Detmar S B, Aaronson N K
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoekhuis Hospital, Amsterdam, The Netherlands.
Eur J Cancer. 1998 Jul;34(8):1181-6. doi: 10.1016/s0959-8049(98)00018-5.
Quality of life (QL) assessments are increasingly being included in clinical trials, but their use in clinical practice is still uncommon. The objectives of this study were to investigate the feasibility of introducing individual QL assessments into the daily routine of an out-patient oncology clinic, and the potential impact of such assessments on doctor-patient communication. The study sample included six physicians and 18 of their patients from the out-patient clinic of the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital in Amsterdam, The Netherlands. For each patient, three follow-up consultations were observed. The first visit was employed for the purpose of a baseline measurement. At the two subsequent visits, the patients were asked to complete the EORTC QLQ-C30, a standardised cancer-specific QL questionnaire. The patients' responses were computer-scored and transformed into a graphic summary. The summary included current scores as well as those elicited at the previous visit. Both the physicians and the patients received a copy of the summary just prior to the medical consultation. Completing, scoring and printing the QL data could be done during waiting room time. The availability of the summary did not lengthen the average consultation time. A small increase was noted in the average number of QL issues discussed per consultation. However, the most notable trend was the increased responsibility taken by the physicians in raising specific QL issues for discussion. When the QL summary was available, the physicians raised three times as many topics than was the case prior to its use (P < 0.05). All six physicians and the majority of patients believed that the QL summary facilitated communication, and expressed interest in continued use of the procedure. The introduction of individual QL assessments in routine out-patient oncology practice is feasible and appears to stimulate physicians to inquire into specific aspects of the health and well-being of their patients. However, given the methodological limitations of this pilot study, the results should be interpreted with caution.
生活质量（QL）评估在临床试验中的应用越来越普遍，但在临床实践中的使用仍不常见。本研究的目的是调查将个体QL评估纳入门诊肿瘤诊所日常工作的可行性，以及此类评估对医患沟通的潜在影响。研究样本包括荷兰阿姆斯特丹荷兰癌症研究所/安东尼·范·列文虎克医院门诊诊所的六位医生及其18名患者。对每位患者进行了三次随访咨询。第一次就诊用于基线测量。在随后的两次就诊中，要求患者完成EORTC QLQ-C30，这是一份标准化的癌症特异性QL问卷。患者的回答由计算机评分并转化为图形摘要。摘要包括当前得分以及上次就诊时的得分。在医疗咨询前，医生和患者都收到了一份摘要副本。完成、评分和打印QL数据可以在候诊时间内完成。摘要的提供并没有延长平均咨询时间。每次咨询中讨论的QL问题平均数量略有增加。然而，最显著的趋势是医生在提出具体的QL问题进行讨论方面承担的责任增加。当有QL摘要时，医生提出的话题数量是使用前的三倍（P < 0.05）。所有六位医生和大多数患者都认为QL摘要促进了沟通，并表示有兴趣继续使用该程序。在门诊肿瘤学常规实践中引入个体QL评估是可行的，并且似乎促使医生询问患者健康和幸福的具体方面。然而，鉴于这项试点研究的方法学局限性，对结果的解释应谨慎。
