Department of Health Policy and Management (L.C.C., S.M.D.), Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Department of Pharmacy (E.G.S.), Massachusetts General Hospital, Boston, USA.
J Pain Symptom Manage. 2022 Dec;64(6):e363-e371. doi: 10.1016/j.jpainsymman.2022.08.008. Epub 2022 Aug 21.
Interpreting clinical meaningfulness of patient reported outcomes (PROs) in palliative care research is key in evidence-based practice. Minimal clinically important differences (MCIDs) can help interpret whether changes in PROs are meaningful to patients.
To examine use of MCIDs in a recent systematic review on integrating palliative care into ambulatory care for U.S. adults with noncancer serious chronic illness and their effect on interpretation of key PROs.
Paired investigators abstracted MCIDs for each PRO in the systematic review from PubMed, tool specific websites, and Google Scholar. Investigators compared findings and resolved differences through consensus. MCIDs were interpreted alongside results from meta-analyses or individual studies to draw conclusions on effectiveness of interventions.
MCIDs could be identified for 10 of 23 instruments affecting seven of nine outcomes. The most notable effect was for depressive symptoms, where three trials reported statistically significant differences that were not clinically meaningful based on available MCIDs. Although differences in statistical significance and MCIDs were noted for other outcomes, they were accounted for in meta-analyses or affected a minimal number of studies within the outcome category.
Incorporating MCIDs affected the interpretation of almost all PROs in the systematic review. MCIDs are important measures of clinical meaningfulness for the interpretation of palliative care research involving PROs. Researchers should consider using instruments with well-established MCIDs and incorporate MCIDs, when available, in study design and interpretation.
在姑息治疗研究中，解释患者报告结局（PROs）的临床意义是循证实践的关键。最小临床重要差异（MCIDs）可帮助解释 PRO 变化对患者是否有意义。
在最近一项关于将姑息治疗整合到美国患有非癌症严重慢性疾病的门诊成人中的系统评价中，考察 MCIDs 的使用及其对关键 PRO 解释的影响。
配对调查员从 PubMed、特定工具网站和 Google Scholar 中为系统评价中的每个 PRO 提取 MCIDs。调查员通过共识比较研究结果并解决差异。MCIDs 与荟萃分析或单独研究的结果一起解释，以得出干预效果的结论。
23 种影响 9 个结局中的 7 个结局的工具中，有 10 种可以确定 MCIDs。最显著的影响是抑郁症状，其中 3 项试验报告了基于现有 MCIDs 无临床意义的统计学显著差异。尽管其他结局的统计显著性和 MCIDs存在差异，但它们在荟萃分析中得到了考虑，或者在结局类别中仅影响了少数研究。
纳入 MCIDs 影响了系统评价中几乎所有 PRO 的解释。MCIDs 是解释涉及 PRO 的姑息治疗研究的临床意义的重要指标。研究人员应考虑使用具有既定 MCIDs 的工具，并在研究设计和解释中纳入 MCIDs（如果可用）。
