癌症护理中的患者报告结局测量：更新的系统评价和荟萃分析。
Patient-Reported Outcome Measures in Cancer Care: An Updated Systematic Review and Meta-Analysis.
机构信息
Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
Hamilton Health Sciences-Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada.
出版信息
JAMA Netw Open. 2024 Aug 1;7(8):e2424793. doi: 10.1001/jamanetworkopen.2024.24793.
IMPORTANCE
Patient-reported outcome measures (PROMs) come directly from the patient, without clinician interpretation, to provide a patient-centered perspective.
OBJECTIVE
To understand the association of PROM integration into cancer care with patient-related, therapy-related, and health care utilization outcomes.
DATA SOURCES
Searches included MEDLINE and MEDLINE Epub ahead of print, in-process, and other nonindexed citations; Embase databases (OvidSP); PsychINFO; CENTRAL; and CINAHL from January 1, 2012 to September 26, 2022.
STUDY SELECTION
Randomized clinical trials (RCTs) that enrolled adult patients (ages 18 years and older) with active cancer receiving anticancer therapy using a PROM as an intervention.
DATA EXTRACTION AND SYNTHESIS
Pairs of review authors, using prepiloted forms, independently extracted trial characteristics, disease characteristics, and intervention details. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. Random-effects analyses were conducted.
MAIN OUTCOMES AND MEASURES
Overall mortality, health-related quality of life (HRQoL) measures, and hospital utilization outcomes.
RESULTS
From 1996 to 2022, 45 RCTs including 13 661 participants addressed the association of PROMs with outcomes considered important to patients. The addition of a PROM likely reduced the risk of overall mortality (HR, 0.84; 95% CI, 0.72-0.98; moderate certainty), improved HRQoL (range 0-100) at 12 weeks (mean difference [MD], 2.45; 95% CI, 0.42-4.48; moderate certainty). Improvements of HRQoL at 24 weeks were not significant (MD, 1.87; 95% CI, -1.21 to 4.96; low certainty). There was no association between the addition of a PROM and HRQoL at 48 weeks. The addition of a PROM was not associated with reduced ED visits (OR, 0.74; 95% CI, 0.54-1.02; low certainty) or hospital admissions (OR, 0.86; 95% CI, 0.73-1.02; low certainty).
CONCLUSION AND RELEVANCE
The findings of this study suggest that the integration of PROMs into cancer care may improve overall survival and quality of life.
重要性
患者报告的结果测量（PROMs）直接来自患者，无需临床医生解释，从而提供以患者为中心的视角。
目的
了解将 PROM 整合到癌症护理中与患者相关、治疗相关和医疗保健利用结果的关联。
数据来源
搜索包括 MEDLINE 和 MEDLINE Epub 提前打印、进行中和其他非索引引文；Embase 数据库（OvidSP）；PsychINFO；CENTRAL；以及 CINAHL，从 2012 年 1 月 1 日至 2022 年 9 月 26 日。
研究选择
随机临床试验（RCT），招募了患有活动性癌症的成年患者（年龄在 18 岁及以上），使用 PROM 作为干预措施。
数据提取和综合
使用预编程表格的一对审查作者，独立提取试验特征、疾病特征和干预细节。遵循系统评价和荟萃分析报告的首选报告项目指南。进行了随机效应分析。
主要结果和措施
总死亡率、与健康相关的生活质量（HRQoL）测量值和医院利用结果。
结果
从 1996 年到 2022 年，45 项 RCT 包括 13661 名参与者，研究了 PROMs 与患者认为重要的结果之间的关联。添加 PROM 可能降低了总体死亡率的风险（HR，0.84；95%CI，0.72-0.98；中等确定性），改善了 12 周时的 HRQoL（范围 0-100）（平均差异[MD]，2.45；95%CI，0.42-4.48；中等确定性）。24 周时的 HRQoL 改善不显著（MD，1.87；95%CI，-1.21 至 4.96；低确定性）。添加 PROM 与 48 周时的 HRQoL 之间没有关联。添加 PROM 与急诊就诊次数减少无关（OR，0.74；95%CI，0.54-1.02；低确定性）或住院人数减少（OR，0.86；95%CI，0.73-1.02；低确定性）。
结论和相关性
本研究的结果表明，将 PROM 整合到癌症护理中可能会提高总体生存率和生活质量。
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