Gilbert Alexandra, Sebag-Montefiore David, Davidson Susan, Velikova Galina
MRCP, University of Leeds, UK.
FRCR FRCP, University of Leeds, UK.
Gynecol Oncol. 2015 Mar;136(3):429-39. doi: 10.1016/j.ygyno.2014.11.071. Epub 2014 Nov 28.
There is increasing interest in the use of patient-reported outcomes (PROs) in routine practice in cancer care to measure symptoms and health related quality of life (HRQOL). PROs are designed to capture the patient's perspective of their care and treatment, and complement the traditional clinical outcomes of survival and toxicity assessment. Integrating routine collection and feedback of PROs has been found to improve care for patients on both an individual level, through improved communication and management of symptoms, and at an organizational level, by enabling aggregation of data to compare performance. This article reviews the benefits and challenges of introducing patient-reported assessments into routine clinical practice. Methods for choosing a questionnaire; collection and presentation of results; timing and frequency of administration as well as clinician training methods to aid the ability of clinicians to integrate the use of PROs into their own practice are described. Electronic PRO capture and integration with electronic health records seems to provide the most effective method for seamless integration into existing patient care pathways. Case studies from our own practice illustrate the issues raised. Electronic methods enabling immediate collection, scoring and interpretation of the data, as well as real-time data capture, email alert systems and individualized, online self-management advice may enable severe symptoms to be managed in a more timely manner. Evaluation methods are described to establish the effectiveness of the PRO intervention. Engaging stakeholders throughout the process of initial consultation and development, during delivery and evaluation is key to success. Future work needs to focus on the effectiveness of PROs in longer-term follow-up of patients in routine care and the relationship between the PRO severity grading and clinician severity grading using the Common Terminology Criteria of Adverse Events (CTCAE).
在癌症护理的常规实践中，使用患者报告结局（PROs）来衡量症状和健康相关生活质量（HRQOL）的兴趣日益浓厚。PROs旨在获取患者对其护理和治疗的看法，并补充生存和毒性评估等传统临床结局。已发现整合PROs的常规收集和反馈，在个体层面上通过改善症状的沟通和管理来改善患者护理，在组织层面上通过汇总数据以比较绩效来实现。本文综述了将患者报告评估引入常规临床实践的益处和挑战。描述了选择问卷的方法、结果的收集和呈现、施测的时间和频率，以及帮助临床医生将PROs的使用整合到自身实践中的临床医生培训方法。电子PRO捕获以及与电子健康记录的整合似乎为无缝整合到现有的患者护理路径中提供了最有效的方法。我们自身实践中的案例研究说明了所提出的问题。能够立即收集、评分和解释数据的电子方法，以及实时数据捕获、电子邮件警报系统和个性化的在线自我管理建议，可能使严重症状得到更及时的管理。描述了评估方法以确定PRO干预的有效性。在初始咨询、开发、实施和评估的整个过程中让利益相关者参与是成功的关键。未来的工作需要关注PROs在常规护理中对患者长期随访的有效性，以及使用不良事件通用术语标准（CTCAE）的PRO严重程度分级与临床医生严重程度分级之间的关系。
