St James's Institute of Oncology, Leeds, United Kingdom.
J Clin Oncol. 2011 Jul 20;29(21):2910-7. doi: 10.1200/JCO.2010.32.2453. Epub 2011 Jun 20.
Regularly collecting patient-reported outcomes (PROs) of health-related quality of life with feedback to oncologists may assist in eliciting and monitoring patients' problems during cancer treatment. This study examined how PRO feedback had an impact on patient-physician communication over time to gain a better understanding of how it may influence patient care.
Exploratory analyses were performed on a data set from a previous study. Patients were randomly assigned to intervention (regular completion of European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Hospital Anxiety and Depression Scale with feedback to oncologists), attention-control (completion of same questionnaires without feedback), and control (standard care) arms. The content of consultation audio recordings between 28 oncologists and 198 patients over four consecutive visits (792 consultations) was analyzed. Mixed-effects models and multivariate regressions were used to examine the longitudinal impact of the intervention on patient-physician communication, dynamics of patient-physician interaction, and the association between PROs and the content of clinic discussion.
Patients in the intervention arm discussed more symptoms over time compared with patients in the attention-control (P = .008) and control (P = .04) arms. No study arm effect was observed for function discussions. Discussion topics were predominantly raised by patients/relatives, regardless of arm allocation. Clinic discussions were associated with severity of patient-reported symptoms but not with patient-reported functional concerns.
A positive longitudinal impact of the intervention on symptom discussion was observed, but not for function discussion, suggesting that potentially serious problems may remain unaddressed. Training oncologists in responding to patient-reported functional concerns may increase the impact of this intervention.
定期收集与健康相关的生活质量的患者报告结果（PRO）并将反馈提供给肿瘤医生，可能有助于在癌症治疗过程中引出和监测患者的问题。本研究探讨了 PRO 反馈如何随时间推移对医患沟通产生影响，以更好地了解其如何影响患者护理。
对先前研究的数据进行了探索性分析。患者被随机分配到干预组（定期完成欧洲癌症研究和治疗组织生活质量问卷核心 30 项和医院焦虑和抑郁量表，并将反馈提供给肿瘤医生）、注意对照组（完成相同的问卷但没有反馈）和对照组（标准护理）。对 28 名肿瘤医生和 198 名患者在连续 4 次就诊（792 次就诊）期间的咨询录音内容进行了分析。采用混合效应模型和多元回归分析来检验干预对医患沟通、医患互动动态以及 PRO 与诊所讨论内容之间的关联的纵向影响。
与注意对照组（P =.008）和对照组（P =.04）相比，干预组患者随时间推移讨论的症状更多。未观察到研究组对功能讨论的影响。讨论主题主要由患者/家属提出，而与手臂分配无关。诊所讨论与患者报告的症状严重程度相关，但与患者报告的功能问题无关。
观察到干预对症状讨论的积极纵向影响，但对功能讨论没有影响，这表明潜在的严重问题可能仍未得到解决。培训肿瘤医生如何应对患者报告的功能问题可能会增加这种干预的效果。
