Hughes Elizabeth F, Wu Albert W, Carducci Michael A, Snyder Claire F
Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
J Support Oncol. 2012 Jul-Aug;10(4):143-8. doi: 10.1016/j.suponc.2012.02.002. Epub 2012 May 18.
There is increased interest in using patient-reported outcome (PRO) measures in routine clinical practice to improve patient management. The effectiveness of this intervention may be facilitated by providing suggestions to clinicians on how to address issues identified by the PROs. We sought to develop recommendations for clinicians on how to respond to issues covered by common cancer PRO questionnaires, including functional problems (eg, physical, social, emotional), symptoms (eg, diarrhea, pain), and needs (eg, patient care and support, information). The recommendations would be incorporated into a Web-based system for PRO assessment and reporting in use at our large, academic cancer center. To develop the recommendations, we conducted a multiphase, multidisciplinary, consensus process. We reviewed the literature and conducted one-on-one interviews with experts from various disciplines. Experts included medical oncologists, radiation oncologists, nurses, an internist, a palliative care specialist, an outcomes researcher, a chaplain, a social worker, and patient advocates. These interviews elicited the experts' recommendations for addressing problems in common PRO domains. Finally, we held a panel meeting attended by all the experts to attain consensus on the recommendations. The final consensus suggestions recommend further assessment of the problem as a first step. Treatment suggestions range from medication adjustments to lifestyle modifications to referrals to other disciplines. Further research will test whether clinicians find these suggestions useful for patient management.
在常规临床实践中使用患者报告结局（PRO）指标以改善患者管理受到了越来越多的关注。通过向临床医生提供如何解决PRO所发现问题的建议，可能会促进这种干预措施的有效性。我们试图为临床医生制定关于如何应对常见癌症PRO问卷所涵盖问题的建议，这些问题包括功能问题（如身体、社交、情感方面）、症状（如腹泻、疼痛）以及需求（如患者护理与支持、信息）。这些建议将被纳入一个基于网络的系统，用于我们大型学术癌症中心正在使用的PRO评估和报告。为了制定这些建议，我们进行了一个多阶段、多学科的共识达成过程。我们查阅了文献，并与来自各个学科的专家进行了一对一访谈。专家包括医学肿瘤学家、放射肿瘤学家、护士、内科医生、姑息治疗专家、结局研究人员、牧师、社会工作者以及患者权益倡导者。这些访谈引出了专家们针对常见PRO领域中问题的应对建议。最后，我们召开了一次由所有专家参加的小组会议，以就这些建议达成共识。最终的共识建议首先是对问题进行进一步评估。治疗建议范围从药物调整到生活方式改变，再到转介至其他学科。进一步的研究将检验临床医生是否发现这些建议对患者管理有用。
