Patient-Reported Outcomes in Cardiothoracic Surgery

Abstract

PROs are integral to patient-centered health care delivery. Outcomes that are meaningful to patients extend beyond traditionally reported measures of survival and morbidity [3]. These often include determinants of HRQoL [1, 4]. Although commonly measured outcomes, including long-term survival and perioperative complications, are important to patients, they often provide an incomplete picture of what patients value and undermine the decision-making power they have about their care. For example, when choosing two treatment options for lung cancer, a patient may value posttreatment functional status, pain quality, and time off from work as important aspects for consideration along with traditional measures [5]. PRO measures are reported directly by patients and are an important way for obtaining accurate data on patient

Patient reported outcomes: integration into clinical practices

“…Several well-validated cancer-specific questionnaires are available for use as well (Table 1). For example, the Rotterdam symptom checklist (RSCL) was designed for oncology patients and measures both the physical and psychological aspects of the quality of life (1,15). In a randomized control trial comparing transthoracic and transhiatal esophagectomy; in addition to tumor stage postoperative social functioning and patient reported activity level, measured with the SF-20 and the RSCL, were found to be independent predictors of survival (16).…”

“…Patient reported outcomes (PRO) have been demonstrated to improve physician-patient communication, help in addressing patient symptoms, and improve patients' quality of life. PROs have also been identified as an independent prognostic marker of survival in both esophageal and lung cancer (1)(2)(3)(4)(5). To this end, there has been increasing utilization of PRO and health-related quality of life metrics (HR-QOL) in thoracic surgery research.…”

The clinical decision algorithm: If it's too complicated, we won't remember it, if it's too hard, we won't use it

“…However, in addition to hard clinical end points, we also need to know the influence on patient-reported outcomes. 4,5 A scoring system that predicts protracted in-hospital stays, rehospitalization, and thus utilization costs such as the CAF would be of value but will require larger validation with patient-reported outcomes. An ideal score would be fast, simple to perform on the wards or in an outpatient clinic, and would fit on a single screen of a smartphone.…”

Expanding enhanced recovery protocols for cardiac surgery to include the patient voice: a scoping review protocol

“…Advances in perioperative care (i.e., care before, during, and after surgery) have contributed to ongoing reductions in mortality and complication rates following cardiac surgery in increasingly older, vulnerable adults [2][3][4]. While these "hard" outcomes are of significant value, it is becoming increasingly evident that attention also needs to be given to enhancing recovery of patients after surgery through, for example, a focus on patient-centered outcomes (i.e., functional capacity and rehospitalization rates) and health-related quality of life [5]. Patients typically spend between 4 and 7 days in hospital following a noncomplicated cardiac surgery procedure, during which time they are monitored for postoperative infections, cardiac dysrhythmias, renal dysfunction, delirium, and other complications [6,7].…”