Mooney Kathi, Berry Donna L, Whisenant Meagan, Sjoberg Daniel
From the University of Utah, Salt Lake City, UT; Hunstman Cancer Institute, Salt Lake City, UT; Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Memorial Sloan Kettering Cancer Center, New York, NY.
Am Soc Clin Oncol Educ Book. 2017;37:695-704. doi: 10.1200/EDBK_175418.
Poorly controlled symptoms are common and debilitating during cancer treatment and can affect functional status and quality of life, health care resource utilization, treatment adherence, and cancer survivorship. Historically, the patient experience, including symptoms during treatment, has not been tracked or documented in the patient health record. Measurement of patient-reported outcomes (PROs), including symptoms, is an essential component to cancer care focused on the illness impact to the patient and family. PROs can be useful at the individual level for monitoring and promoting symptom care both in the clinic and remotely and at the population level for aggregating population data for use in research and quality improvement initiatives. Implementation of PROs in cancer clinical care requires a carefully thought out process to overcome challenges related to integrating PROs into existing electronic health records and clinical work flow. Issues with implementing PRO collection may include making decisions about measurement tools, modes of delivery, frequency of measurement, and interpretation that are guided by a clarification of the purpose for collecting PROs. We focus on three aspects of PRO use: (1) improving care for individual patients, (2) analyzing aggregated data to improve care and outcomes overall, and (3) considerations in implementing PRO collection.
在癌症治疗期间，症状控制不佳的情况很常见且会导致身体衰弱，可能影响功能状态、生活质量、医疗资源利用、治疗依从性以及癌症幸存者的生活。从历史上看，患者体验，包括治疗期间的症状，在患者健康记录中并未得到追踪或记录。对患者报告结果（PROs）的测量，包括症状，是癌症护理的重要组成部分，其重点在于疾病对患者及其家庭的影响。PROs在个体层面上，对于在诊所及远程监测和促进症状护理很有用，在群体层面上，对于汇总群体数据以用于研究和质量改进举措也很有用。在癌症临床护理中实施PROs需要一个深思熟虑的过程，以克服将PROs整合到现有电子健康记录和临床工作流程中所涉及的挑战。实施PROs收集的问题可能包括在测量工具、交付方式、测量频率和解读方面做出决策，这些决策需要在明确收集PROs目的的指导下进行。我们关注PROs使用的三个方面：（1）改善对个体患者的护理；（2）分析汇总数据以总体改善护理和结果；（3）实施PROs收集时的注意事项。
