The impact of measuring patient-reported outcomes in clinical practice: A systematic review of the literature

National Primary Care Research and Development Center, The University of Manchester, Manchester, UK.
Quality of Life Research (Impact Factor: 2.49). 04/2008; 17(2):179-93. DOI: 10.1007/s11136-007-9295-0
Source: PubMed


The purpose of this paper is to summarize the best evidence regarding the impact of providing patient-reported outcomes (PRO) information to health care professionals in daily clinical practice.
Systematic review of randomized clinical trials (Medline, Cochrane Library; reference lists of previous systematic reviews; and requests to authors and experts in the field).
Out of 1,861 identified references published between 1978 and 2007, 34 articles corresponding to 28 original studies proved eligible. Most trials (19) were conducted in primary care settings performed in the USA (21) and assessed adult patients (25). Information provided to professionals included generic health status (10), mental health (14), and other (6). Most studies suffered from methodologic limitations, including analysis that did not correspond with the unit of allocation. In most trials, the impact of PRO was limited. Fifteen of 23 studies (65%) measuring process of care observed at least one significant result favoring the intervention, as did eight of 17 (47%) that measured outcomes of care.
Methodological concerns limit the strength of inference regarding the impact of providing PRO information to clinicians. Results suggest great heterogeneity of impact; contexts and interventions that will yield important benefits remain to be clearly defined.

Download full-text


Available from: Anna Kotzeva,
  • Source
    • "A patient reported outcome (PRO) is dened as the perceptions of symptoms, functioning, QoL, and satisfaction with care that come directly from the patient without the interpretation of the patient's responses by a caregiver (US Department of Health Human Services and Research, 2009). Studies show that routine use of PROM in the clinic can improve the communication process between the patient and the care provider and can help the provider to better meet the patient's needs (Snyder et al., 2010; Valderas et al., 2008). There are some promising results showing that using different Information and Communication Technology (ICT) based platforms and applications for collecting PROM for clinical routine use can increase patients' symptom control and self-care (McCann et al., 2009; Ruland et al., 2010; Seto et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Under-diagnosed and uncontrolled symptoms in patients with prostate cancer during radiotherapy can have a negative impact on the individual's quality of life. An opportunity for patients to report their symptoms systematically, communicate these symptoms to cancer nurses and to receive self-care advice via an application in an Information and Communication Technology-platform could overcome this risk. The content in the application must precisely capture symptoms that are significant to both patients and health care professionals. Therefore, the aim of the study was to map and describe symptoms and self-care strategies identified by patients with prostate cancer undergoing radiotherapy, by health care professionals caring for these patients, and in the literature. Methods: The study combines data from interviews with patients (n = 8) and health care professionals (n = 10) and a scoping review of the literature (n = 26) focusing on the period during and up to 6 months after radiotherapy. Results: There was a concordance between the patients, health care professionals, and the literature on symptoms during and after radiotherapy. Urinary symptoms, bowel problems, pain, sexual problems, fatigue, anxiety, depression, cognitive impairment and irregular symptoms were commonly described during the initial treatment period. Self-care strategies were rarely described in all three of the sources. Conclusions: The results show which symptoms to regularly assess using an Information and Communication Technology-platform for patients with newly-diagnosed prostate cancer during radiotherapy. The next step is to evaluate the efficacy of using the platform and the accuracy of the selected symptoms and self-care advice included in a smartphone application.
    European journal of oncology nursing: the official journal of European Oncology Nursing Society 10/2015; DOI:10.1016/j.ejon.2015.09.004 · 1.43 Impact Factor
    • "Department of Health Human Services and Research, 2006). Routine clinical use of PROs in real time may facilitate the assessment of problems, provide information on the effects of treatment, facilitate patienteclinician communication, promote shared decision making, improve patient satisfaction, and monitor quality improvement (Snyder and Aaronson, 2009; Valderas et al., 2008). Traditionally, PROs have been collected using pen and paper, but now more frequently a broad range of ICT solutions have been employed, including mobile phones, web-based systems and applications for smartphones and touch screens (Rose and Bezjak, 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to test the feasibility and acceptability of an Information and Communication Technology platform for assessing and managing patient reported symptoms during radiotherapy for prostate cancer. In cooperation with a health management company, using a patient experience co-design, we developed the platform operated by an interactive application for reporting and managing symptoms in real time. Nine patients diagnosed with prostate cancer and receiving radiotherapy were recruited from two university hospitals in Sweden. Evidence-based symptoms and related self-care advice specific to prostate cancer were implemented in the application based on a literature review and interviews with patients and health care professionals. In the test of the platform the patients reported symptoms, via a mobile phone, daily for two weeks and were afterwards interviewed about their experiences. Overall, the patients found the symptom questionnaire and the self-care advice relevant and the application user friendly. The alert system was activated on several occasions when the symptoms were severe leading to a nurse contact and support so the patients felt safe and well cared for. The platform enabled increased patient involvement and facilitated symptom assessment and communication between the patient and the health care provider. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations. Copyright © 2015 Elsevier Ltd. All rights reserved.
    European journal of oncology nursing: the official journal of European Oncology Nursing Society 03/2015; 19(5). DOI:10.1016/j.ejon.2015.02.013 · 1.43 Impact Factor
  • Source
    • "Feeding back the PRO information in a structured format to the clinician can promote patient-centered care by highlighting an individual's concerns [5]. Improvements in symptom or function monitoring, and patient– physician communication have been found [5] [6] [7]. On a systemic level, individual's PRO information may be collated and used within or across organizations to look at the impact of treatment on cohorts of patients and as a performance measure to assess quality of care [8]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is increasing interest in the use of patient-reported outcomes (PROs) in routine practice in cancer care to measure symptoms and health related quality of life (HRQOL). PROs are designed to capture the patient's perspective of their care and treatment, and complement the traditional clinical outcomes of survival and toxicity assessment. Integrating routine collection and feedback of PROs has been found to improve care for patients on both an individual level, through improved communication and management of symptoms, and at an organizational level, by enabling aggregation of data to compare performance. This article reviews the benefits and challenges of introducing patient-reported assessments into routine clinical practice. Methods for choosing a questionnaire; collection and presentation of results; timing and frequency of administration as well as clinician training methods to aid the ability of clinicians to integrate the use of PROs into their own practice are described. Electronic PRO capture and integration with electronic health records seems to provide the most effective method for seamless integration into existing patient care pathways. Case studies from our own practice illustrate the issues raised. Electronic methods enabling immediate collection, scoring and interpretation of the data, as well as real-time data capture, email alert systems and individualized, online self-management advice may enable severe symptoms to be managed in a more timely manner. Evaluation methods are described to establish the effectiveness of the PRO intervention. Engaging stakeholders throughout the process of initial consultation and development, during delivery and evaluation is key to success. Future work needs to focus on the effectiveness of PROs in longer-term follow-up of patients in routine care and the relationship between the PRO severity grading and clinician severity grading using the Common Terminology Criteria of Adverse Events (CTCAE).
    Gynecologic Oncology 11/2014; 136(3). DOI:10.1016/j.ygyno.2014.11.071 · 3.77 Impact Factor
Show more