Scheibe Madlen, Herrmann Alina, Schmitt Jochen, Einhart Natascha, Sedlmayr Brita, Kowalski Christoph
Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
German Cancer Society, Berlin, Germany.
Z Evid Fortbild Qual Gesundhwes. 2020 Nov;156-157:11-23. doi: 10.1016/j.zefq.2020.08.001. Epub 2020 Sep 24.
To give an overview of patient-reported outcome measures (PROMs) programs in routine cancer care that allow for both major purposes of PROM assessment: 1) monitoring of an individual patient's outcome to assist treatment decision making, and 2) use in quality improvement initiatives including the benchmarking of providers. We synthesize information on program elements like the mode of assessment and questionnaire used, as well as information relevant for adaptation following a PDCA scheme.
We carried out a systematic literature research in the databases PubMed and EMBASE using MeSH terms and keywords related to PROM assessment in routine cancer care to identify eligible studies published between January 2003 and November 2018 (PROSPERO reg. no. CRD42019141402). We included studies in which PROM assessment programs had been reported as being implemented in clinical practice as well as collected multicentrically with at least one site in Europe and in which PROMs had been collected before and at least once after intervention. Study authors were queried to verify or correct the program elements extracted and merged during the review. Study quality assessment was not done, since it is not expedient for the objective of this review.
Overall, 5,545 unique references were identified, 5,416 of which were excluded after the screening of titles and abstracts. Of the 29 references assessed, five programs were identified and included in the synthesis. The programs included those from Germany, Austria, Denmark, the Netherlands and the UK, and patients with different cancer types and tumor stages, which used paper-based or purely electronic PROM assessment.
Few reports have so far been published on PROM programs that allow for both the monitoring of an individual patient's outcome and use in quality improvement initiatives. The studies revealed relevant information on existing PROM programs and gave valuable insight into issues that need to be considered when setting up such an infrastructure. Some critical issues, however, were hardly addressed, among them costs, staff resources and methods of reporting and responding.
概述常规癌症护理中患者报告结局测量（PROMs）项目，这些项目可实现PROM评估的两个主要目的：1）监测个体患者的结局以辅助治疗决策，以及2）用于质量改进举措，包括对医疗服务提供者进行基准评估。我们综合了有关项目要素的信息，如评估方式和使用的问卷，以及遵循PDCA方案进行调整时的相关信息。
我们在PubMed和EMBASE数据库中进行了系统的文献研究，使用与常规癌症护理中PROM评估相关的医学主题词和关键词，以识别2003年1月至2018年11月期间发表的符合条件的研究（PROSPERO注册号：CRD42019141402）。我们纳入了报告在临床实践中实施PROM评估项目以及在欧洲至少有一个中心多中心收集数据且在干预前和干预后至少收集一次PROMs的研究。向研究作者咨询以核实或纠正综述过程中提取和合并的项目要素。未进行研究质量评估，因为这对本综述的目标而言并不合适。
总体而言，共识别出5545篇独特参考文献，其中5416篇在标题和摘要筛选后被排除。在评估的29篇参考文献中，确定了5个项目并纳入综述。这些项目来自德国、奥地利、丹麦、荷兰和英国，涉及不同癌症类型和肿瘤分期的患者，采用纸质或纯电子PROM评估。
到目前为止，关于既允许监测个体患者结局又可用于质量改进举措的PROM项目的报道很少。这些研究揭示了现有PROM项目的相关信息，并对建立此类基础设施时需要考虑的问题提供了有价值的见解。然而，一些关键问题几乎未得到解决，其中包括成本、人员资源以及报告和回应方法。
