Utilizing the Patient Reported Outcomes Measurement Information System (PROMIS®) to increase referral to ancillary support services for severely symptomatic patients with gynecologic cancer

Gressel, Gregory M.; Dioun, Shayan; Richley, Michael; Lounsbury, David W.; Rapkin, Bruce D.; Isani, Sara; Nevadunsky, Nicole S.; Kuo, Dennis Yi-Shin; Novetsky, Akiva P.

doi:10.1016/j.ygyno.2018.10.042

Cited by 24 publications

(21 citation statements)

References 18 publications

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“…14,21,22 In previous projects, the applicability of thresholds for referrals to palliative care was demonstrated in various cancer populations, including patients with advanced cancer 23 and gynecologic cancer. 24 Thresholds for clinical importance or similar criteria have been developed for several commonly used PRO instruments for patients with cancer, 25 including the EORTC QLQ-C30. 26 The EORTC QLQ-C30 is one of the most widely used PRO instruments in cancer research.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Thresholds for Clinical Importance of the EORTC QLQ-C15-PAL in Patients Receiving Palliative Treatment

Pilz

Aaronson

Arrarás

et al. 2021

Journal of Palliative Medicine

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Background: The EORTC QLQ-C15-PAL is a shortened version of the widely used EORTC QLQ-C30. This questionnaire was developed to measure the symptoms and functional health of patients receiving palliative care. Objective: To enhance clinical interpretability of the EORTC QLQ-C15-PAL, our aim was to evaluate the sensitivity and specificity of thresholds for clinical importance developed previously for the QLQ-C30 when applied to the QLQ-C15-PAL scales. Design: Cross-sectional observational study. Setting/Subjects: Patients with cancer receiving any type of palliative treatment. Measurement: Patients completed the EORTC QLQ-C15-PAL and anchor items on limitations, worries, and need for help for each of the health domains covered by the questionnaire. The anchor items were summarized in a binary criterion for clinical importance to calculate the sensitivity and specificity of the thresholds for clinical importance. Results: In total, 225 patients participated in the study (mean age 64.5 years). Patients were recruited from Austria, Italy, the Netherlands, Poland, Spain, and the United Kingdom. The thresholds for clinical importance for the QLQ-C15-PAL scales showed a median sensitivity of 0.88 (range: 0.82 for sleep disturbances to 1.00 for dyspnea) and a median specificity of 0.74 (range: 0.54 for dyspnea to 0.89 for constipation). Conclusion:The thresholds for clinical importance showed high sensitivity and mostly high specificity in identifying clinically important symptoms and functional health impairments as assessed by the QLQ-C15-PAL. These thresholds will facilitate interpretation of EORTC QLQ-C15-PAL scores in daily clinical practice and clinical research.

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Section: Introductionmentioning

confidence: 99%

Evaluating the Thresholds for Clinical Importance of the EORTC QLQ-C15-PAL in Patients Receiving Palliative Treatment

Pilz

Aaronson

Arrarás

et al. 2021

Journal of Palliative Medicine

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“…However, during a more complex or intensive treatment phase, a more frequent (even daily) assessment of more than 8 symptoms might be well regarded and positively associated with an increased use of educational materials about home symptom management. In another trial, almost 40% of patients (particularly older patients and those living in rural areas) chose to use an automated telephone interface rather than a web interface or preferred personal contact in the case of severe symptoms affecting cognitive or sexual dysfunction [ 23 ]. Web-based, guided, self-help interventions can provide clinically meaningful improvements in quality of life; however, producing a meaningful effect might require punctual psychological interventions [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Collaborative Reviews of Electronic Patient-Reported Outcomes on the Congruence of Patient- and Clinician-Reported Toxicity in Cancer Patients Receiving Systemic Therapy: Prospective, Multicenter, Observational Clinical Trial

Trojan¹,

Leuthold²,

Thomssen³

et al. 2021

J Med Internet Res

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Background Electronic patient-reported outcomes (ePRO) are a relatively novel form of data and have the potential to improve clinical practice for cancer patients. In this prospective, multicenter, observational clinical trial, efforts were made to demonstrate the reliability of patient-reported symptoms. Objective The primary objective of this study was to assess the level of agreement κ between symptom ratings by physicians and patients via a shared review process in order to determine the future reliability and utility of self-reported electronic symptom monitoring. Methods Patients receiving systemic therapy in a (neo-)adjuvant or noncurative intention setting captured ePRO for 52 symptoms over an observational period of 90 days. At 3-week intervals, randomly selected symptoms were reviewed between the patient and physician for congruency on severity of the grading of adverse events according to the Common Terminology Criteria of Adverse Events (CTCAE). The patient-physician agreement for the symptom review was assessed via Cohen kappa (κ), through which the interrater reliability was calculated. Chi-square tests were used to determine whether the patient-reported outcome was different among symptoms, types of cancer, demographics, and physicians’ experience. Results Among the 181 patients (158 women and 23 men; median age 54.4 years), there was a fair scoring agreement (κ=0.24; 95% CI 0.16-0.33) for symptoms that were entered 2 to 4 weeks before the intended review (first rating) and a moderate agreement (κ=0.41; 95% CI 0.34-0.48) for symptoms that were entered within 1 week of the intended review (second rating). However, the level of agreement increased from moderate (first rating, κ=0.43) to substantial (second rating, κ=0.68) for common symptoms of pain, fever, diarrhea, obstipation, nausea, vomiting, and stomatitis. Similar congruency levels of ratings were found for the most frequently entered symptoms (first rating: κ=0.42; second rating: κ=0.65). The symptom with the lowest agreement was hair loss (κ=–0.05). With regard to the latency of symptom entry into the review, hardly any difference was demonstrated between symptoms that were entered from days 1 to 3 and from days 4 to 7 before the intended review (κ=0.40 vs κ=0.39, respectively). In contrast, for symptoms that were entered 15 to 21 days before the intended review, no congruency was demonstrated (κ=–0.15). Congruency levels seemed to be unrelated to the type of cancer, demographics, and physicians’ review experience. Conclusions The shared monitoring and review of symptoms between patients and clinicians has the potential to improve the understanding of patient self-reporting. Our data indicate that the integration of ePRO into oncological clinical research and continuous clinical practice provides reliable information for self-empowerment and the timely intervention of symptoms. Trial Registration ClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731

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“…The PROMIS network has created a bank of electronic patient report outcome measures (ePROs) related to symptom burden in patients with cancer. Gressel et al (33) investigated the use of PROMIS ePROs in gynecologic oncology patients to improve ancillary support service referral (including PC) in the outpatient setting. The ePRO assessment employed was composed of the computer adaptive tests completed on electronic tablets by patients waiting for their oncology appointment (33).…”

Section: Promis ®mentioning

confidence: 99%

“…Gressel et al (33) investigated the use of PROMIS ePROs in gynecologic oncology patients to improve ancillary support service referral (including PC) in the outpatient setting. The ePRO assessment employed was composed of the computer adaptive tests completed on electronic tablets by patients waiting for their oncology appointment (33). The authors selected "PROMIS-CA Bank v1.1-Physical Function", "PROMIS-CA Bank v1.1-Pain Interference", "PROMIS-CA Bank v1.1-Fatigue", "PROMIS-CA Bank v1.1-Depression", and "PROMIS-CA Bank v1.1-Anxiety" to be utilized in their study.…”

Section: Promis ®mentioning

confidence: 99%

Palliative care screening tools in the gynecologic oncology population: a narrative review

Vetter¹

2022

Ann Palliat Med

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Background and Objective: Patients with gynecologic malignancies experience high symptom burden associated with both their disease and sequelae of treatment, and are at risk for aggressive (and often futile) care at end-of-life. Early palliative care (PC) involvement is essential to improving quality of life in this population of patients through symptom management and advanced care planning discussions. The purpose of this review article is to discuss current PC screening tools used to trigger PC consultations for patients with gynecologic malignancies. PC screening tools are reviewed across both inpatient and outpatient clinical settings.Methods: A literature search was conducted utilizing PubMed ® and Excerpta Medica database (EMBASE ® ).Search terms included various combinations of palliative care, gynecologic oncology, gynecologic cancer, gynecologic malignancy, female genital tract cancer, trigger, consult, referral, and screen.

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Utilizing the Patient Reported Outcomes Measurement Information System (PROMIS®) to increase referral to ancillary support services for severely symptomatic patients with gynecologic cancer

Cited by 24 publications

References 18 publications

Evaluating the Thresholds for Clinical Importance of the EORTC QLQ-C15-PAL in Patients Receiving Palliative Treatment

Evaluating the Thresholds for Clinical Importance of the EORTC QLQ-C15-PAL in Patients Receiving Palliative Treatment

The Effect of Collaborative Reviews of Electronic Patient-Reported Outcomes on the Congruence of Patient- and Clinician-Reported Toxicity in Cancer Patients Receiving Systemic Therapy: Prospective, Multicenter, Observational Clinical Trial

Palliative care screening tools in the gynecologic oncology population: a narrative review

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