Patient-reported outcome measures and supportive care need assessment in patients attending an Australian comprehensive care centre: a multi-method study

Abstract

Purpose

Patient-reported outcome measures (PROMs) are useful clinical tools to recognise symptoms, patient needs and their severity. Whilst PROMs are routinely utilised in integrative oncology (IO) and supportive care (SC) services to improve patient care, they are not as common in general oncology. We explored our patients’ symptom burden, the approach taken by clinicians to identify and manage patient needs, and barriers and facilitators to using PROMs in an Australian tertiary comprehensive cancer centre to inform wider implementation of PROMs.

Methods

From 2017 to 2018, PROM data collected for patients accessing IO and SC was retrospectively analysed. Semi-structured interviews with oncology doctors and nurses explored their approach to patient needs assessment and their use of PROMs.

Results

A total of 404 patients completed the Edmonton Symptom Assessment Scale (ESAS). The most frequently identified symptoms were sleep disturbance, fatigue and lack of wellbeing. Symptom clusters included drowsiness, fatigue and shortness of breath; anxiety and depression; sleep and pain; appetite and nausea. In total, 9 nurse consultants, 5 surgeons, 7 medical and 5 radiation oncologists were interviewed. Most participants took an intuitive approach to identifying and managing patient needs and did not routinely use PROMs. Perceived risks, barriers and facilitators to using PROMS are presented.

Conclusions

High and complex symptom burden was found in our IO and SC patient population, reinforcing the need for screening. Whilst wider clinical use of PROMs within the hospital may improve clinical outcomes, the barriers and facilitators identified by Health Care Professionals (HCPs) need to be addressed before implementing PROMs more broadly.

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Data Availability

The authors declare that data and material supporting the findings of this study are available within the article and its supplementary information files.

Code availability

Not applicable

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Funding

Dr Diana Naehrig has been funded through philanthropic donation (Gloria Vallarta Fellowship).

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Authors

Corresponding author

Correspondence to Judith Lacey.

Ethics declarations

Ethics approval

Approval has been obtained from the ethics committee (Sydney Local Health District Human Ethics Committee (Nos. X18-0243 and LNR/18/RPAH/344)). This study was performed in line with the principles of the Declaration of Helsinki.

Consent to participate

Written informed consent was obtained from individual interview participants included in the study as per approved HREC study protocol.

Consent for publication

Written informed consent was obtained to publish study data as part of consent to participate as per approved HREC study protocol.

Conflict of interest

The authors declare no competing interests.

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Appendix

Appendix

Table 5 Summary of services accessed for patients that completed ESAS (n=404)
Table 6 Symptom clusters as determined by PCA

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Naehrig, D.N., Dhillon, H.M., Asher, R. et al. Patient-reported outcome measures and supportive care need assessment in patients attending an Australian comprehensive care centre: a multi-method study. Support Care Cancer (2021). https://doi.org/10.1007/s00520-021-06028-9

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Keywords

  • PROMs
  • Patient-reported outcome measures
  • Integrative oncology
  • Symptom clusters
  • Supportive care
  • Patient needs