Routine feedback on patient-reported outcomes to healthcare providers and patients in clinical practice

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

K.5

Presenter:

Ian Porter

Co-authors:

Chris Gibbons, Daniela C Gonçalves-Bradley, Stanimir Stoilov, Ignacio Ricci-Cabello, Elena Tsangaris, Jaheeda B Gangannagaripalli, Antoinette Davey, Elizabeth J Gibbons, Anna Kotzeva, Philip J van der Wees, Evangelos Kontopantelis, Joanne Greenhalgh, Peter Bower, Jordi Alonso, Jose M Val

Author institutions:

University of Exeter Medical School, Harvard Medical School, University of Oxford, University of Exeter Medical School, Instituto de Investigación Sanitaria Illes Balears, Harvard Medical School, University of Exeter Medical School, University of Oxford, Agency for Health Quality and Assessment of Catalonia, Radboud University Medical Center, University of Manchester, University of Leeds, Universi

Problem

Patient-reported outcomes measures (PROM) assess a patient’s subjective appraisal of outcomes from their own perspective. Despite hypothesised benefits of PROM feedback supporting decision making in clinical practice and improving outcomes, there is uncertainty surrounding their effectiveness in these areas. We assessed the impact of PROM feedback on patient-reported health outcomes and processes of care.

Approach

We registered the protocol of this systematic review of randomised controls trials (RCTs) in the Cochrane Library. We searched MEDLINE, EMBASE, CINAHL, clinical trial registries and five other databases, as well as grey literature. We included RCTs directly comparing the effects on outcomes and processes of care of feedback of PROM to clinicians and/or patients with the impact of not providing such feedback. We evaluated the impact on patient-reported outcomes including symptoms, functioning, health perceptions, and quality of life; and a range of processes of health care including communication, clinical management and health service utilisation, and patient satisfaction. Where possible we conducted a meta-analysis of the results.

Findings

We identified 97 randomised trials assessing the effectiveness of PROM feedback in improving processes and/or outcomes. Studies were conducted across diverse ambulatory primary and secondary care settings in North America and Europe. Certainty of the evidence varied between very low and moderate. Many studies were at risk of bias due to designs which increased the likelihood of allocation concealment and contamination.PROM feedback probably slightly improves quality of life (standardised mean difference (SMD) 0.015, 95% confidence interval (CI) 0.03 to 0.27; 11 studies; 1998 participants), and probably leads to an increase in disease control (odds ratio (OR) 1.56, 95% CI 1.23 to 1.97; 14 studies, 2806 participants), patient-physician communication (SMD 0.37, 95% CI 0.2 to 0.54; 3 studies; 571 participants), and diagnosis and notation (OR 2.56, 95% CI 1.86 to 3.53; 22 studies; 7223 participants), for which we graded the evidence as moderate certainty. The intervention probably makes little or no difference for general health perceptions, social functioning, and pain. We are uncertain about the effect of PROM feedback on physical and mental functioning, as well as fatigue. We did not find studies reporting on adverse effects.

Consequences

Interventions which assess and feedback patient-reported outcomes using PROMs can improve the detection of healthcare issues, leading to appropriate diagnosis and referral as well as increasing patient perception of their care and disease control. Patient functioning and outcomes were improved slightly in mental health care settings and small improvements to quality of life were associated with the intervention across all studies. There is a need for more high-quality studies in this area, particularly cluster designs and techniques to maintain allocation concealment.

Submitted by:

Ian Porter

Funding acknowledgement: