Improving Recovery after Major Cancer Surgery using Patient-Reported Outcomes

项目摘要/摘要 在临床实践中增加对患者报告结果(PRO)的利用可能会导致更好的停药后- 结果令人满意，疼痛评估和管理是一个很好的例子。尽管专业人士被广泛使用 在医学和放射肿瘤学的临床研究中被接受，并得到美国食品和药物管理局的认可- 在围手术期护理实践中，引入主观结果是相对新颖的。 尽管专业人士是定义和测量患者对症状的看法的最好资源- 癌症大手术后的躯体和功能恢复，他们提供的信息可能会- 在康复期间及时指导护理。一个主要的知识差距是，尽管存在经过验证的PRO工具，但 没有既定的、用户友好的临床方法来理解和应对症状和功能- 复杂大手术后患者的AL状态报告。我们研究的目标是建立一个框架 对于PRO的临床应用，定义解释MD Anderson符号的PRO数据所需的方法- TOM量表(MDASI)，并检查MDASI的临床应用以及患者和专业视角 在未来的实践中使用它。如果我们成功了，专业人士可能会被添加到定义明确的传统指标中 围手术期护理，例如减少30天的死亡率，减少并发症，缩短住院时间，以及很少- 急诊室再入院。专业门户网站越来越多地纳入电子病历系统(例如 EPIC)，可以纵向跟踪远离医院的患者报告，使这种方法可行。vt.给出 EPIC决定在全国范围内(也在MD安德森癌症中心)纳入MDASI，我们相信我们有一个 及时提供第一个以证据为基础的一揽子方案，以支持#年MDASI的实施 围手术期护理。在MD Anderson，围手术期的恢复通过合并一个 挑战传统外科实践的增强恢复计划(ERP)。需要有效地实现- PRARE ERP和传统手术结果说明了该项目的紧迫性。我们提出了一个纵向的 临床研究，外加对专业人士的调查，以确定/解决使用专业药物的障碍。我们有阿西姆- 拥有强大的多学科团队，从症状研究、外科护理、外科和麻醉学到 研究接受胃肠道、妇科或泌尿生殖道癌手术的患者。目标1：建立 以PRO为基础的方法确定有临床意义的术后症状负担。解决的差距：不足 量化定义的、特定于程序的症状配置文件和严重程度阈值，用于管理中度 到严重的症状，尤其是出院后。目的2：建立以PRO为基础的术后评估方法 功能恢复。解决差距：缺乏自我报告的功能恢复的经验数据来表明 准备好恢复有计划的肿瘤科护理或恢复正常活动。目标3：检查专业人员的效用 通过对患者进行PRO研究和临床“探索性”观察研究，作为术后结局的衡量标准。 内科医生。解决了差距：缺乏证据表明专业人士的可用性可能会如何改变临床实践。

PROJECT SUMMARY/ABSTRACT Increasing utilization of patient-reported outcomes (PROs) in clinical practice may lead to better postop- erative outcomes, with pain assessment and management as an excellent example. Although PROs are widely accepted in clinical research in medical and radiation oncology and are endorsed by the US Food & Drug Ad- ministration, the introduction of subjective outcomes is relatively novel in perioperative care practice― despite the fact that PROs are the best resource for defining and measuring the patient’s perspective of symp- tomatic and functional recovery after major cancer surgery and that the information they provide could poten- tially guide care during recovery. A major knowledge gap is that, although validated PRO tools exist, there are no established, user-friendly clinical methods for understanding and responding to symptom and function- al-status reports from patients after complex major surgery. The goal of our study is to establish a framework for clinical adoption of PROs, to define methods needed to interpret PRO data from the MD Anderson Symp- tom Inventory (MDASI), and to examine the MDASI’s clinical utility and patient and professional perspectives on using it in future practice. If we are successful, PROs could be added to well-defined, traditional metrics in perioperative care, such as decreased 30-day mortality, fewer complications, shortened hospital stays, and few- er hospital readmissions. The increasing inclusion of PRO portals in electronic medical record systems (such as EPIC) that can longitudinally track patient report away from the hospital make this approach feasible. Given EPIC’s decision to include the MDASI nationwide (also at MD Anderson Cancer Center), we believe we have a timely opportunity to provide the first evidence-based package to support implementation of the MDASI in perioperative care. At MD Anderson, perioperative recovery is being further improved by incorporation of an Enhanced Recovery Program (ERP) that challenges traditional surgical practices. The need to effectively com- pare ERP and traditional surgery outcomes exemplifies the urgency of this project. We propose a longitudinal clinical study, plus a survey of professionals to identify/address barriers to the use of PROs. We have assem- bled a strong multidisciplinary team from symptom research, surgical nursing, surgery, and anesthesiology to study patients undergoing surgery for gastrointestinal, gynecologic, or genitourinary cancer. Aim 1: Establish PRO-based methods to determine clinically meaningful postoperative symptom burden. Gap addressed: lack of quantitatively defined, procedure-specific symptom profiles and severity thresholds for managing moderate to severe symptoms, especially postdischarge. Aim 2: Establish PRO-based methods to evaluate postoperative functional recovery. Gap addressed: lack of empirical data on self-reported functional recovery to indicate readiness to resume planned oncology care or return to normal activities. Aim 3: Examine the utility of PROs as a postoperative outcome measure through a PRO study in patients and a “probe” observational study of cli- nicians. Gap addressed: lack of evidence about how the availability of PROs might alter clinical practice.