Real time patient‐reported outcome measures in patients with cancer: Early experience within an integrated health system

Tam, Samantha; Zatirka, Theresa; Neslund‐Dudas, Christine; Su, Wan-Ting; Cannella, Cara E; Grewal, Jeewanjot S.; Mattour, Ahmad Hatem; Movsas, Benjamin; Chang, Steven S.

doi:10.1002/cam4.5635

Cited by 12 publications

(4 citation statements)

References 33 publications

(106 reference statements)

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“…To our knowledge, our institution was one of the first cancer programs to use real-time PRO scores as a “vital sign” for cancer care across the entire system [ 24 ]. In our practice, PRO scores that meet the threshold for a “severe” issue are transmitted immediately to a team that can refer patients for needed interventions during the clinic visit.…”

Section: Discussionmentioning

confidence: 99%

Association of Social Determinants with Patient-Reported Outcomes in Patients with Cancer

Hutchings,

Behinaein,

Enofe

et al. 2024

Cancers

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Patient-reported outcome (PRO) scores have been utilized more frequently, but the relationship of PRO scores to determinants of health and social inequities has not been widely studied. Our goal was to determine the association of PRO scores with social determinants. All patients with a new cancer diagnosis who completed a PRO survey from 2020 to 2022 were included. The PRO survey recorded scores for depression, fatigue, pain interference and physical function. Higher depression, fatigue and pain scores indicated more distress. Higher physical condition scores indicated improved functionality. A total of 1090 patients were included. Married patients had significantly better individual PRO scores for each domain. Patients who were able to use the online portal to complete their survey also had better individual scores. Male patients and non-White patients had worse pain scores than female and White patients, respectively. Patients with prostate cancer had the best scores while patients with head and neck and lung cancer had the worst scores. PRO scores varied by cancer disease site and stage. Social support may act in combination with specific patient/tumor factors to influence PRO scores. These findings present opportunities to address patient support at institutional levels.

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Section: Discussionmentioning

confidence: 99%

Association of Social Determinants with Patient-Reported Outcomes in Patients with Cancer

Hutchings,

Behinaein,

Enofe

et al. 2024

Cancers

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“…Prevalent service level barriers are integration into clinical workflows and inadequate information technology infrastructure to enable ease of PRO data collection [ 17 ]. To address such barriers a US study implemented PROMs in cancer care that included real-time reporting, and effective resourcing and governance using an integrated health system approach [ 18 ]. The program used iterative cycles of implementation and review which involved engagement of multidisciplinary providers representing a wide breadth of clinical disease sites, strong support from cancer leadership focused on the implementation domain rather than disease specific instruments, having a physician champion, local supervisors and integrated case managers for each clinical unit [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

The use of patient reported outcome measures in oncology clinical practice across Australia and New Zealand

Maharaj,

Roberts,

Jefford

et al. 2024

J Patient Rep Outcomes

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Background While there is increasing evidence on the benefits of PROMs in cancer care, the extent of routine collection and use of PROMs in clinical cancer practice across Australia and New Zealand (ANZ) is unknown. This study examined the prevalence and characteristics of PROMs use in routine clinical cancer care in ANZ. Methods An online survey was designed and disseminated via professional societies and organisations using a snowball sampling approach to clinical and health administration professionals managing cancer care in ANZ. A poster advertising the study was also circulated on professional social media networks via LinkedIn and Twitter inviting health professionals from ANZ to participate if they were using or intending to use PROMs in clinical cancer practice. Responders opted into the survey via the survey link. Results From 132 survey views, 91(response rate, 69%) respondents from 56 clinical practices across ANZ agreed to participate in the survey, and of these 55 (n = 55/91, 60%) respondents reported collecting PROMs within their clinical practice. The majority of the respondents were from the State of New South Wales in Australia (n = 21/55, 38%), hospital (n = 35/55, 64%), and a public setting (n = 46/55, 83%). PROMs were collected in all cancer types (n = 21/36, 58%), in all stages of the disease (n = 31/36, 86%), in an adult population (n = 33/36, 92%), applied in English (n = 33/36, 92%), and used to facilitate communication with other reasons (27/36, 75%). A geospatial map analysis provided insights into the variation in PROMs uptake between the two countries and in certain jurisdictions within Australia. This study also highlights the limited resources for PROMs implementation, and a lack of systematic priority driven approach. Conclusion PROM use across Australia and New Zealand seems variable and occurring predominantly in larger metropolitan centres with limited standardisation of approach and implementation. A greater focus on equitable adoption of PROMs in diverse cancer care settings is urgently needed.

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“…Embedding pre-and post-operative PROMs collection within clinical pathways could enable direct contact or expedited review to be initiated, where patients report poor post-operative scores or do not meet thresholds for expected improvement (for example, less than twopoint improvement in hip pain VAS [30,31] or less than 12-point improvement in Oxford Hip Score [32]). This approach is already being used in other clinical specialties, such as oncology care [40]. While we acknowledge that administering multiple PROMs instruments is not feasible in all settings, the single-item measures (joint pain VAS, satisfaction, and perceived change) used in our THR and TKR studies are simple, no-cost, licensefree tools that are relatively easy to collect in clinical and registry contexts.…”

Section: Discussionmentioning

confidence: 99%

Hip-specific and generic patient-reported outcome measure scores after primary hip replacement are associated with early revision surgery: a national registry study

Ackerman,

Cashman,

Lorimer

et al. 2024

J Patient Rep Outcomes

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Background The ability to efficiently identify patients at higher risk of poor outcomes after joint replacement would enable limited resources for post-operative follow-up to be directed to those with the greatest clinical need. This is particularly important as joint replacement rates continue to grow internationally, stretching health system capabilities. Patient-reported outcome measures (PROMs) are routinely administered in many settings and offer an opportunity to detect suboptimal patient outcomes early. This study aimed to determine whether hip-specific and generic PROM scores are associated with early revision hip replacement within six to 24 months after the primary procedure. Methods Pre-operative and six-month post-operative PROM scores for patients undergoing primary total hip replacement (THR) were obtained from the Australian Orthopaedic Association National Joint Replacement Registry and Arthroplasty Clinical Outcomes Registry National and linked to revision surgery data. Clinically important improvement was defined using anchor-based thresholds. Associations between PROM scores (hip pain, Oxford Hip Score, HOOS-12, EQ-5D-5L, EQ VAS, patient-perceived change, satisfaction) and revision surgery were evaluated using t-tests, chi-square tests and regression models. Results Data were analysed for 21,236 primary THR procedures between 2013 and 2022. Eighty-eight revision procedures were performed at six to 24 months. Patients who were revised had more back pain and worse HOOS-12 scores pre-operatively but between-group differences were small. Worse post-operative PROM scores (hip pain, Oxford, HOOS-12, EQ-5D-5L, EQ VAS) were associated with early revision, after adjusting for age and sex (p < 0.001 for all analyses). Patient dissatisfaction (relative risk (RR) 10.18, 95%CI 6.01–17.25) and patient-perceived worsening (RR 19.62, 95%CI 11.33–33.98) were also associated with a higher likelihood of revision. Patients who did not achieve clinically important improvement in hip pain, function, or quality of life had a higher revision risk (RRs 2.54–5.64), compared with those who did (reference). Conclusion Six-month hip-specific and generic PROM scores can identify patients at higher risk of early revision surgery. Our data highlight the utility of routine post-operative PROM assessment for signaling suboptimal surgical outcomes.

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Real time patient‐reported outcome measures in patients with cancer: Early experience within an integrated health system

Cited by 12 publications

References 33 publications

Association of Social Determinants with Patient-Reported Outcomes in Patients with Cancer

Association of Social Determinants with Patient-Reported Outcomes in Patients with Cancer

The use of patient reported outcome measures in oncology clinical practice across Australia and New Zealand

Hip-specific and generic patient-reported outcome measure scores after primary hip replacement are associated with early revision surgery: a national registry study

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