School of Sociology and Social Policy, University of Leeds, Leeds, LS2 9JT, UK.
Qual Life Res. 2013 Jun;22(5):939-50. doi: 10.1007/s11136-012-0218-3. Epub 2012 Jun 16.
We conducted a secondary qualitative analysis of consultations between oncologists and their patients to explore how patient-reported outcome measures (PROMs) data were referred to in the process of (1) eliciting and exploring patients' concerns; (2) making decisions about supportive treatment and (3) making decisions about chemotherapy and other systemic treatments.
We purposively sampled audio recordings of 18 consultations from the intervention arm and 4 from the attention control arm of a previous UK randomised controlled trial of the feedback of PROMs data to doctors (Velikova et al. in J Clin Oncol 22(4):714-724 [1]). We used a combination of content and conversation analysis to examine how opportunities for discussion of health-related quality of life issues are opened up or closed down within the consultation and explore why this may or may not lead to changes in patient management.
Explicit reference to the PROMs data provided an opportunity for the patient to clarify and further elaborate on the side effects of chemotherapy. High scores on the PROMs data were not explored further if the patient indicated they were not a problem or were not related to the cancer or chemotherapy. Symptomatic treatment was more often offered for problems like nausea, constipation, pain and depression but much less so for fatigue. Doctors discussed fatigue by providing a cause for the fatigue (e.g. the chemotherapy), presenting this as 'something to be expected', minimising its impact or moving on to another topic. Chemotherapy regimens were not changed on the basis of the PROMs data alone, but PROMs data were sometimes used to legitimise changes.
Explicit mention of PROMs data in the consultation may strengthen opportunities for patients to elaborate on their problems, but doctors may not always know how to do this. Our findings have informed the development of a training package to enable doctors to optimise their use of PROMs data within the consultation.
我们对肿瘤学家与其患者之间的咨询进行了二次定性分析，以探讨患者报告结局测量（PROM）数据在以下三个方面的咨询过程中是如何被提及的：（1）引出和探讨患者的关注点；（2）做出支持性治疗决策；（3）做出化疗和其他全身治疗决策。
我们从先前英国一项关于向医生反馈 PROM 数据的随机对照试验的干预组中，有针对性地抽取了 18 次咨询的音频记录，从对照组中抽取了 4 次。我们使用内容分析和会话分析相结合的方法，检查在咨询中如何开启或关闭与健康相关的生活质量问题的讨论机会，并探讨为什么这可能会或可能不会导致患者管理的变化。
对 PROM 数据的明确提及为患者澄清和进一步阐述化疗的副作用提供了机会。如果患者表示副作用不是问题，或者与癌症或化疗无关，那么 PROM 数据的高分就不会进一步探讨。对于恶心、便秘、疼痛和抑郁等问题，更常提供对症治疗，但对于疲劳则不然。医生通过提供疲劳的原因（如化疗）来讨论疲劳问题，将其描述为“可以预料到的”，将其影响最小化，或者转移到另一个话题。不会仅根据 PROM 数据来改变化疗方案，但有时会使用 PROM 数据来使治疗方案的改变合法化。
在咨询中明确提及 PROM 数据可能会加强患者详细说明问题的机会，但医生可能并不总是知道如何做到这一点。我们的研究结果为开发一个培训包提供了信息，以使医生能够在咨询中优化 PROM 数据的使用。
