Dataset Information

The use of volunteers to implement electronic patient reported outcomes in lung cancer outpatient clinics.

ABSTRACT: Background:Treatment related toxicity is common after chemotherapy and radiotherapy. Our group has developed and validated an electronic Patient Reported Outcome questionnaire (ePRO) to assess symptoms and toxicity in lung cancer patients receiving (chemo)radiotherapy treatment. We assessed the need for volunteer support in clinics to assist patients in completing ePROs. Methods:Lung Cancer patients attending outpatient or radiotherapy clinics at The Christie NHS Foundation Trust, Manchester were consented and asked to complete a Patient Reported Outcomes questionnaire using an electronic device (a touchscreen). Trained volunteers were available if patients required help such as verbal or physical assistance. The primary objective was to determine the need for volunteers to assist lung cancer patients in completing ePROs. Results:27/86 (31.4%) of patients who consented to this study required assistance to complete the ePRO. After questioning, we found that only 7/86 (8.1%) would have relied on volunteers for assistance as the majority of patients had a companion that could have provided help. 81/86 (94.2%) of patients were satisfied with the use of a touchscreen tablet to complete the ePRO. Conclusion:Our results demonstrate that the introduction of ePROs in lung cancer outpatient clinics is feasible, even without the use of volunteers for the majority of patients. The implementation of ePROs would allow large volumes of high quality (chemo)radiotherapy toxicity data to be collected accurately and quickly. This is essential for the development of predictive models of outcome using population-based data, which could allow the personalisation of (chemo)radiotherapy treatment for lung cancer patients.

SUBMITTER: Ala-Aldeen K

PROVIDER: S-EPMC7033755 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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The use of volunteers to implement electronic patient reported outcomes in lung cancer outpatient clinics.

Ala-Aldeen Kardo K Stones Nicola N Woolf David D Bayman Neil N Coote Joanna J Harris Margaret M Pemberton Laura L Sheikh Hamid H Chan Clara C Hodgson Clare C Yorke Janelle J Faivre-Finn Corinne C

Technical innovations & patient support in radiation oncology 20180605

<h4>Background</h4>Treatment related toxicity is common after chemotherapy and radiotherapy. Our group has developed and validated an electronic Patient Reported Outcome questionnaire (ePRO) to assess symptoms and toxicity in lung cancer patients receiving (chemo)radiotherapy treatment. We assessed the need for volunteer support in clinics to assist patients in completing ePROs.<h4>Methods</h4>Lung Cancer patients attending outpatient or radiotherapy clinics at The Christie NHS Foundation Trust, ...[more]

PMID: 32095576

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Project description:BackgroundUse of patient-reported outcome measures (PROM) in clinical practice can offer clinicians important information about the impact of illness on patients and their quality of life. Electronic reporting of patient-reported outcomes (ePROs) provide quick access of this information to the health care team. Although this type of information is acknowledged to be critical to not only improving the quality of care but also involving patients in care planning, little is known about how ePRO reports can be used in nephrology clinics to enhance person-centered care.ObjectiveThe purpose of this research was to examine how ePROs were used in home dialysis clinics.DesignA pilot qualitative research design was employed.SettingThe study was conducted in 2 home dialysis clinics over 6 months.PatientsA total of 99 home dialysis patients and 12 nurses participated in the study.MeasurementsPatients completed 2 ePROs (the Edmonton Symptom Assessment System revised for renal patients and Kidney Disease Quality of Life-36) prior to their clinic appointment, and results were given to their health care providers. Nurses saw patients first, along with ePRO data. Patients and nurses consented to having their clinic interactions observed and audio recorded (n = 169).MethodsSummative content analysis was used to synthesize the data.ResultsThe ePRO data were used to discuss 24 specific issues (brought up a total of 456 times over 165 interactions), most frequently: itchiness (n = 55), appetite (n = 51), problems with sleeping (n = 50), tiredness (n = 46), and shortness of breath (n = 45) as well as overall patient health and the general effects of kidney disease on the patient's daily life. The issues that most often prompted a change in care plan, referral to another health care professional, or further assessment included itching (n = 23), depression (n = 18), tiredness (n = 13), sleeping (n = 12), anxiety (n = 11), and disease interfering with daily life (n = 7).LimitationsLimitations include the duration of follow-up (6 months), the restriction to 2 home dialysis clinics, and the potential for the Hawthorne effect due to observation.ConclusionsUse of these ePROs in the home dialysis clinics provided useful information that guided focused assessments and augmented standard assessments to support person-centered care. Further studies are warranted to identify whether this practice offers benefits over usual care.

Project description:Background and objectivesElectronic health record (EHR) patient portals allow individuals to access their medical information with the intent of patient empowerment. However, little is known about portal use in nephrology patients. We addressed this gap by characterizing adoption of an EHR portal, assessing secular trends, and examining the association of portal adoption and BP control (<140/90 mmHg).Design, setting, participants, & measurementsPatients seen between January 1, 2010, and December 31, 2012, at any of four university-affiliated nephrology offices who had at least one additional nephrology follow-up visit before June 30, 2013, were included. Sociodemographic characteristics, comorbidities, clinical measurements, and office visits were abstracted from the EHR. Neighborhood median household income was obtained from the American Community Survey 2012.ResultsOf 2803 patients, 1098 (39%) accessed the portal. Over 87% of users reviewed laboratory results, 85% reviewed their medical information (e.g., medical history), 85% reviewed or altered appointments, 77% reviewed medications, 65% requested medication refills, and 31% requested medical advice from their renal provider. In adjusted models, older age, African-American race (odds ratio [OR], 0.50; 95% confidence interval [95% CI], 0.39 to 0.64), Medicaid status (OR, 0.53; 95% CI, 0.36 to 0.77), and lower neighborhood median household income were associated with not accessing the portal. Portal adoption increased over time (2011 versus 2010: OR, 1.38 [95% CI, 1.09 to 1.75]; 2012 versus 2010: OR, 1.95 [95% CI, 1.44 to 2.64]). Portal adoption was correlated with BP control in patients with a diagnosis of hypertension; however, in the fully adjusted model this was somewhat attenuated and no longer statistically significant (OR, 1.11; 95% CI, 0.99 to 1.24).ConclusionWhile portal adoption appears to be increasing, greater attention is needed to understand why vulnerable populations do not access it. Future research should examine barriers to the use of e-health technologies in underserved patients with CKD, interventions to address them, and their potential to improve outcomes.

Project description:ImportanceOutpatient postpartum recovery is an underexplored area of obstetrics. There is currently no consensus regarding which patient-reported outcome measure (PROM) clinicians and researchers should use to evaluate postpartum recovery.ObjectiveTo evaluate PROMs of outpatient postpartum recovery using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.Evidence reviewAn initial literature search performed in July 2019 identified postpartum recovery PROMs and validation studies. A secondary search in July 2020 identified additional validation studies. Both searches were performed using 4 databases (Web of Science, Embase, PubMed, and CINAHL), with no date limiters. Studies with PROMs evaluating more than 3 proposed outpatient postpartum recovery domains were considered. Studies were included if they assessed any psychometric measurement property of the included PROMs in the outpatient postpartum setting. The PROMs were assessed for the following 8 psychometric measurement properties, as defined by COSMIN: content validity, structural validity, internal consistency, cross-cultural validity and measurement invariance, reliability, measurement error, hypothesis testing, and responsiveness. Psychometric measurement properties were evaluated in each included study using the COSMIN criteria by assessing (1) the quality of the methods (very good, adequate, doubtful, inadequate, or not assessed); (2) overall rating of results (sufficient, insufficient, inconsistent, or indeterminate); (3) level of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations assessment tool; and (4) level of recommendation, which included class A (recommended for use; showed adequate content validity with at least low-quality evidence for sufficient internal consistency), class B (not class A or class C), or class C (not recommended).FindingsIn total, 15 PROMs (7 obstetric specific and 8 non-obstetric specific) were identified, evaluating outpatient postpartum recovery in 46 studies involving 19 165 women. The majority of psychometric measurement properties of the included PROMs were graded as having very-low-level or low-level evidence. The best-performing PROMs that received class A recommendations were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF. The remainder of the evaluated PROMs had insufficient evidence to make recommendations regarding their use (and received class B recommendations).Conclusions and relevanceThis review found that the best-performing PROMs currently available to evaluate outpatient postpartum recovery were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF; however, these tools all had significant limitations. This study highlights the need to focus future efforts on robustly developing and validating a new PROM that may comprehensively evaluate outpatient postpartum recovery.

Dataset Information

The use of volunteers to implement electronic patient reported outcomes in lung cancer outpatient clinics.

Publications

The use of volunteers to implement electronic patient reported outcomes in lung cancer outpatient clinics.

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