Using Stakeholder Engagement to Overcome Barriers to Implementing Patient-reported Outcomes (PROs) in Cancer Care Delivery Approaches From 3 Prospective Studies
Using Stakeholder Engagement to Overcome Barriers to Implementing Patient-reported Outcomes (PROs) in Cancer Care Delivery Approaches From 3 Prospective Studies
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DOI：
10.1097/mlr.0000000000001103
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发表时间：
2019-05-01
期刊：
影响因子：
3
通讯作者：
Basch, Ethan M.
中科院分区：
文献类型：
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作者：
Stover, Angela M.;Stricker, Carrie Tompkins;Basch, Ethan M.
简介：癌症护理过程中使用的患者报告结果 (PRO) 措施可改善患者和临床医生之间有关症状的沟通，并减少对不受控制的症状的服务利用率。然而，PRO 在常规癌症护理中的应用进展缓慢。在本文中，我们描述了用于克服实施 PRO 障碍的利益相关者参与活动。在 2 个研究环境中实施：PRO 在候诊室完成并在临床访视期间进行审查，以指导多发性骨髓瘤的症状管理（基于访视的 PRO）；癌症患者在化疗期间完成的每周 PRO 在家中监测症状（远程 PRO）。方法：跨研究的 PRO 实施步骤包括：（1）临床医生和患者对关键症状、PRO 措施的输入，并确定哪些 PRO 反应与临床相关，以更好地瞄准护理行动； (2) 开发基于 PRO 的临床决策支持（CDS），以应对相关的 PRO； (3) 培训临床医生和临床研究助理解读PRO和使用软件； (4) 描述实施影响（有关 PRO 反应和护理行动的频率）。讨论：临床医生和患者的意见对于确定关键症状、PRO 措施以及临床相关的应对方案至关重要。对于基于访问的 PRO 观察性研究，所有症状评分都显示在临床医生仪表板上，并且患者评分 >= 1 的评分（按 0-4 或 0-10 等级）可访问基于 PRO 的 CDS。对于 2 个远程 PRO 试验，利益相关者建议 2 个“最差”响应选项（例如“经常”/“总是”或“严重”/“非常严重”的 PRO 响应）将触发向护士发送自动电子邮件警报以及基于 PRO 的 CDS。在每项研究中，基于 PRO 的 CDS 都是根据临床医生的意见定制的。在所有研究中，对相关 PRO 的最常见的护理反应是向患者提供有关症状自我管理的咨询（或提供护理计划）。在试验中，每周远程 PRO 向护士发出警报的比例从学术中心的 13% 到社区肿瘤实践的 36% 不等。
Introduction: Patient-reported outcome (PRO) measures used during cancer care delivery improve communication about symptoms between patients and clinicians and reduce service utilization for uncontrolled symptoms. However, uptake of PROs in routine cancer care has been slow. In this paper, we describe stakeholder engagement activities used to overcome barriers to implementing PROs. Implementation occurred in 2 study settings: PROs completed in the waiting room and reviewed during clinical visits to guide symptom management for multiple myeloma (visit-based PROs); and weekly PROs completed by cancer patients between chemotherapy visits to monitor symptoms at home (remote PROs). Methods: PRO implementation steps across studies included: (1) clinician and patient input on key symptoms, PRO measures, and identifying which PRO responses are clinically concerning to better target nursing actions; (2) developing PRO-based clinical decision support (CDS) for responding to concerning PROs; (3) training clinicians and clinical research assistants to interpret PROs and use software; and (4) describing implementation impact (frequency of concerning PRO responses and nursing actions). Discussion: Clinician and patient input was critical for identifying key symptoms, PRO measures, and clinically concerning response options. For the visit-based PRO observational study, all symptom scores appeared on a clinician dashboard, and those rated >= 1 by patients (on a 0-4 or 0-10 scale) had PRO-based CDS available for access. For the 2 remote PROs trials, stakeholders recommended that the 2 "worst" response options (eg, PRO responses of "often"/"always" or "severe"/"very severe") would trigger an automated email alert to a nurse along with PRO-based CDS. In each study, PRO-based CDS was tailored based on clinician input. Across studies, the most common nursing response to concerning PROs was counseling patients on (or providing care plans for) self-management of symptoms. In the trials, the percentage of weekly remote PROs generating an alert to a nurse ranged from 13% at an academic center to 36% in community oncology practices.