Starting from scratch: implementing outcome measurement in clinical practice

Abstract

Outcome measurement is becoming increasingly important in palliative care both in research as well as clinical care. Regular ongoing assessments in palliative care clinical practice have the potential to enable monitoring of the patient's situation, assess the effectiveness of interventions, assess symptoms accurately and focus on patients' priorities. Implementing routine outcome measurement into clinical practice remains a challenge. Therefore, the aim of this article is to describe the process of implementing routine outcome measurement into daily clinical work in a university palliative care unit. According to the recommendations of Antunes, the following steps were used to implement routine outcome measurement in clinical care in a university palliative care unit. (I) Selection of outcomes of interest by the clinical leads and head of department: most prevalent symptoms; psychological, practical and spiritual concerns, functional status, carer burden; (II) selection of outcome measures: Integrated Palliative Care Outcome Scale (IPOS), phase of illness, Australian Karnofsky Performance Status; (III) educational component about the measure and how to use results: team meetings and team retreat with introduction of outcome measurement in palliative care, chosen measures and role plays with use of measures; (IV) selection of responsible consultant on the ward as coordinator and facilitator for outcome measurement; (V) who applies the measure and its periodicity. Implementation of outcome measurement in clinical routine is feasible following a structured process. Nevertheless, it is a time consuming and long-lasting process which needs continuous attention. However, the benefits outweigh the burden of implementation and it is a task worthwhile undertaking.

Implementing person-centred outcome measures in palliative care: An exploratory qualitative study using Normalisation Process Theory to understand processes and context

“…15 Consequently, there has been calls for theoretical development in outcome measure implementation within palliative care. 8,10,[16][17][18] Implementation theories go beyond description by providing comprehensive and generalisable explanations of individual, organisational, and structural mechanisms underpinning implementation, including how, why and in which contexts specific relationships between barriers/ enablers might improve implementation effectiveness. 15 They offer an opportunity to 'move the field beyond simply identifying barriers and enablers of [outcome measure] implementation' by proactively specifying 'practical steps in translating research evidence into practice'.…”

Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure

“…23 The IPOS is widely accepted among patients with advanced diseases, 23 responsive to change, 24 and established in clinical care and research for cancer and non-cancer patients. 22,25,26 A version for staff and informal caregivers allows for the assessment of patient-centred outcomes also in cognitively impaired, extremely ill or dying patients. 27 The POS successfully assessed the PC needs of HF patients with breathlessness.…”

Systematic symptom and problem assessment at admission to the palliative care ward – perspectives and prognostic impacts

“…In addition, patients' self-assessment of multidimensional symptoms and problems (patient-reported outcomes: PROs) also grew in importance over the last years. Several studies have highlighted the relevance of incorporating patient perspectives alongside those of clinicians when developing palliative care measures [1][2][3][4][5]. A previous study demonstrated significant differences between patients' and physicians' ratings in specific symptoms even when using identical scales, underlining the importance of this double assessment and especially the need for obtaining self-assessments [6].…”