Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
Qual Life Res. 2023 May;32(5):1231-1238. doi: 10.1007/s11136-022-03246-4. Epub 2022 Sep 10.
Patient-reported outcomes (PROs) are used in clinical practice for several purposes, including to monitor whether a treatment is working or whether a patient is experiencing adverse events from treatment. This study surveyed oncology providers (OP) and mental health providers (MHP) to determine how clinicians from different disciplines determine individual-level meaningful change on PROs. Understanding how clinicians determine change on PROs could help inform methods for individualizing meaningful change definitions, an approach we have dubbed "Precision PROs".
Three hundred and forty-seven providers utilizing PROs completed an online survey about PRO use to monitor patients in clinical practice. A question on methods used to determine individual-level meaningful change on PROs was developed with input from clinicians. Multivariate logistic regression analyses were used to assess whether specific methods were associated with clinician characteristics.
The most commonly reported method was comparing the previous score to the current score (65%). Other methods included examining the numerical scores without a visual aid (59%), considering other factors affecting scores (42%), comparing scores to norms (31%) and using a graph of scores (29%). Provider age was negatively associated with odds of using a graph (OR = 0.95, 95% CI 0.91, 1.0) but no other method. Provider gender, hours per week in clinical practice and years in practice were not associated with odds of using a specific method.
Most providers determined individual-level meaningful change without a visual aid and used only the previous score and current score, the minimum number (2 scores) to determine change. Consistent with current practice, future research on methods of determining within-individual meaningful change for clinical use should focus on methods requiring two rather than three or more scores. When attempting to personalize within-individual change definitions (Precision PROs), methods examining a baseline and single follow-up may be most useful for clinical practice.
患者报告的结局（PROs）在临床实践中用于多种目的，包括监测治疗是否有效以及患者是否因治疗而出现不良反应。本研究调查了肿瘤学提供者（OP）和心理健康提供者（MHP），以确定来自不同学科的临床医生如何确定 PRO 上的个体水平有意义的变化。了解临床医生如何确定 PRO 上的变化可以帮助确定用于个性化有意义的变化定义的方法，我们将这种方法称为“精准 PROs”。
347 名使用 PROs 的提供者完成了一项关于 PRO 使用的在线调查，以监测临床实践中的患者。一个关于确定 PRO 上个体水平有意义变化的方法的问题是在临床医生的投入下开发的。采用多变量逻辑回归分析评估特定方法是否与临床医生特征相关。
最常报告的方法是将以前的分数与当前的分数进行比较（65%）。其他方法包括检查没有视觉辅助的数字分数（59%）、考虑影响分数的其他因素（42%）、将分数与标准进行比较（31%）和使用分数图表（29%）。提供者年龄与使用图表的几率呈负相关（OR=0.95，95%CI 0.91,1.0），但其他方法则不然。提供者性别、每周临床实践时间和实践年限与使用特定方法的几率无关。
大多数提供者在没有视觉辅助的情况下确定个体水平的有意义变化，仅使用以前的分数和当前分数，这是确定变化所需的最少分数（2 个分数）。与当前实践一致，未来关于确定临床应用中个体内有意义变化的方法的研究应侧重于需要两个而不是三个或更多分数的方法。在尝试个性化个体内变化定义（精准 PROs）时，检查基线和单次随访的方法可能对临床实践最有用。
