Detmar Symone B, Muller Martin J, Schornagel Jan H, Wever Lidwina D V, Aaronson Neil K
Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
JAMA. 2002 Dec 18;288(23):3027-34. doi: 10.1001/jama.288.23.3027.
There has been increasing interest in the use of health-related quality-of-life (HRQL) assessments in daily clinical practice, yet few empirical studies have been conducted to evaluate the usefulness of such assessments.
To evaluate the efficacy of standardized HRQL assessments in facilitating patient-physician communication and increasing physicians' awareness of their patients' HRQL-related problems.
Prospective, randomized crossover trial.
Outpatient clinic of a cancer hospital in the Netherlands.
Ten physicians and 214 patients (76% women; mean age, 57 years) undergoing palliative chemotherapy who were invited to participate between June 1996 and June 1998.
At 3 successive outpatient visits, patients completed an HRQL questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30). The responses were computer scored and transformed into a graphic summary. Physicians and patients received a copy of the summary before the consultation.
Audiotapes of the consultations were content analyzed to evaluate patient-physician communication. Physicians' awareness of their patients' health problems was assessed by comparing physicians' and patients' ratings on the Dartmouth Primary Care Cooperative Information Functional Health Assessment (COOP) and the World Organisation Project of National Colleges and Academics (WONCA) charts.
The HRQL-related issues were discussed significantly more frequently in the intervention than in the control group (mean [SD] communication composite scores: 4.5 [2.3] vs 3.7 [1.9], respectively (P =.01). Physicians in the intervention group identified a greater percentage of patients with moderate-to-severe health problems in several HRQL domains than did those in the control group. All physicians and 87% of the patients believed that the intervention facilitated communication and expressed interest in its continued use.
Incorporating standardized HRQL assessments in daily clinical oncology practice facilitates the discussion of HRQL issues and can heighten physicians' awareness of their patients' HRQL.
在日常临床实践中，人们对使用健康相关生活质量（HRQL）评估的兴趣日益浓厚，但很少有实证研究来评估此类评估的有用性。
评估标准化HRQL评估在促进医患沟通以及提高医生对患者HRQL相关问题认识方面的效果。
前瞻性随机交叉试验。
荷兰一家癌症医院的门诊诊所。
1996年6月至1998年6月期间受邀参与的10名医生和214名接受姑息化疗的患者（76%为女性；平均年龄57岁）。
在连续3次门诊就诊时，患者完成一份HRQL问卷（欧洲癌症研究与治疗组织生活质量问卷核心30项）。回答由计算机计分并转化为图表摘要。医生和患者在会诊前收到一份摘要副本。
对会诊录音进行内容分析以评估医患沟通。通过比较医生和患者在达特茅斯初级保健合作信息功能健康评估（COOP）和世界家庭医生组织（WONCA）图表上的评分来评估医生对患者健康问题的认识。
与对照组相比，干预组中与HRQL相关的问题讨论更为频繁（平均[标准差]沟通综合得分：分别为4.5[2.3]和3.7[1.9]，P = 0.01）。干预组的医生在几个HRQL领域中识别出中度至重度健康问题患者的比例高于对照组。所有医生和87%的患者认为干预促进了沟通，并表示有兴趣继续使用。
在日常临床肿瘤学实践中纳入标准化HRQL评估有助于讨论HRQL问题，并可提高医生对患者HRQL的认识。
