The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory?
The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory?
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DOI：
10.1016/j.socscimed.2004.06.022
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发表时间：
2005-02-01
影响因子：
5.4
通讯作者：
Flynn, R
中科院分区：
文献类型：
--
作者：
Greenhalgh, J;Long, AF;Flynn, R
本文采用理论驱动的方法来探讨为什么在临床实践中使用患者报告的结果（PRO）的措施，特别是健康相关的生活质量（HRQoL）的工具，很少或没有明显的影响，临床决策。理论驱动的方法包括将干预是否有效以及如何有效的知识结合起来。有人认为，这种方法是目前缺乏的文献中评估的有效性反馈HRQoL信息的临床医生。该文件确定了一些机制，可能会导致预期的结果，目前隐含在设计的干预和假设中指定的试验，评价HRQoL措施在临床实践中的使用。然后，它研究了目前的临床实践与这些机制相匹配的程度，并在此过程中，对HRQoL对临床决策缺乏影响的一些可能的解释进行了审查。HRQoL信息对临床决策的影响取决于与干预设计、患者和临床医生在咨询中讨论HRQoL问题的愿望以及临床医生给予HRQoL工具的合法性相关的大量因素。迄今关于HRQoL信息反馈给临床医生如何改善医患沟通或临床决策制定的知识还没有充分告知对患者护理的这些方面是否得到改善的评估。最后，本文详细说明了如何修改HRQoL信息反馈给临床医生，以最大限度地提高其对临床决策的影响。(C)2004爱思唯尔有限公司保留所有权利。
This paper applies a theory-driven approach to explore why the use of patient-reported outcome (PRO) measures in clinical practice, in particular, health-related quality of life (HRQoL) instruments, has little or no apparent influence on clinical decision making. A theory-driven approach involves combining knowledge of whether and how an intervention works. It is argued that such an approach is currently lacking within the literature evaluating the effectiveness of feeding back HRQoL information to clinicians. The paper identifies a number of mechanisms that might give rise to the expected outcomes that are currently implicit within the design of the intervention and hypotheses specified within the trials evaluating the use of HRQoL measures in clinical practice. It then examines how far cur-rent clinical practice matches these mechanisms and in doing so, a number of possible explanations for the lack of impact of HRQoL on clinical decision making are reviewed. The influence of HRQoL information on clinical decision making depends on a large number of factors related to the design of the intervention, patients' and clinicians' desire to discuss HRQoL issues within the consultation and the legitimacy that clinicians give to HRQoL instruments. To date. knowledge of how the feedback of HRQoL information to clinicians might improve doctor-patient communication or clinical decision making has yet to sufficiently inform an assessment of whether these aspects of patient care are improved. The paper concludes by specifying how the feedback of HRQoL information to clinicians might be modified to maximise its impact on clinical decision making. (C) 2004 Elsevier Ltd. All rights reserved.