Dy Sydney M, Walling Anne M, Mack Jennifer W, Malin Jennifer L, Pantoja Philip, Lorenz Karl A, Tisnado Diana M
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of California, Los Angeles; Veterans Health Administration of Greater Los Angeles, Los Angeles, CA; and Dana-Farber Cancer Institute, Boston, MA
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; University of California, Los Angeles; Veterans Health Administration of Greater Los Angeles, Los Angeles, CA; and Dana-Farber Cancer Institute, Boston, MA.
J Oncol Pract. 2014 Jul;10(4):e223-30. doi: 10.1200/JOP.2013.001237. Epub 2014 Mar 11.
Patient-reported data may provide valuable information for oncology quality measurement. We evaluated applying patient-reported data from the Cancer Care Outcomes Research and Surveillance Consortium national study to quality indicators addressing supportive oncology domains.
We analyzed surveys including validated instruments for symptoms and care planning from 4,174 patients newly diagnosed with lung or colorectal cancer. We adapted existing supportive oncology indicators for use with patient-reported data from Cancer Quality-ASSIST and the American Society of Clinical Oncology Quality Oncology Practice Initiative. Where feasible, we examined indicators using medical record data for comparison purposes.
Using patient-reported data, the percentage of patients meeting indicator criteria for screening ranged from 74% (significant depressive symptoms) to 93% (pain, nausea/vomiting). The percentage meeting indicator criteria for symptom treatment ranged from 73% (significant depressive symptoms) to 99% (nausea/vomiting). Symptom severity did not affect the results. Using medical record data, the percentage meeting indicator criteria varied between 4% (significant depressive symptoms) and 23% (pain). For information and care planning, 44% met criteria for discussion about resuscitation and 32% for hospice discussion using survey data. Using medical record data, 11% met criteria for goals-of-care discussion in intensive care and 46% for hospice/pain management/palliative care referral before death.
Quality of care for symptoms measured using patient self-report was higher than when including medical record data. Use of patient-reported and medical record data allowed measurement of different perspectives on care planning indicators. Patient-reported data provide a complementary, patient-centered perspective on the quality of supportive oncology care.
患者报告的数据可为肿瘤学质量评估提供有价值的信息。我们评估了将癌症护理结果研究与监测联盟全国性研究中的患者报告数据应用于涉及支持性肿瘤学领域的质量指标。
我们分析了对4174例新诊断为肺癌或结直肠癌患者进行的调查，这些调查包括经过验证的症状和护理计划工具。我们对现有的支持性肿瘤学指标进行了调整，以用于来自癌症质量辅助系统和美国临床肿瘤学会质量肿瘤学实践倡议的患者报告数据。在可行的情况下，我们使用病历数据检查指标以作比较。
使用患者报告的数据，达到筛查指标标准的患者百分比范围为74%（严重抑郁症状）至93%（疼痛、恶心/呕吐）。达到症状治疗指标标准的百分比范围为73%（严重抑郁症状）至99%（恶心/呕吐）。症状严重程度不影响结果。使用病历数据时，达到指标标准的百分比在4%（严重抑郁症状）至23%（疼痛）之间。对于信息和护理计划，44%的患者符合关于复苏讨论的标准，32%的患者符合使用调查数据进行临终关怀讨论的标准。使用病历数据时，11%的患者符合重症监护中护理目标讨论的标准，46%的患者符合临终关怀/疼痛管理/姑息治疗在死亡前转诊的标准。
使用患者自我报告测量的症状护理质量高于纳入病历数据时的情况。使用患者报告数据和病历数据能够从不同角度测量护理计划指标。患者报告数据为支持性肿瘤护理质量提供了一个补充性的、以患者为中心的视角。
