背景:临床试验表明,患者报告的结果指标(PROM)在临床实践中使用时可以改善死亡率和发病率。
目的:本研究旨在前瞻性地探讨PROM在常规肿瘤学中的应用。测量的结果包括改善症状检测,对症状信息的临床反应,和卫生服务成果。
方法:12个符合条件的诊所中有2个在澳大利亚的一个肿瘤内科门诊部随机实施症状PROM。在临床水平上进行随机化。对照诊所的患者继续接受常规护理;干预诊所的患者在出现时完成了症状性PROM。这是一项调查症状检测的试点研究,使用二元逻辑模型,以及使用多元回归模型调查的对PROM的临床反应。
结果:共纳入461例患者,由控制中的242次相遇和干预条件中的222次相遇组成。这些诊所的患者最常见的是头部和颈部,肺,前列腺,乳房,或结直肠癌,并在临床上进行监测和口服或全身治疗以治愈,转移性,或姑息癌症治疗途径。与控制遭遇相比,在介入治疗中检测到的症状比例增加(比值比1.05,95%CI0.99-1.11;P=.08).接受支持性治疗的可能性,通过非常规联合健康审查证明,与对照组相比,干预措施增加(比值比3.54,95%CI1.26-9.90;P=.02)。
结论:在常规护理中实施PROM并未显着改善症状检测,但增加了支持护理的非常规联合健康审查的可能性。需要更大的研究来调查卫生服务结果。
背景:澳大利亚新西兰临床试验注册中心ACTRN12618000398202;https://tinyurl.com/3cxbemy4。
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.
BACKGROUND: Australian New Zealand Clinical Trials Registry ACTRN12618000398202; https://tinyurl.com/3cxbemy4.