Feasibility and acceptability of the use of patient-reported outcome measures (PROMs) in the delivery of nurse-led supportive care to people with colorectal cancer

Abstract

Purpose Logistical issues pertinent to the use of patient-reported outcome measures (PROMs) by colorectal cancer nurse specialists (CNS) to identify the needs of people with colorectal cancer (CRC) in acute care remain unknown. We explored the feasibility and acceptability of PROMs-driven, CNS-led consultations to enhance delivery of supportive care to people with CRC completing adjuvant chemotherapy. Methods A systematic literature review and focus groups with patients and CNS (Phase 1) were followed by a repeated-measures, exploratory study (Phase 2), whereby pre-consultation PROM data were collected during three consecutive, monthly consultations, and used by the CNS to enable delivery of personalised supportive care. Results Based on Phase 1 data, the Supportive Care Needs Survey was selected for use in Phase 2. Fourteen patients were recruited (recruitment rate: 56%); thirteen (93%) completed all study assessments. Forty in-clinic patient-clinician consultations took place. At baseline, 219 unmet needs were reported in total, with a notable 21% (T2) and 32% (T3) over-time reduction. Physical/daily living and psychological domain scores declined from T1 to T3, yet not statistically significantly. In exit interviews, patients described how using the PROM helped them shortlist and prioritise their needs. CNS stressed how the PROM helped them tease out more issues with patients than they would normally. Conclusions Nurse-led, PROMs-driven needs assessments with patients with CRC appear to be feasible and acceptable in clinical practice, possibly associated with a sizeable reduction in the frequency of unmet needs, and smaller decreases in physical/daily living and psychosocial needs in the immediate post-chemotherapy period

What is needed by staff to implement PROMs into routine oncology care? A qualitative study with the multi‐disciplinary team

“…Specific strategies for making the PROMs data usable, also consistent with the published literature, were that staff wanted to be able to readily access this data and that it is presented in a “clear, appropriate, accurate, consistent way” (Hunter et al, ; Kotronoulas et al, ; Kwan et al, ). Any complexity acts as a barrier to patient care and workflow (Boyce et al, ; Hahn et al, ; Knox, ).…”

“…Research published in academic journals and from international financial audits shows that the failure rate for implementing of innovations into health care is 50%-90% (Hardy-Vallee, 2012;Hunter et al, 2015;Jahn, 2016). Most fail because they do not bring value, nor acknowledge the experiential knowledge of staff, the needs of consumers and the evidence that is already in place (Hughes et al, 2003;Kaplan & Harris-Salamone, 2009;Kotronoulas, Papadopoulou, MacNicol, Simpson, & Maguire, 2017). Active facilitation has been shown to increase the success of implementation of new technological innovations into the health sector (Baskerville, Liddy, & Hogg, 2012;Harvey, Llewellyn, Maniatopoulos, Boyd, & Proctor, 2018).…”

What are the attitudes of health professionals regarding patient reported outcome measures (PROMs) in oncology practice? A mixed-method synthesis of the qualitative evidence

“…Where PROMs were completed prior to a consultation, this could aid HP preparation [27,32,33,36] and promote careful reflection on the part of patients [52,55]. PROMs were also a means to structure consultations and interactions, and aided to prioritise issues of importance [10,29,37,40,42,43,50,57] (see also "Attitudes to the care experience"). Some studies [31,42,48,49] noted that HPs also saw PROMs as prompting patients to identify and prioritise issues from their own perspectives: "Actually, it [using the questionnaire] meant that we talked about issues which we wouldn't otherwise have touched upon because she hadn't thought of it, and I usually don't ask about it / … / it…”

“…Concerns Checklist "The aim of the study is to explore how specialist cancer nurses carry out first Items from PRO-CTCAE and PROMIS and authors own "Our primary objectives were the following: (1) solicit feedback from cancer clinicians and patients to develop a web- Sensitive issues A few studies (n = 6) reported that PROMs could "facilitate open dialogue and discussion of sensitive topics" [29] (p776), related to issues that could be potentially upsetting or distressing [33,40,43,48]. It was noted that this may vary by patient: "I do think it's an important issue for patients, but obviously for some people it's an embarrassing one to bring up … and it might be that you can't solve the problem … but for some patients it's a very simple 'how many platelets do I need to have sex?"…”

High symptom burden is associated with impaired quality of life in colorectal cancer patients during chemotherapy:A prospective longitudinal study

“…[221] It seems that the process of selfassessment has a positive effect on QoL. [222] Patient-reported outcome measures can be used to examine the effectiveness of interventions. A number of validated symptom assessment tools are available to evaluate multiple symptoms.…”