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Kristensen PK, Johnsen SP. Patient-reported outcomes as hospital performance measures: the challenge of confounding and how to handle it. Int J Qual Health Care 2022; 34:ii59-ii64. [PMID: 35357444 DOI: 10.1093/intqhc/mzac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
It is highly appealing to use patient-reported outcomes (PROs) as hospital performance measures; however, so far, the attention to key methodological issues has been limited. One of the most critical challenges when comparing PRO-based performance measures across providers is to rule out confounding. In this paper, we explain confounding and why it matters when comparing across providers. Using examples from studies, we present potential strategies for dealing with confounding when using PRO data at an aggregated level. We aim to give clinicians an overview of how confounding can be addressed in both the design stage (restriction, matching, self-controlled design and propensity score) and the analysis stage (stratification, standardization and multivariable adjustment, including multilevel analysis) of a study. We also briefly discuss strategies for confounding control when data on important confounders are missing or unavailable.
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Affiliation(s)
- Pia Kjær Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg 9000, Denmark
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2
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Implementation of patient-reported outcome measures into health care for men with localized prostate cancer. Nat Rev Urol 2022; 19:263-279. [PMID: 35260844 DOI: 10.1038/s41585-022-00575-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
Measuring treatment-related quality of life (QOL) has become an increasingly requisite component of delivering high-quality care for patients with prostate cancer. Patient-reported outcome measures (PROMs) have, therefore, become an important tool for understanding the adverse effects of radical prostate cancer treatment and have been widely integrated into clinical practice. By providing real-time symptom monitoring and improved clinical feedback to patients and providers, PRO assessment has led to meaningful gains in prostate cancer care delivery and quality improvement worldwide. By providing an avenue for benchmarking, collaboration and population health monitoring, PROMs have delivered substantial improvements beyond providing individual symptom feedback. However, multilevel barriers exist that need to be addressed before the routine implementation of PROMs is achieved. Improvements in collection, interpretation, standardization and reporting will be crucial for the continued implementation of PROM instruments in prostate cancer pathways.
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Smith L, Downing A, Norman P, Wright P, Hounsome L, Watson E, Wagland R, Selby P, Kind P, Donnelly DW, Butcher H, Huws D, McNair E, Gavin A, Glaser AW. Influence of deprivation and rurality on patient-reported outcomes of men living with and beyond prostate cancer diagnosis in the UK: A population-based study. Cancer Epidemiol 2020; 69:101830. [PMID: 33002843 DOI: 10.1016/j.canep.2020.101830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the UK, inequalities exist in prostate cancer incidence, survival and treatment by area deprivation and rurality. This work aimed to identify variation in patient-reported outcomes of men with prostate cancer by area type. METHODS A population-based survey of men 18-42 months after prostate cancer diagnosis (N = 35608) measured self-assessed health (SAH) using the EQ-5D and five functional domains using the Expanded Prostate Cancer Index Composite (EPIC-26). RESULTS Mean SAH was higher for men in least deprived areas compared to most deprived (difference 6.3 (95 %CI 5.6-7.2)). SAH scores were lower for men in most urban areas compared to most rural (difference 2.4 (95 %CI 1.8-3.0)). Equivalent estimates in the general population reported a 13 point difference by deprivation and a 4 point difference by rurality. For each EPIC-26 domain, functional outcomes were better for men in the least deprived areas, with clinically meaningful differences observed for urinary incontinence and hormonal function. There were no clinically meaningful differences in EPIC-26 outcomes by rurality with less than a three point difference in scores for each domain between urban and rural areas. CONCLUSION In men 18-42 months post diagnosis of prostate cancer in the UK, impacts of area deprivation and rurality on self-assessed health related quality of life were not greater than would be expected in the general population. However, clinically meaningful differences were identified for some prostate functional outcomes (urinary and hormonal function) by deprivation. No impact by rurality of residence was identified.
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Affiliation(s)
- Lesley Smith
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK.
| | - Amy Downing
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Eila Watson
- Department of Midwifery, Community and Public Health, School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Peter Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Kind
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - David W Donnelly
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Emma McNair
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Adam W Glaser
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Okoye JO. High mortality risk of prostate cancer patients in Asia and West Africa: A systematic review. Avicenna J Med 2020; 10:93-101. [PMID: 32832424 PMCID: PMC7414604 DOI: 10.4103/ajm.ajm_19_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Globally, prostate cancer (PCa) is the second most preponderant cancer in men. It contributes to the high mortality-to-incidence ratio reported in West Africa and Asia largely due to low screening. The mortality risk is determined or predicted based on the prevalence of high-risk or aggressive PCa using a scoring or grading system such as Gleason score (GS), Gleason grade (GG), and prostate-specific antigen (PSA) level. In this review, peer-reviewed articles found on databases such as Google Scholar, Scopus, Web of Science, PubMed Central and, EMBASE were selected based on adherence to clinical guidelines for the classification of PCa. In West Africa and Asia, the result revealed that the frequency of high-risk PCa was 42% and 51.2% based on GS, 48.8% and 25.3% based on GG pattern, and 87.5% and 44.3% based on PSA level >10 ng/mL, respectively. Data revealed a high prevalence of high-risk PCa both in West Africa and Asia when compared with developed countries. However, the prevalence of high-risk PCa is higher in West Africa than in Asia. Studies have shown that high-risk PCas are associated with germline mutations and such mutations are prevalent in blacks and Asians than in whites. Thus, testing for germline mutations in patients with GS of ≥ 7, GG ≥ 3, high prostate density, low prostate volume, and PSA levels of >4.0 ng/mL may identify those at risk of developing lethal PCa and could reduce the mortality rates in Asia and West Africa.
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Affiliation(s)
- Jude O Okoye
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, College of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
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Jones P, Sandoval Barba H, Johnson MI, Soomro N, Robson W, Ferguson J, Aning JJ. Erectile dysfunction after robotic radical prostatectomy: Real-life impact of vacuum erection device clinic. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820946630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Post-radical prostatectomy erectile dysfunction (post-RPED) is a common and potentially devastating complication. The role of PDE5-inhibitors (PDE5-Is) in post-RPED is controversial and invasive pharmacological treatments are associated with poor long-term compliance. Vacuum erection devices (VEDs) are a non-pharmacological alternative. Little data regarding VED efficacy and associated patient satisfaction in post-RPED exists. This study aimed to investigate the outcomes of VED therapy in a post-robot assisted radical prostatectomy (post-RARP) population. Methods: All men who underwent RARP at a single centre between February 2015 and October 2017 attended a nurse-led holistic-needs-assessment (HNA) appointment at 10 weeks post-RARP. All men identifying ED as a concern at HNA were offered dedicated nurse-led post-RPED clinic and VED clinic appointments. A cross-sectional survey of patient reported outcomes in these men was performed. Results: In total 137/539 (25%) men reported ED as a concern at HNA. All 137 men attended the VED clinic, 124/137 (90%) responded to the survey. Commonest reason for choosing VED therapy was for combined psychological, penetration and lengthening purposes (48%). Median time from RARP to VED clinic and from VED clinic to survey was 122 days (range 56–595) and 462 days (range 66–932) respectively. At survey 88/124(70.9%) reported continued use of VED, 69/88 (78%) of this group perceived VED treatment to be successful. Of those who had stopped using VED, 7/36 (19%) felt it had been successful. Key reasons for discontinuation were either because men felt it ineffective (13/36 (37%)) or disliked the device (10/36 (29%)). Conclusion: VED therapy is an effective treatment for men with post-RARP ED that is well tolerated with good short- to medium-term compliance. Up to two-thirds of men may find overall satisfaction with their post-RPED after VED therapy. Level of Evidence: 3
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Affiliation(s)
- Patrick Jones
- Bristol Urological Institute, North Bristol NHS Trust, Bristol
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Re: David W. Donnelly, Anna Gavin, Amy Downing, et al. Regional Variations in Quality of Survival Among Men with Prostate Cancer Across the United Kingdom. Eur Urol 2019;76:228-37. Eur Urol 2019; 77:e65. [PMID: 31213325 DOI: 10.1016/j.eururo.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/06/2019] [Indexed: 11/21/2022]
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