How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis
Joanne Greenhalgh,Kate Gooding,Kate Gooding,Elizabeth Gibbons,Sonia Dalkin,Sonia Dalkin,Judy Wright,Jose M Valderas,Nick Black +8 more
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The findings show thatPROMs completion is not a neutral act of information retrieval but can change how patients think about their condition and reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries.Abstract:
In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians’ awareness of patients’ problems and prompts discussion and action We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships Individualised PROMs supported dialogue by enabling the patient to tell their story In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL) Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit This paper makes two important contributions to the literature First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision makingread more
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References
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Framework to assess the effects of using patient-reported outcome measures in chronic care management
TL;DR: A conceptual framework describing the potential effects of the use of PROMs in chronic care management and adding unique domains, including patient engagement, patient activation, shared clinical decision making, and patient self-management is developed.
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Screening for Psychological Distress in Cancer Patients: Challenges and Opportunities
TL;DR: The article by Mitchell in the this issue of the Journal of Clinical Oncology represents the first comprehensive evaluation of the accuracy of ultrashort methods in detecting heightened distress in people with cancer.
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Training clinicians in how to use patient-reported outcome measures in routine clinical practice.
Maria J. Santana,Lotte Haverman,Kate Absolom,Elena Takeuchi,David Feeny,Martha A. Grootenhuis,Galina Velikova +6 more
TL;DR: Adult learning programs teaching clinicians how to use and act on PROs in clinical practice are a key steps in supporting patient engagement and participation in shared decision-making.
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Towards a methodology for cluster searching to provide conceptual and contextual "richness" for systematic reviews of complex interventions: case study (CLUSTER)
TL;DR: A single case study suggests the potential utility of cluster searching, particularly for reviews that depend on an understanding of context, e.g. realist synthesis.
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Capture, Transfer, and Feedback of Patient-Centered Outcomes Data in Palliative Care Populations: Does It Make a Difference? A Systematic Review
Simon Noah Etkind,Barbara A Daveson,Wingfai Kwok,Jana Witt,Claudia Bausewein,Irene J Higginson,Fliss E M Murtagh +6 more
TL;DR: In palliative care populations, PCOMs feedback improves awareness of unmet need and allows professionals to act to address patients' needs and benefits patients' emotional and psychological quality of life.