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Wintner LM, Sztankay M, Riedl D, Rumpold G, Nickels A, Licht T, Holzner B. How to implement routine electronic patient-reported outcome monitoring in oncology rehabilitation. Int J Clin Pract 2021; 75:e13694. [PMID: 32885565 PMCID: PMC8047907 DOI: 10.1111/ijcp.13694] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/28/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Implemenation of patient-reported outcomes (PRO) like quality of life can add the patient's perspective to traditional clinical outcomes of cancer rehabilitation in a structured and standardized way. AIM To present useful steps for a successful implementation of routine electronic patient-reported outcomes (ePRO) monitoring. The presented steps are exemplified by describing the procedure applied in an Austrian inpatient cancer rehabilitation centre. METHODS The suggested implementation steps are presented based on the structure of the replicating effective programmes framework, which was used for developing a pragmatic implementation strategy. RESULTS We scheduled alternating trainings and process evaluations for audit and enhancement of procedures. In this way, the ePRO participation rates could be improved. Stakeholder involvement led to initiatives that included the integration of ePRO data into the medical discharge letter and the implementation of follow-up assessments. DISCUSSION Tailored changes in assessment procedures enabled the successful implementation of ePRO, which has been shown to be feasible before and after cancer rehabilitation. The continuous involvement of stakeholders paved the way for further projects initiated by medical staff as users themselves (inclusion of PRO data in the discharge letter and a comprehensive ePRO follow-up using a versatile online patient portal).
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Affiliation(s)
- Lisa M. Wintner
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of Psychiatry IMedical University of InnsbruckInnsbruckAustria
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of Psychiatry IMedical University of InnsbruckInnsbruckAustria
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of Psychiatry IIMedical University of InnsbruckInnsbruckAustria
| | - David Riedl
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of Medical PsychologyMedical University of InnsbruckInnsbruck Austria Medical University of InnsbruckInnsbruckAustria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of Medical PsychologyMedical University of InnsbruckInnsbruck Austria Medical University of InnsbruckInnsbruckAustria
| | - Alain Nickels
- Oncological Rehabilitation St. Veit im PongauSt. Veit im PongauAustria
| | - Thomas Licht
- Oncological Rehabilitation St. Veit im PongauSt. Veit im PongauAustria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of Psychiatry IMedical University of InnsbruckInnsbruckAustria
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of Psychiatry IIMedical University of InnsbruckInnsbruckAustria
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Sztankay M, Neppl L, Wintner LM, Loth FL, Willenbacher W, Weger R, Weyrer W, Steurer M, Rumpold G, Holzner B. Complementing clinical cancer registry data with patient reported outcomes: A feasibility study on routine electronic patient-reported outcome assessment for the Austrian Myelome Registry. Eur J Cancer Care (Engl) 2019; 28:e13154. [PMID: 31465136 PMCID: PMC6900154 DOI: 10.1111/ecc.13154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/22/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Routinely assessed patient-reported outcomes (PROs), such as quality of life (QOL), are important to supplement clinical cancer data but requires rigorous implementation. This study aims at depicting the implementation procedure and evaluating the feasibility of routine electronic PRO monitoring (ePRO) for collecting data supplementing the Austrian Myeloma Registry (AMR). METHODS Integration of ePRO monitoring into clinical routine was planned according to the Replicating Effective Programs framework. QOL data were assessed regularly during treatment and aftercare at the hematooncological outpatient unit at the Medical University of Innsbruck with the EORTC QLQ-C30/ +MY20 and the EQ-5D-5L. Feasibility and usability testing were performed via a multimethod approach. RESULTS Within the first year, 94.4% of the MM patients (N = 142, mean age 65.4, SD 11.8, 60% male) provided 748 PRO assessment time points overall. Patients and clinicians were satisfied with ePRO monitoring and indicated no to little disruption in clinical routine. Patient preference on assessment time points and completion frequency became evident. CONCLUSIONS Complementing the AMR with ePRO data proved to be feasible. Our findings provide useful insights for healthcare providers considering introducing ePRO monitoring to their units for informing clinical registries as well as individualised feedback to patients alike.
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Affiliation(s)
- Monika Sztankay
- Medical University of InnsbruckInnsbruckTirolAustria
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
- University of InnsbruckInnsbruckTirolAustria
| | - Lucia Neppl
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
| | - Lisa M. Wintner
- Medical University of InnsbruckInnsbruckTirolAustria
- University of InnsbruckInnsbruckTirolAustria
| | - Fanny L. Loth
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
| | - Wolfgang Willenbacher
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
- Oncotyrol–Center for Personalized Cancer MedicineInnsbruckTirolAustria
| | - Roman Weger
- Oncotyrol–Center for Personalized Cancer MedicineInnsbruckTirolAustria
| | - Walpurga Weyrer
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
| | - Michael Steurer
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
| | | | - Bernhard Holzner
- Medical University of InnsbruckInnsbruckTirolAustria
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
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Berry DL, Hong F, Blonquist TM, Halpenny B, Filson CP, Master VA, Sanda MG, Chang P, Chien GW, Jones RA, Krupski TL, Wolpin S, Wilson L, Hayes JH, Trinh QD, Sokoloff M, Somayaji P. Decision Support with the Personal Patient Profile-Prostate: A Multicenter Randomized Trial. J Urol 2017; 199:89-97. [PMID: 28754540 DOI: 10.1016/j.juro.2017.07.076] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE We evaluated the efficacy of the web based P3P (Personal Patient Profile-Prostate) decision aid vs usual care with regard to decisional conflict in men with localized prostate cancer. MATERIALS AND METHODS A randomized (1:1), controlled, parallel group, nonblinded trial was performed in 4 regions of the United States. Eligible men had clinically localized prostate cancer and an upcoming consultation, and they spoke and read English or Spanish. Participants answered questionnaires to report decision making stage, personal characteristics, concerns and preferences plus baseline symptoms and decisional conflict. A randomization algorithm allocated participants to receive tailored education and communication coaching, generic teaching sheets and external websites plus a 1-page summary to clinicians (intervention) or the links plus materials provided in clinic (usual care). Conflict outcomes and the number of consultations were measured at 1 month. Univariate and multivariable models were used to analyze outcomes. RESULTS A total of 392 men were randomized, including 198 to intervention and 194 to usual care, of whom 152 and 153, respectively, returned 1-month outcomes. The mean ± SD 1-month decisional conflict scale (score range 0 to 100) was 10.9 ± 16.7 for intervention and 9.9 ± 18.0 for usual care. The multivariable model revealed significantly reduced conflict in the intervention group (-5.00, 95% CI -9.40--0.59). Other predictors of conflict included income, marital or partner status, decision status, number of consultations, clinical site and D'Amico risk classification. CONCLUSIONS In this multicenter trial the decision aid significantly reduced decisional conflict. Other variables impacted conflict and modified the effect of the decision aid, notably risk classification, consultations and resources. P3P is an effective adjunct for shared decision making in men with localized prostate cancer.
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Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts.
| | - Fangxin Hong
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Traci M Blonquist
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Barbara Halpenny
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts
| | | | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Peter Chang
- Department of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Randy A Jones
- University of Virginia Schools of Nursing, Charlottesville, Virginia
| | - Tracey L Krupski
- Department of Urology, School of Medicine, Charlottesville, Virginia
| | - Seth Wolpin
- University of Washington School of Nursing, Seattle, Washington
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California-San Francisco, San Francisco, California
| | - Julia H Hayes
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mitchell Sokoloff
- Department of Urology, University of Massachusetts Memorial Healthcare, Worcester, Massachusetts
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Wurz A, Brunet J. Evaluating Questionnaires Used to Assess Self-Reported Physical Activity and Psychosocial Outcomes Among Survivors of Adolescent and Young Adult Cancer: A Cognitive Interview Study. J Adolesc Young Adult Oncol 2017; 6:482-488. [PMID: 28430009 DOI: 10.1089/jayao.2017.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Physical activity is increasingly being studied as a way to improve psychosocial outcomes (e.g., quality of life, self-efficacy, physical self-perceptions, self-esteem, body image, posttraumatic growth) among survivors of adolescent and young adult (AYA) cancer. Assessing levels of and associations between self-reported physical activity and psychosocial outcomes requires clear, appropriate, and relevant questionnaires. To explore how survivors of AYA cancer interpreted and responded to the following eight published questionnaires: Leisure Time Exercise Questionnaire, Exercise Self-Efficacy Scale, Physical Self-Description Questionnaire, Rosenberg Global Self-Esteem Scale, Multidimensional Body-Self Relations Questionnaire, Posttraumatic Growth Inventory, Functional Assessment of Cancer Therapy-General (FACT-G), RAND 36-Item Health Survey 1.0 (RAND-36), cognitive interviews were conducted with three men and four women age 18-36 years who were diagnosed with cancer at age 16-35 years. Initially, the first seven questionnaires listed above were assessed. Summaries of the interviews were prepared and compared across participants. Potential concerns were identified with the FACT-G; thus, a second interview was conducted with participants to explore the clarity, appropriateness, and relevance of the RAND-36. Concerns identified for the FACT-G related mostly to the lack of relevance of items pertaining to cancer-specific aspects of quality of life given that participants were posttreatment. No or few concerns related to comprehension and/or structure/logic were identified for the other questionnaires. In general, the questionnaires assessed were clear, appropriate, and relevant. Participants' feedback suggested they could be used to assess self-reported physical activity and varied psychosocial outcomes in studies with survivors of AYA cancer, either with or without slight modifications.
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Affiliation(s)
- Amanda Wurz
- 1 School of Human Kinetics, University of Ottawa , Ottawa, Canada
| | - Jennifer Brunet
- 1 School of Human Kinetics, University of Ottawa , Ottawa, Canada .,2 Cancer Therapeutic Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada .,3 Institut du Savoir Montfort - Recherche, Hôpital Montfort, Ottawa, Canada
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