The Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool 2170NSW, Australia.
BMC Health Serv Res. 2013 Jun 11;13:211. doi: 10.1186/1472-6963-13-211.
Despite growing interest and urges by leading experts for the routine collection of patient reported outcome (PRO) measures in all general care patients, and in particular cancer patients, there has not been an updated comprehensive review of the evidence regarding the impact of adopting such a strategy on patients, service providers and organisations in an oncologic setting.
Based on a critical analysis of the three most recent systematic reviews, the current systematic review developed a six-method strategy in searching and reviewing the most relevant quantitative studies between January 2000 and October 2011 using a set of pre-determined inclusion criteria and theory-based outcome indicators. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to rate the quality and importance of the identified publications, and the synthesis of the evidence was conducted.
The 27 identified studies showed strong evidence that the well-implemented PROs improved patient-provider communication and patient satisfaction. There was also growing evidence that it improved the monitoring of treatment response and the detection of unrecognised problems. However, there was a weak or non-existent evidence-base regarding the impact on changes to patient management and improved health outcomes, changes to patient health behaviour, the effectiveness of quality improvement of organisations, and on transparency, accountability, public reporting activities, and performance of the health care system.
Despite the existence of significant gaps in the evidence-base, there is growing evidence in support of routine PRO collection in enabling better and patient-centred care in cancer settings.
尽管领先专家们不断呼吁在所有普通护理患者中,特别是在癌症患者中常规收集患者报告的结果(PRO)测量数据,但在肿瘤学环境中,采用这种策略对患者、服务提供者和组织的影响方面,仍缺乏对证据的最新全面审查。
基于对最近的三项系统评价的批判性分析,本系统评价制定了一个六方法策略,用于在 2000 年 1 月至 2011 年 10 月期间使用一套预先确定的纳入标准和基于理论的结果指标搜索和审查最相关的定量研究。使用 Grading of Recommendations, Assessment, Development, and Evaluation(GRADE)系统对确定出版物的质量和重要性进行评级,并进行证据综合。
27 项已确定的研究表明,实施良好的 PRO 可显著改善患者与提供者之间的沟通和患者满意度。越来越多的证据表明,它还改善了治疗反应的监测和未识别问题的检测。然而,关于对患者管理的改变和改善健康结果、患者健康行为的改变、组织质量改进的有效性以及透明度、问责制、公共报告活动和医疗保健系统的绩效的影响,证据基础较弱或不存在。
尽管证据基础存在重大差距,但越来越多的证据支持在癌症环境中常规收集 PRO,以实现更好的以患者为中心的护理。