Montgomery Nicole, Howell Doris, Ismail Zahra, Bartlett Susan J, Brundage Michael, Bryant-Lukosius Denise, Krzyzanowska Monika, Moody Lesley, Snyder Claire, Barbera Lisa
Cancer Care Ontario, Toronto, Canada.
University Health Network, Toronto, Canada.
J Patient Rep Outcomes. 2020 Nov 26;4(1):101. doi: 10.1186/s41687-020-00270-1.
The use of Patient-Reported Outcome Measures (PROMs) in routine clinical care can help ensure symptoms are identified, acknowledged and addressed. In 2007, the provincial cancer agency, Cancer Care Ontario, began to implement routine symptom screening with the Edmonton Symptom Assessment System (ESAS) for ambulatory cancer patients. Having had a decade of experience with ESAS, the program developed a strategic interest in implementing new and/or additional measures. This article describes the development of a streamlined PROM selection and implementation evaluation process with core considerations.
Development of the PROM selection and implementation evaluation process involved analysis of quantitative and qualitative data as well as consensus building through a multi-stakeholder workshop. Core PROM selection considerations were developed through a literature scan, review and refinement by a panel of methodological experts and patient advisors, and testing via a test case. Core PROM implementation evaluation considerations were developed through analysis of PROM evaluation frameworks, and review and refinement by a committee of provincial implementation leads.
Core PROM selection considerations were identified under three overarching themes: symptom coverage, usability and psychometric properties. The symptom coverage category assesses each PROM to determine how well the PROM items address the most prevalent and burdensome symptoms in the target patient population. The usability category aims to assess each measure on characteristics key to successful implementation in the clinical setting. The psychometric properties category assesses each PROM to ensure the data collected is credible, meaningful and interpretable. A scoring system was developed to rate PROM performance by assigning a grade of "weak", "average" or "good" for each category. The process results in a summary matrix which illustrates the overall assessment of each PROM. Implementation evaluation considerations were identified under three overarching concepts: acceptability, outcomes, and sustainability. A consensus building exercise resulted in the further identification of patient, provider, and clinic specific indicators for each consideration.
To address the need for a systematic, evidence-based approach to selection, implementation and evaluation of PROMs in the clinical setting, Cancer Care Ontario defined a process with embedded core considerations to facilitate decision-making and encourage standardization.
在常规临床护理中使用患者报告结局测量指标（PROMs）有助于确保症状得到识别、确认和处理。2007年，省级癌症机构安大略癌症护理中心开始对门诊癌症患者采用埃德蒙顿症状评估系统（ESAS）进行常规症状筛查。在使用ESAS十年后，该项目对实施新的和/或额外的测量指标产生了战略兴趣。本文介绍了一个简化的PROM选择和实施评估流程以及核心考量因素。
PROM选择和实施评估流程的制定涉及定量和定性数据分析，以及通过多利益相关方研讨会达成共识。核心PROM选择考量因素通过文献检索、由方法学专家和患者顾问组成的小组进行审查和完善，并通过一个测试案例进行测试来确定。核心PROM实施评估考量因素通过对PROM评估框架的分析以及由省级实施负责人组成的委员会进行审查和完善来确定。
在三个总体主题下确定了核心PROM选择考量因素：症状覆盖范围、可用性和心理测量特性。症状覆盖范围类别评估每个PROM，以确定PROM项目在多大程度上解决了目标患者群体中最普遍和最具负担的症状。可用性类别旨在根据在临床环境中成功实施的关键特征评估每个测量指标。心理测量特性类别评估每个PROM，以确保收集到的数据可信、有意义且可解释。开发了一个评分系统，通过为每个类别分配“弱”“中等”或“好”的等级来对PROM性能进行评分。该流程产生一个汇总矩阵，展示了对每个PROM的总体评估。在三个总体概念下确定了实施评估考量因素：可接受性、结果和可持续性。通过一次共识达成活动进一步确定了针对每个考量因素的患者、提供者和诊所特定指标。
为满足临床环境中对PROMs进行系统、循证选择、实施和评估的需求，安大略癌症护理中心定义了一个包含核心考量因素的流程，以促进决策制定并鼓励标准化。
