Yang L Y, Manhas D S, Howard A F, Olson R A
Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
School of Nursing, University of British Columbia, 201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
Support Care Cancer. 2018 Jan;26(1):41-60. doi: 10.1007/s00520-017-3865-7. Epub 2017 Aug 28.
Patient-reported outcomes (PROs) are an increasingly popular tool to optimize care and bridge the gap between patient experience and clinician understanding. The aim of this review was to identify mechanisms through which PROs facilitate patient-clinician communication in the adult oncology population.
We conducted a systematic review of the published literature using the following data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Cab Direct, and CDSR. Studies included in this review reported on the outcomes of PRO use, used PROs as an intervention and not as a study outcome measurement tool, included cancer patients or survivors as study participants, and analyzed patient-clinician communication.
We identified 610 unique records, of which 43 publications met the inclusion and exclusion criteria. Synthesis of the reviewed studies provided evidence of the usefulness of PROs in facilitating patient-clinician communication on a variety of topics. We identified mechanisms though which PROs influenced patient-clinician communication to include increasing symptom awareness, prompting discussion, streamlining consultations, and facilitating inter-professional communication. Barriers to PRO use in communication improvement include technical problems impeding its administration and completion, compliance issues due to lack of incentive or forgetfulness, and use of PROs that do not appropriately assess issues relevant to the patient. Facilitators include increased education on PRO use, using PRO tools that patients find more acceptable, and providing patient data summaries in an easily accessible format for clinicians.
Our review suggests that PROs facilitate patient-clinician communication through various mechanisms that could perhaps contribute to improvements in symptom management and survival. The impact of PROs on clinical outcomes, however, remains poorly studied.
患者报告结局（PROs）是一种越来越受欢迎的工具，用于优化医疗护理并弥合患者体验与临床医生理解之间的差距。本综述的目的是确定PROs在成人肿瘤患者群体中促进患者与临床医生沟通的机制。
我们使用以下数据来源对已发表的文献进行了系统综述：MEDLINE、EMBASE、CINAHL、PsycINFO、Cab Direct和CDSR。本综述纳入的研究报告了PROs使用的结局，将PROs用作干预措施而非研究结局测量工具，纳入癌症患者或幸存者作为研究参与者，并分析了患者与临床医生的沟通情况。
我们识别出610条独特记录，其中43篇出版物符合纳入和排除标准。对纳入研究的综合分析提供了证据，证明PROs在促进患者与临床医生就各种主题进行沟通方面的有用性。我们确定了PROs影响患者与临床医生沟通的机制，包括提高症状意识、促使讨论、简化会诊以及促进跨专业沟通。在改善沟通方面使用PROs的障碍包括阻碍其管理和完成的技术问题、由于缺乏激励或遗忘导致的依从性问题，以及使用的PROs未适当评估与患者相关问题。促进因素包括加强对PROs使用的教育、使用患者认为更可接受的PRO工具，以及以临床医生易于获取的格式提供患者数据摘要。
我们的综述表明，PROs通过各种机制促进患者与临床医生的沟通，这些机制可能有助于改善症状管理和生存率。然而，PROs对临床结局的影响仍研究不足。
