Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice
Top Cited Papers
- 12 October 2021
- journal article
- review article
- Published by Wiley in Emergencias
- Vol. 2021 (10)
- https://doi.org/10.1002/14651858.cd011589.pub2
Abstract
Background Patient‐reported outcomes measures (PROMs) assess a patient’s subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision‐making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. Objectives To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient‐reported health outcomes and processes of care. Search methods We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. Selection criteria Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. Data collection and analysis Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta‐analyses of the results where possible. Main results We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient‐physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI ‐0.17 to 0.24; 2 studies, 552 participants; low‐certainty evidence), social functioning (SMD 0.02, 95% CI ‐0.06 to 0.09; 15 studies; 2632 participants; moderate‐certainty evidence), and pain (SMD 0.00, 95% CI ‐0.09 to 0.08; 9 studies; 2386 participants; moderate‐certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. Authors' conclusions PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high‐quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.Keywords
This publication has 239 references indexed in Scilit:
- The case for an international patient-reported outcomes measurement information system (PROMIS®) initiativeHealth and Quality of Life Outcomes, 2013
- Direct improvement of quality of life using a tailored quality of life diagnosis and therapy pathway: randomised trial in 200 women with breast cancerBritish Journal of Cancer, 2012
- Development of a patient reported outcome measure for fatigue in motor neurone disease: the Neurological Fatigue Index (NFI-MND)Health and Quality of Life Outcomes, 2011
- Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients' need for symptom management support: a randomized clinical trialJournal of the American Medical Informatics Association, 2010
- Developing and evaluating complex interventions: the new Medical Research Council guidanceBMJ, 2008
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendationsBMJ, 2008
- Effectiveness of health-related quality-of-life measurement in clinical practice: a prospective, randomized controlled trial in patients with chronic liver disease and their physiciansQuality of Life Research, 2008
- The Patient-Reported Outcomes Measurement Information System (PROMIS)Medical Care, 2007
- Measuring inconsistency in meta-analysesBMJ, 2003
- The Functional Status of PatientsMedical Care, 1990