Impact of Patient-Reported Outcomes in Oncology: A Longitudinal Analysis of Patient-Physician Communication

• Published in: Journal of clinical oncology Vol. 29; no. 21; pp. 2910 - 2917
• Main Authors: TAKEUCHI, Elena E, KEDING, Ada, AWAD, Noha, HOFMANN, Ursula, CAMPBELL, Lyndsay J, SELBY, Peter J, BROWN, Julia M, VELIKOVA, Galina
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 20-07-2011
• Subjects: Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Biological and medical sciences; Communication; England; Feedback, Psychological; Female; Health Knowledge, Attitudes, Practice; Humans; Least-Squares Analysis; Logistic Models; Longitudinal Studies; Male; Medical Oncology - statistics & numerical data; Medical sciences; Middle Aged; Neoplasms - complications; Neoplasms - diagnosis; Neoplasms - psychology; Neoplasms - therapy; Patients - psychology; Patients - statistics & numerical data; Physician-Patient Relations; Prospective Studies; Quality of Health Care; Quality of Life; Referral and Consultation; Self Report; Severity of Illness Index; Treatment Outcome; Tumors; Young Adult; England; Human; Cancerology; Prognosis; Physician patient relation; Malignant tumor; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2010.32.2453

Regularly collecting patient-reported outcomes (PROs) of health-related quality of life with feedback to oncologists may assist in eliciting and monitoring patients' problems during cancer treatment. This study examined how PRO feedback had an impact on patient-physician communication over time to gain a better understanding of how it may influence patient care.
Exploratory analyses were performed on a data set from a previous study. Patients were randomly assigned to intervention (regular completion of European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Hospital Anxiety and Depression Scale with feedback to oncologists), attention-control (completion of same questionnaires without feedback), and control (standard care) arms. The content of consultation audio recordings between 28 oncologists and 198 patients over four consecutive visits (792 consultations) was analyzed. Mixed-effects models and multivariate regressions were used to examine the longitudinal impact of the intervention on patient-physician communication, dynamics of patient-physician interaction, and the association between PROs and the content of clinic discussion.
Patients in the intervention arm discussed more symptoms over time compared with patients in the attention-control (P = .008) and control (P = .04) arms. No study arm effect was observed for function discussions. Discussion topics were predominantly raised by patients/relatives, regardless of arm allocation. Clinic discussions were associated with severity of patient-reported symptoms but not with patient-reported functional concerns.
A positive longitudinal impact of the intervention on symptom discussion was observed, but not for function discussion, suggesting that potentially serious problems may remain unaddressed. Training oncologists in responding to patient-reported functional concerns may increase the impact of this intervention.