Assessment is not enough: a randomized controlled trial of the effects of HRQL assessment on quality of life and satisfaction in oncology clinical practice

Abstract

The potential benefits of health-related quality of life (HRQL) assessment in oncology clinical practice include better detection of problems, enhanced disease and treatment monitoring and improved care. However, few empirical studies have investigated the effects of incorporating such assessments into routine clinical care. Recent randomized studies have reported improved detection of and communication about patients' concerns, but few have found effects on patient HRQL or satisfaction. This study examined whether offering interpretive assistance of HRQL results would improve these patient outcomes. Two hundred and thirteen participants with metastatic breast, lung or colorectal cancer were randomly assigned to one of three conditions: usual care; HRQL assessment or HRQL assessment followed by a structured interview and discussion. Interviews about patients' assessment responses were conducted by a research nurse, who then presented HRQL information to the treating nurse. HRQL and treatment satisfaction outcomes were assessed at 3 and 6 months. No significant differences were found between study conditions in HRQL or satisfaction. Results suggest that routine HRQL assessment, even with description of results, is insufficient to improve patient HRQL and satisfaction. It is suggested that positive effects may require supplementing assessment results with specific suggestions for clinical management changes.

Using guided individualised feedback to review self-reported quality of life in health and its importance

“…However, this is consistent with previous studies investigating the effects of QoL assessments with outcome measures other than the WHOQOL-BREF, for example the Functional Assessment of Cancer Therapy (FACT), Palliative Care Quality of Life Index (PQLI) and the Functional Living Index (FLIC) (Hilarius et al, 2008;Mills et al, 2009;Rosenbloom et al, 2007). In the present study it is possible that there were changes but these were not detected by the measures we used.…”

“…This represents an intervention in its own right, and evidence for its efficacy is contradictory. While some studies found no effects (Hilarius et al, 2008;Rosenbloom et al, 2007;Santana et al, 2010), others provide limited evidence of positive outcomes such as improved emotional wellbeing (Velikova et al, 2004), disease-specific QoL and mental QoL (Gutteling et al, 2008), behavior, psychosocial health and family activities (De Wit et al, 2008). Although indicating that QoL feedback is an important mechanism whereby wellbeing can be influenced, the exact process remains unclear, as feedback methods vary widely.…”

“…Although person-centred studies have examined the effects of QoL assessment on individual patient satisfaction (De Wit et al, 2008;Gutteling et al, 2008;Hilarius, Kloeg, Gundy, & Aaronson, 2008;Mills, Murray, Johnston, Cardwell, & Donnelly, 2009;Rosenbloom, Victorson, Hahn, Peterman, & Cella, 2007), few have specifically examined whether patients' QoL can improve as an consequence of completing a QoL measure and receiving feedback about it. This represents an intervention in its own right, and evidence for its efficacy is contradictory.…”

Effects of screening for psychological distress on patient outcomes in cancer: A systematic review

“…Indeed, with the exception of 1 study [52], all of the studies included in these reviews were excluded from the current review for a number of reasons (see Table 4 for excluded distress screening studies). Five studies [26,[54][55][56][57] screened for multiple problems at the same time (i.e., fatigue, pain, perceived support, and psychological distress), which made it impossible to assess the specific effects of screening for psychological distress. One of those studies [26] screened simultaneously for multiple problems with substantially different possible care responses (e.g., psychological distress, pain, fatigue, weight change, transportation, parking, drug coverage, finances).…”

“…It was not possible, however, to determine in this study how many patients screened positive for psychological distress versus other practical or logistical issues, such as difficulties with transportation, parking, drug coverage, or finances, none of which would be best managed through psychological intervention. Six studies [55][56][57][58][59][60] did not use a defined cutoff score to indicate a positive screen for heightened distress or to determine which patients would receive further assessment or treatment. In addition, 6 of the studies [58,[60][61][62][63][64] were not RCTs, but were, for example, sequential cohort designs.…”