Common methods of determining meaningful change in clinical practice: implications for precision patient-reported outcomes.

Abstract

Patient-reported outcomes (PROs) are used in clinical practice for several purposes, including to monitor whether a treatment is working or whether a patient is experiencing adverse events from treatment. This study surveyed oncology providers (OP) and mental health providers (MHP) to determine how clinicians from different disciplines determine individual-level meaningful change on PROs. Understanding how clinicians determine change on PROs could help inform methods for individualizing meaningful change definitions, an approach we have dubbed "Precision PROs". Three hundred and forty-seven providers utilizing PROs completed an online survey about PRO use to monitor patients in clinical practice. A question on methods used to determine individual-level meaningful change on PROs was developed with input from clinicians. Multivariate logistic regression analyses were used to assess whether specific methods were associated with clinician characteristics. The most commonly reported method was comparing the previous score to the current score (65%). Other methods included examining the numerical scores without a visual aid (59%), considering other factors affecting scores (42%), comparing scores to norms (31%) and using a graph of scores (29%). Provider age was negatively associated with odds of using a graph (OR = 0.95, 95% CI 0.91, 1.0) but no other method. Provider gender, hours per week in clinical practice and years in practice were not associated with odds of using a specific method. Most providers determined individual-level meaningful change without a visual aid and used only the previous score and current score, the minimum number (2 scores) to determine change. Consistent with current practice, future research on methods of determining within-individual meaningful change for clinical use should focus on methods requiring two rather than three or more scores. When attempting to personalize within-individual change definitions (Precision PROs), methods examining a baseline and single follow-up may be most useful for clinical practice.