Basch Ethan
From the Departments of Medicine and Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
Am Soc Clin Oncol Educ Book. 2014:161-5. doi: 10.14694/EdBook_AM.2014.34.161.
Patient-reported outcomes (PROs) such as symptoms and functional status are commonly measured in clinical trials. There is increasing interest to integrate PROs into routine clinical practice, for example during chemotherapy or postoperatively. There are several rationales for this. First, patient self-reporting improves patient-clinic communication, symptom detection, and symptom control. Second, patient-reported data may be used for quality assessment. Third, aggregated patient-reported data can be informative in comparative-effectiveness research (CER). Of particular interest is an approach that employs electronic collection of PROs with interfaces to the electronic health record (EHR) and clinician alerts for concerning symptoms. Multiple systems have been developed in oncology with these characteristics. Barriers to implementation exist, such as cost, logistics, EHR interfacing, data representation, and data interpretation, but have been largely overcome. Missing data remain a concern, but backup data collection strategies can bring self-report compliance rates up to about 85% in unselected routine care patients with advanced cancers. Overall, including patient self-reporting in routine care enhances quality of care and patient satisfaction, and is expected to become more common in the future. American Society for Clinical Oncology (ASCO) has several ongoing initiatives to develop standards and clinical practice tools in this area.
患者报告的结局（PROs），如症状和功能状态，在临床试验中通常会进行测量。将PROs纳入常规临床实践的兴趣与日俱增，例如在化疗期间或术后。这样做有几个理由。首先，患者自我报告可改善医患沟通、症状检测和症状控制。其次，患者报告的数据可用于质量评估。第三，汇总的患者报告数据在比较效果研究（CER）中可能具有参考价值。特别值得关注的是一种采用电子收集PROs的方法，该方法与电子健康记录（EHR）接口，并为相关症状设置临床医生警报。肿瘤学领域已经开发了多个具有这些特点的系统。实施存在障碍，如成本、后勤、EHR接口、数据表示和数据解释，但已基本克服。缺失数据仍然是一个问题，但在未选择的晚期癌症常规护理患者中，备份数据收集策略可使自我报告的依从率提高到约85%。总体而言，在常规护理中纳入患者自我报告可提高护理质量和患者满意度，预计未来会变得更加普遍。美国临床肿瘤学会（ASCO）有几项正在进行的举措，以制定该领域的标准和临床实践工具。
