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采用患者报告结局进行精准医学干预以实现癌症个体化护理:干预措施的制定和可行性测试。

A PRO-cision medicine intervention to personalize cancer care using patient-reported outcomes: intervention development and feasibility-testing.

机构信息

Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.

出版信息

Qual Life Res. 2022 Aug;31(8):2341-2355. doi: 10.1007/s11136-022-03093-3. Epub 2022 Feb 8.


DOI:10.1007/s11136-022-03093-3
PMID:35133567
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9253074/
Abstract

PURPOSE: PRO-cision medicine refers to personalizing care using patient-reported outcomes (PROs). We developed and feasibility-tested a PRO-cision Medicine remote PRO monitoring intervention designed to identify symptoms and reduce the frequency of routine in-person visits. METHODS: We conducted focus groups and one-on-one interviews with metastatic breast (n = 15) and prostate (n = 15) cancer patients and clinicians (n = 10) to elicit their perspectives on a PRO-cision Medicine intervention's design, value, and concerns. We then feasibility-tested the intervention in 24 patients with metastatic breast cancer over 6-months. We obtained feedback via end-of-study surveys (patients) and interviews (clinicians). RESULTS: Focus group and interview participants reported that remote PRO symptom reporting could alert clinicians to issues and avoid unneeded/unwanted visits. However, some patients did not perceive avoiding visits as beneficial. Clinicians were concerned about workflow. In the feasibility-test, 24/236 screened patients (10%) enrolled. Many patients were already being seen less frequently than monthly (n = 97) or clinicians did not feel comfortable seeing them less frequently than monthly (n = 31). Over the 6-month study, there were 75 total alerts from 392 PRO symptom assessments (average 0.19 alert/assessment). Patients had an average of 4 in-person visits (vs. expected 6.5 without the intervention). Patients (n = 19/24) reported high support on the end-of-study survey, with more than 80% agreeing with positive statements about the intervention. Clinician end-of-study interviews (n = 11/14) suggested that PRO symptom monitoring be added to clinic visits, rather than replacing them, and noted the increasing role of telemedicine. CONCLUSIONS: Future research should explore combining remote PRO symptom monitoring with telemedicine and in-person visits.

摘要

目的:精准医学是指利用患者报告的结果(PROs)来实现个体化治疗。我们开发并测试了一种 PRO 精准医学远程 PRO 监测干预措施的可行性,旨在识别症状并减少常规门诊就诊的频率。

方法:我们对 15 例转移性乳腺癌和 15 例前列腺癌患者以及 10 例临床医生进行了焦点小组和一对一访谈,以了解他们对 PRO 精准医学干预措施设计、价值和关注点的看法。然后,我们在 24 例转移性乳腺癌患者中进行了为期 6 个月的干预可行性测试。我们通过结束研究的调查(患者)和访谈(临床医生)获得反馈。

结果:焦点小组和访谈参与者报告说,远程 PRO 症状报告可以提醒临床医生注意问题,避免不必要/不想要的就诊。然而,一些患者并不认为避免就诊有益。临床医生担心工作流程。在可行性测试中,236 名筛选患者中有 24 名(10%)入组。许多患者已经比每月一次的就诊频率要低(n=97),或者临床医生认为他们不适合每月就诊少于一次(n=31)。在 6 个月的研究期间,392 次 PRO 症状评估中有 75 次发出了警报(平均 0.19 次警报/评估)。患者平均有 4 次门诊就诊(而没有干预时预计为 6.5 次)。患者(n=24/24)在结束研究的调查中报告了高度支持,超过 80%的患者同意关于干预的积极陈述。临床医生结束研究的访谈(n=11/14)表明,PRO 症状监测应添加到临床就诊中,而不是替代它们,并注意到远程医疗的作用不断增加。

结论:未来的研究应探索将远程 PRO 症状监测与远程医疗和门诊就诊相结合。

相似文献

[1]
A PRO-cision medicine intervention to personalize cancer care using patient-reported outcomes: intervention development and feasibility-testing.

Qual Life Res. 2022-8

[2]
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[3]
A PRO-cision Medicine Methods Toolkit to Address the Challenges of Personalizing Cancer Care Using Patient-Reported Outcomes: Introduction to the Supplement.

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[4]
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[5]
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[6]

2022-2

[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
PROM-based monitoring and alerts reduce post-surgery healthcare utilization of patients undergoing joint replacement: A secondary analysis of the PROMoting Quality RCT.

Eur J Health Econ. 2025-8-7

[2]
Benefits and Limitations of Real-World Patient-Reported Toxicity Symptom Monitoring for Guidelines and Care, as Perceived by Patients, Clinicians, and Guideline Developers.

Cancer Med. 2025-4

[3]
The Johns Hopkins Hope at Hopkins Clinic: supporting the comprehensive needs of individuals with metastatic breast cancer.

Breast Cancer Res Treat. 2025-4

[4]
A perspective on the use of patient-reported experience and patient-reported outcome measures in ambulatory healthcare.

Expert Rev Pharmacoecon Outcomes Res. 2025-4

本文引用的文献

[1]
In-Person and Telehealth Ambulatory Contacts and Costs in a Large US Insured Cohort Before and During the COVID-19 Pandemic.

JAMA Netw Open. 2021-3-1

[2]
Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment.

JAMA. 2017-7-11

[3]
Implementing a Method for Evaluating Patient-Reported Outcomes Associated With Oral Oncolytic Therapy.

J Oncol Pract. 2017-4

[4]
The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments.

J Pain Symptom Manage. 2017-3

[5]
AmbuFlex: tele-patient-reported outcomes (telePRO) as the basis for follow-up in chronic and malignant diseases.

Qual Life Res. 2016-3

[6]
PRO-cision Medicine: Personalizing Patient Care Using Patient-Reported Outcomes.

J Clin Oncol. 2016-2-20

[7]
Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial.

J Clin Oncol. 2016-2-20

[8]
When using patient-reported outcomes in clinical practice, the measure matters: a randomized controlled trial.

J Oncol Pract. 2014-9

[9]
Feasibility and value of PatientViewpoint: a web system for patient-reported outcomes assessment in clinical practice.

Psychooncology. 2012-4-30

[10]
Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial.

J Clin Oncol. 2011-1-31

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