby, Jane

doi:10.1002/bjs.8989

Cited by 29 publications

(22 citation statements)

References 56 publications

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“…It is thought to be the most broadly applicable and reliable tool for patient-reported clinical pain assessment, 29 and is included in recommendations for perioperative care from the American Society of Anesthesiologists Task Force on Pain Management. 30 With increasing interest in patient-reported outcomes in surgery, 4,31 the insight into patients' experiences with this measure probably outweighs any loss of clinical precision. Further, by evaluating practices by hospital, rather than by the individual patient level, the reliability of measures is substantially more stable and less susceptible to confounding by indication and selection bias.…”

Section: Discussionmentioning

confidence: 99%

Hospital Analgesia Practices and Patient-reported Pain After Colorectal Resection

et al. 2016

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Objective The aim of the study was to characterize patient-reported outcomes of analgesia practices in a population-based surgical collaborative. Background Pain control among hospitalized patients is a national priority and effective multimodal pain management is an essential component of postoperative recovery, but there is little understanding of the degree of variation in analgesia practice and patient-reported pain between hospitals. Methods We evaluated patient-reported pain scores after colorectal operations in 52 hospitals in a state-wide collaborative. We stratified hospitals by quartiles of average pain scores, identified hospital characteristics, pain management practices, and clinical outcomes associated with highest and lowest case-mix-adjusted pain scores, and compared against Hospital Consumer Assessment of Healthcare Providers and Systems pain management metrics. Results Hospitals with the lowest pain scores were larger (503 vs 452 beds; P<0.001), higher volume (196 vs 112; P=0.005), and performed more laparoscopy (37.7% vs 27.2%; P<0.001) than those with highest scores. Their patients were more likely to receive local anesthesia (31.1% vs 12.9%; P<0.001), nonsteroidal anti-inflammatory drugs (33.5% vs 14.4%; P<0.001), and patient-controlled analgesia (56.5% vs 22.8%; P<0.001). Adverse postoperative outcomes were less common in hospitals with lowest pain scores, including complications (20.3% vs 26.4%; P<0.001), emergency department visits (8.2% vs 15.8%; P<0.001), and readmissions (11.3% vs 16.2%; P=0.01). Conclusions Pain management after colorectal surgery varies widely and predicts significant differences in patient-reported pain and clinical outcomes. Enhanced postoperative pain management requires dissemination of multimodal analgesia practices. Attention to patient-reported outcomes often omitted from surgical outcomes registries is essential to improving quality from the patient's perspective.

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Section: Discussionmentioning

confidence: 99%

Hospital Analgesia Practices and Patient-reported Pain After Colorectal Resection

et al. 2016

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“…41,42 In contrast, patients’ and surgeons’ global assessments of surgical outcomes and postoperative quality of life often diverge in important ways. 40 With increasing interest in patient-reported outcomes in surgery and cancer care, 43 the insight into patients’ perceptions and experiences in our survey probably outweighs any loss of clinical precision.…”

Section: Discussionmentioning

confidence: 99%

The effect of complications on the patient-surgeon relationship after colorectal cancer surgery

Regenbogen

Veenstra

Hawley

et al. 2014

Surgery

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Background Trust in physicians is an essential part of therapeutic relationships. Complications are common after colorectal cancer procedures, but little is known of their effect on patient-surgeon relationships. We hypothesized that unexpected complications impair trust and communication between patients and surgeons. Methods We performed a population-based survey of surgically diagnosed stage III colorectal cancer patients in the Surveillance Epidemiology and End Results registries for Georgia and Metropolitan Detroit between August 2011 and October 2012. Using published survey instruments, we queried subjects about trust in and communication with their surgeon. The primary predictor was the occurrence of an operative complication. We examined patient factors associated with trust and communication then compared the relationship between operative complications and patient-reported trust and communication with their surgeons. Results Among 622 preliminary respondents (54% response rate), 25% experienced postoperative complications. Those with complications were less likely to report high trust (73% vs 81%, P = .04) and high-quality communication (80% vs 95%, P < .001). Complications reduced trust among only 4% of patient-surgeon dyads with high-quality communication, whereas complications diminished patients’ trust in 50% with poorer communication (P < .001). After controlling for communication ratings, we found there was no residual effect of complications on trust (P = .96). Conclusion Most respondents described trust in and communication with their surgeons as high. Complications were common and were associated with lower trust and poorer communication. However, the relationship between complications and trust was modified by communication. Trust remained high, even in the presence of complications, among respondents who reported high levels of patient-centered communication with their surgeons.

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“…9,[18][19][20][21] Multiple studies confirm that clinical integration of PROs does not increase the duration of clinic visits, that provider and patient satisfaction is high, and that all parties feel their use improves communication. 12,19,20,[22][23][24] The successful use of PROs in outpatient orthopedic surgery clinics highlights the feasibility of use in busy outpatient settings and the benefit in clinical decision making.…”

Section: Pro Use In Clinical Practice Is Feasible and Beneficialmentioning

confidence: 99%