Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 27, 2023
Date Accepted: May 13, 2024
Do patient reported outcomes in routine oncology care improve symptom detection: A type II hybrid implementation study (The iPROMOS study)
ABSTRACT
Background:
Clinical trials have demonstrated that patient reported outcome measures (PROMs) have been identified to improve mortality and morbidity outcomes when used in clinical practice. This study aimed to prospectively investigate implementation of patient reported outcome measures (PROMs) in routine oncology.
Objective:
Outcomes aimed to measure improved symptom detection, clinical response to symptom information and health service outcomes.
Methods:
Two clinics were randomised to implement symptom PROMs in a medical oncology outpatient department in Australia. Randomisation was done at the level of clinic. Patients in control clinics continued with usual care; patients in intervention clinics completed a symptom PROM at presentation. The main outcome of interest was symptom detection, using binary logistic models, and clinical response to PROMs investigated using multiple regression models.
Results:
A total of 461 patient encounters were included, consisting of 242 encounters in the control and 222 in the intervention condition. Patients in these clinics most commonly had head and neck, lung, prostate, breast or colorectal cancers, and were seen in the clinic for surveillance, oral or systemic treatments for curative, metastatic or palliative cancer care pathways. Compared to control encounters, symptom detection improved in intervention encounters (OR 1.05, 0.99-1.11, p=0.08).The odds of receiving supportive care, demonstrated by non-routine allied health review, increased in the intervention compared to control encounters (odds ratio 3.54, 95% confidence interval 1.26 – 9.90; p=0.02).
Conclusions:
Implementation of PROMs in routine care did not significantly improve symptom detection but increased the likelihood of non-routine allied health reviews for supportive care. Further studies with a greater number of clinics are needed to investigate health service outcomes. Clinical Trial: The study is registered on the Australia New Zealand Clinical Trials Register, registration number ACTRN12618000398202 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374630) on 05 March 2018
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