A prospective, randomized trial of patient-reported outcome measures to drive management decisions in hematology and oncology

Electronic Patient Reported Outcome Measures and quality of life in cancer (E-PROMISE): systematic review of the evidence and meta-analysis

OBJECTIVE

The objective of this systematic review and meta-analysis (SRMA) was to evaluate the impact of electronic patient-reported outcomes (ePROs) on health-related quality of life (HRQoL) in patients with cancer.

DESIGN

We performed SRMA of randomised controlled trials (RCTs) comparing ePRO interventions with usual care in patients with cancer. The primary outcome was HRQoL. We used a random effects model a priori due to the anticipated clinical heterogeneity. Subgroup analyses and meta-regressions were performed to explore sources of heterogeneity. After assessing the risk of bias using risk-of-bias tool (RoB V.2), we rated the evidence certainty using the Grading of Recommendations, Assessment, Development and Evaluations framework.

ELIGIBILITY CRITERIA

We included studies meeting the following criteria: (1) RCTs; (2) patients diagnosed with any type of cancer, undergoing or having completed treatment; (3) comparing ePROs with usual care without ePRO interventions; (4) assessing the effect on HRQoL.

INFORMATION SOURCES

We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to April 2024.

RESULTS

We screened 7706 records to include 36 RCTs with 9608 patients. ePRO interventions showed a standardised mean difference (SMD) of 0.35; 95% CI 0.18 to 0.51 compared with usual care. Patients receiving ongoing therapy had an SMD of 0.39 (95% CI 0.21 to 0.58), while those who had completed therapy had an SMD of 0.12 (95% CI 0.01 to 0.22), with a significant subgroup difference (p=0.01). No statistically significant differences were observed across the method of ePRO assessment, cancer site, metastasis status, therapy status, average age or duration of ePRO use. The results remained consistent with Bayesian and other sensitivity analyses.

CONCLUSIONS

ePRO interventions improve HRQoL more than usual care in patients with cancer, with greater effect in those currently undergoing therapy. This improvement is independent of cancer type, duration of ePRO use or patient age. Future research should address sources of heterogeneity, explore long-term impacts and develop strategies to increase patient engagement and adherence to ePRO systems.

PROSPERO REGISTRATION NUMBER

CRD42024531708.

Patient-Reported Outcome Measures in Routine Hematology Cancer Care: A Scoping Review

BACKGROUND

Hematological cancers have devastating effects on patients' physical, emotional, and psychosocial health. There is growing evidence to support the use of patient-reported outcome measures (PROMs) through validated tools. Although PROMs are widely adopted in oncology, uptake in hematology remains limited in routine clinical care.

OBJECTIVE

This review seeks to explore the utility of PROMs in routine hematology clinical practice and to understand the extent and type of evidence in relation to benefits of PROMs to patients.

METHODS

The review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analysis scoping review model for organizing information.

RESULTS

Ten thousand and seventy-one articles were identified, 110 full texts were reviewed, and 14 articles met the final inclusion criteria. More than 20 individual outcome measures were identified that fell into the following categories: accessibility and usability, self-efficacy, shared decision-making, and implementation.

CONCLUSIONS

Studies focused primarily on the choice of PROM, acceptability and usability, motivation for use, patient and healthcare professionals' experience of using PROMs, the stated value of PROMs, and implementation advice. However, there are limited published studies supporting how PROMs can be adopted into routine care for people with hematological cancer.

IMPLICATIONS FOR PRACTICE

There are various validated PROMs but limited research on how to meaningfully implement them to improve clinical and patient outcomes in the routine care of hematology patients.

The Performance of Kaizen Tasks Across Three Online Discrete Choice Experiment Surveys: An Evidence Synthesis

BACKGROUND

Kaizen is a Japanese term for continuous improvement (kai ~ change, zen ~ good). In a kaizen task, a respondent makes sequential choices to improve an object's profile, revealing a preference path. Including kaizen tasks in a discrete choice experiment has the advantage of collecting greater preference evidence than pick-one tasks, such as paired comparisons. OBJECTIVE AND METHODS: So far, three online discrete choice experiments have included kaizen tasks: the 2020 US COVID-19 vaccination (CVP) study, the 2021 UK Children's Surgery Outcome Reporting (CSOR) study, and the 2023 US EQ-5D-Y-3L valuation (Y-3L) study. In this evidence synthesis, we describe the performance of the kaizen tasks in terms of response behaviors, conditional logit and Zermelo-Bradley-Terry (ZBT) estimates, and their standard errors in each of the surveys.

RESULTS

Comparing the CVP and Y-3L, including hold-outs (i.e., attributes shared by all alternatives) seems to reduce positional behavior by half. The CVP tasks excluded multi-level improvements; therefore, we could not estimate logit main effects directly. In the CSOR, only 12 of the 21 logit estimates are significantly positive (p < 0.05), possibly due to the fixed attribute order. All Y-3L estimates are significantly positive, and their predictions are highly correlated (Pearson: logit 0.802, ZBT 0.882) and strongly agree (Lin: logit 0.744, ZBT 0.852) with the paired-comparison probabilities.

CONCLUSIONS

These discrete choice experiments offer important lessons for future studies: (1) include warm-up tasks, hold-outs, and multi-level improvements; (2) randomize the attribute order (i.e., up-down) at the respondent level; and (3) recruit smaller samples of respondents than traditional discrete choice experiments with only pick-one tasks.

Patient-Reported Outcome Measures in Cancer Care: An Updated Systematic Review and Meta-Analysis

Importance

Patient-reported outcome measures (PROMs) come directly from the patient, without clinician interpretation, to provide a patient-centered perspective.

Objective

To understand the association of PROM integration into cancer care with patient-related, therapy-related, and health care utilization outcomes.

Data Sources

Searches included MEDLINE and MEDLINE Epub ahead of print, in-process, and other nonindexed citations; Embase databases (OvidSP); PsychINFO; CENTRAL; and CINAHL from January 1, 2012 to September 26, 2022.

Study Selection

Randomized clinical trials (RCTs) that enrolled adult patients (ages 18 years and older) with active cancer receiving anticancer therapy using a PROM as an intervention.

Data Extraction and Synthesis

Pairs of review authors, using prepiloted forms, independently extracted trial characteristics, disease characteristics, and intervention details. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. Random-effects analyses were conducted.

Main Outcomes and Measures

Overall mortality, health-related quality of life (HRQoL) measures, and hospital utilization outcomes.

Results

From 1996 to 2022, 45 RCTs including 13 661 participants addressed the association of PROMs with outcomes considered important to patients. The addition of a PROM likely reduced the risk of overall mortality (HR, 0.84; 95% CI, 0.72-0.98; moderate certainty), improved HRQoL (range 0-100) at 12 weeks (mean difference [MD], 2.45; 95% CI, 0.42-4.48; moderate certainty). Improvements of HRQoL at 24 weeks were not significant (MD, 1.87; 95% CI, -1.21 to 4.96; low certainty). There was no association between the addition of a PROM and HRQoL at 48 weeks. The addition of a PROM was not associated with reduced ED visits (OR, 0.74; 95% CI, 0.54-1.02; low certainty) or hospital admissions (OR, 0.86; 95% CI, 0.73-1.02; low certainty).

Conclusion and Relevance

The findings of this study suggest that the integration of PROMs into cancer care may improve overall survival and quality of life.

The Well-Being of Social Health Professionals: Relationship between Coping Strategies, Emotional Regulation, Metacognition and Quality of Professional Life

Social health professionals should have the knowledge and skills and use personal resources that promote the helping relationship, access to effective intervention strategies, and well-being at work. This study aims to investigate the relationship between some personal resources (coping strategies, emotional regulation and metacognition) and professional satisfaction in a group of social-health professionals working with minors suffering from psychosocial distress. In this professional group, the risk of burnout is common and the quality of professional life is strongly related to the intensity and frequency of exposure to critical and traumatic events. The sample was assessed using self-report instruments: Professional Quality of Life Scale, Coping Orientation to the Problem Experienced, Difficulties in Emotional Regulation Scale and Metacognition Self-Assessment Scale. The quality of professional life showed significant correlations with the psychological characteristics studied. We then tested different regression models: coping orientation scores were found to be a significant predictor of quality of work life for all three components, while emotional dysregulation scores appeared to predict only the burnout component. The quality of professional life of social health professionals was influenced by individual resources at different levels, regardless of knowledge and skills. They showed greater fatigue and aspects of secondary traumatization when emotional disengagement occurred and it seemed to be difficult for them to accept their emotional reactions.