在医学肿瘤学环境中实施患者报告结局（iPROMOS 研究）：II 型混合实施研究。

Implementation of Patient-Reported Outcomes in a Medical Oncology Setting (the iPROMOS Study): Type II Hybrid Implementation Study.

机构信息

The University of Queensland Centre for Clinical Research, Herston, Australia.

Surgical Treatment and Rehabilitation Service Metro North Health and University of Queensland, Herston, Australia.

出版信息

J Med Internet Res. 2024 Aug 27;26:e55841. doi: 10.2196/55841.

DOI:10.2196/55841

PMID:39190468

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11387919/

Abstract

BACKGROUND

Clinical trials have demonstrated that patient-reported outcome measures (PROMs) can improve mortality and morbidity outcomes when used in clinical practice.

OBJECTIVE

This study aimed to prospectively investigate the implementation of PROMs in routine oncology. Outcomes measured included improved symptom detection, clinical response to symptom information, and health service outcomes.

METHODS

Two of 12 eligible clinics were randomized to implement symptom PROMs in a medical oncology outpatient department in Australia. Randomization was carried out at the clinic level. Patients in control clinics continued with usual care; those in intervention clinics completed a symptom PROM at presentation. This was a pilot study investigating symptom detection, using binary logistic models, and clinical response to PROMs investigated using multiple regression models.

RESULTS

A total of 461 patient encounters were included, consisting of 242 encounters in the control and 222 in the intervention condition. Patients in these clinics most commonly had head and neck, lung, prostate, breast, or colorectal cancer and were seen in the clinic for surveillance and oral or systemic treatments for curative, metastatic, or palliative cancer care pathways. Compared with control encounters, the proportion of symptoms detected increased in intervention encounters (odds ratio 1.05, 95% CI 0.99-1.11; P=.08). The odds of receiving supportive care, demonstrated by nonroutine allied health review, increased in the intervention compared with control encounters (odds ratio 3.54, 95% CI 1.26-9.90; P=.02).

CONCLUSIONS

Implementation of PROMs in routine care did not significantly improve symptom detection but increased the likelihood of nonroutine allied health reviews for supportive care. Larger studies are needed to investigate health service outcomes.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12618000398202; https://tinyurl.com/3cxbemy4.

摘要

背景

临床试验表明，在临床实践中使用患者报告结局测量（PROMs）可以改善死亡率和发病率结局。

目的

本研究旨在前瞻性调查 PROM 在常规肿瘤学中的实施情况。测量的结果包括改善症状检测、对症状信息的临床反应以及卫生服务结果。

方法

在澳大利亚的一家医学肿瘤学门诊中，随机选择了 12 家符合条件的诊所中的 2 家来实施症状 PROM。随机化在诊所层面进行。对照组诊所的患者继续接受常规护理；干预组诊所的患者在就诊时完成症状 PROM。这是一项试点研究，使用二项逻辑模型调查症状检测，使用多元回归模型调查对 PROM 的临床反应。

结果

共纳入 461 例患者就诊，其中对照组 242 例，干预组 222 例。这些诊所的患者最常见的癌症类型为头颈部、肺部、前列腺、乳腺或结直肠，就诊的目的是为了进行监测以及接受口服或系统治疗，以治疗、转移性或姑息性癌症护理途径。与对照组就诊相比，干预组就诊时检测到的症状比例增加（优势比 1.05，95%CI 0.99-1.11；P=.08）。与对照组就诊相比，干预组就诊时接受非常规辅助健康检查以获得支持性护理的可能性增加（优势比 3.54，95%CI 1.26-9.90；P=.02）。