Implementation of thyroid-related patient-reported outcomes in routine clinical practice

Abstract

Patient-reported outcomes (PROs) are increasingly used in clinical practice to improve clinical care. Multiple studies show that systematic use of PROs can enhance communication with patients and improve patient satisfaction, symptom management and quality of life. Further, such data can be aggregated to examine health levels for patient groups, improve quality of care, and compare patient outcomes at the institutional, regional or national level. However, there are barriers and challenges that should be handled appropriately to achieve successful implementation of PROs in routine clinical practice. This paper briefly overviews thyroid-related PROs, describes unsolved quality of life issues in benign thyroid diseases, provides examples of routine collection of PROs, and summarizes key points facilitating successful implementation of thyroid-related PROs in routine clinical practice. Finally, the paper touches upon future directions of PRO research.

Effect of Radioiodine Treatment on Quality of Life in Patients with Subclinical Hyperthyroidism: A Prospective Controlled Study

“…Patient-reported outcomes have been increasingly employed as an additional measure to improve the quality of clinical care, structure physician-patient communication and enhance patient satisfaction [23]. Functional thyroid diseases affect many organs in the human body and thyroid patients present with a broad spectrum of symptoms that may interfere with their daily life activities and also impair their quality of life in various ways [19,20,21,22]. Apart from general QoL aspects, thyroid diseases affect a number specific domains to warrant a more specific QoL instrument [20,21].…”

“…Functional thyroid diseases affect many organs in the human body and thyroid patients present with a broad spectrum of symptoms that may interfere with their daily life activities and also impair their quality of life in various ways [19,20,21,22]. Apart from general QoL aspects, thyroid diseases affect a number specific domains to warrant a more specific QoL instrument [20,21]. To provide the desired content validity and evaluation of QoL domains most relevant for the target population, Thy-PRO has been developed and validated as a thyroid specific assessment tool by Watt and co-workers [19].…”

“…Individual ThyPRO scales range from 0 to 100 for each item, with higher scores indicating a worse QoL status [20]. In patients with Graves' disease and toxic nodular goitre, QoL impairments in the overtly hyperthyroid state ranged between 20 and 35 in most domains, except for tiredness which reached 50 on its scale [25].…”

“…Given increasing evidence of the shortcomings of biochemical testing and particularly a TSH-centred approach, interest in clinical markers including QoL measures has resurged [17,18]. This has been aided by the development of validated and thyroid specific QoL instruments [19,20].…”

Hypothyroidism: The difficulty in attributing symptoms to their underlying cause

“…Systematic use of PROs can enhance communication with patients, thereby improving patient satisfaction, symptom management and quality of life. For an overview of the challenges to be handled to achieve successful implementation of PROs in routine clinical practice see the minireview by Cramon et al in the present article collection on "(Re) defining hypothyroidism: the key to patient-centered treatment" (8). A final factor that may contribute to less than optimal patient management and symptom relief in hypothyroidism is the pivotal role of plasma thyroid stimulating hormone (TSH) and free thyroxine (FT4) both in diagnosis and treatment.…”