Velikova Galina, Booth Laura, Smith Adam B, Brown Paul M, Lynch Pamela, Brown Julia M, Selby Peter J
Cancer Research UK Clinical Centre-Leeds, Cancer Medicine Research Unit, St James's University Hospital, Beckett St, Leeds LS9 7TF, UK.
J Clin Oncol. 2004 Feb 15;22(4):714-24. doi: 10.1200/JCO.2004.06.078.
PURPOSE: To examine the effects on process of care and patient well-being, of the regular collection and use of health-related quality-of-life (HRQL) data in oncology practice. PATIENTS AND METHODS: In a prospective study with repeated measures involving 28 oncologists, 286 cancer patients were randomly assigned to either the intervention group (regular completion of European Organization for Research and Treatment of Cancer-Core Quality of Life Questionnaire version 3.0, and Hospital Anxiety and Depression Scale on touch-screen computers in clinic and feedback of results to physicians); attention-control group (completion of questionnaires, but no feedback); or control group (no HRQL measurement in clinic before encounters). Primary outcomes were patient HRQL over time, measured by the Functional Assessment of Cancer Therapy-General questionnaire, physician-patient communication, and clinical management, measured by content analysis of tape-recorded encounters. Analysis employed mixed-effects modeling and multiple regression. RESULTS: Patients in the intervention and attention-control groups had better HRQL than the control group (P =.006 and P =.01, respectively), but the intervention and attention-control groups were not significantly different (P =.80). A positive effect on emotional well-being was associated with feedback of data (P =.008), but not with instrument completion (P =.12). A larger proportion of intervention patients showed clinically meaningful improvement in HRQL. More frequent discussion of chronic nonspecific symptoms (P =.03) was found in the intervention group, without prolonging encounters. There was no detectable effect on patient management (P =.60). In the intervention patients, HRQL improvement was associated with explicit use of HRQL data (P =.016), discussion of pain, and role function (P =.046). CONCLUSION: Routine assessment of cancer patients' HRQL had an impact on physician-patient communication and resulted in benefits for some patients, who had better HRQL and emotional functioning.
目的：探讨肿瘤学实践中定期收集和使用健康相关生活质量（HRQL）数据对医疗过程及患者福祉的影响。 患者与方法：在一项涉及28位肿瘤学家的重复测量前瞻性研究中，286例癌症患者被随机分为干预组（在诊所通过触摸屏电脑定期完成欧洲癌症研究与治疗组织核心生活质量问卷第3.0版以及医院焦虑抑郁量表，并将结果反馈给医生）、注意力控制组（完成问卷，但不反馈结果）或对照组（就诊前不在诊所进行HRQL测量）。主要结局指标包括通过癌症治疗功能评估通用问卷测量的患者随时间变化的HRQL、通过录音就诊内容分析测量的医患沟通及临床管理情况。分析采用混合效应模型和多元回归。 结果：干预组和注意力控制组患者的HRQL均优于对照组（分别为P = 0.006和P = 0.01），但干预组和注意力控制组之间无显著差异（P = 0.80）。数据反馈对情绪福祉有积极影响（P = 0.008），但与问卷完成情况无关（P = 0.12）。干预组中更大比例的患者在HRQL方面有临床意义的改善。干预组中对慢性非特异性症状的讨论更频繁（P = 0.03），且未延长就诊时间。对患者管理未发现可检测到的影响（P = 0.60）。在干预组患者中，HRQL改善与HRQL数据的明确使用（P = 0.016）、疼痛讨论及角色功能有关（P = 0.046）。 结论：对癌症患者HRQL进行常规评估对医患沟通有影响，并使部分患者受益，这些患者的HRQL和情绪功能更好。
J Clin Oncol. 2009-1-1
Am J Otolaryngol. 2003
Diagnostics (Basel). 2025-6-27
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