Abstract
PurposeThe patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL).MethodsA pragmatic cluster preference randomised control trial with 15 consultants, 8 ‘using’ and 7 ‘not using’ the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible.ResultsConsultants saw a median (inter-quartile range) 16 (13–26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (− 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time.ConclusionThis novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.
Highlights
Health-related quality of life (HRQOL) is a key outcome in cancer care
It is possible to augment the patient concerns inventory (PCI) with feedback from the patient as to their HRQOL outcome and one example of this is through the use of the University of Washington questionnaire (UW-QOLv4) [12, 13]
The combination of the PCI and UW-QOL has been shown to be feasible in routine practice and early evidence would suggest that their use in consultations could have a beneficial impact on quality of life [14, 15]
Summary
Health-related quality of life (HRQOL) is a key outcome in cancer care. For head and neck cancer (HNC) survivors, HRQOL is influenced by site of the tumour, stage and treatment [2] but shaped by European Archives of Oto-Rhino-Laryngology (2021) 278:3435–3449 patient–clinician relationship, identification of needs, participation in therapeutic alliance, and quality of the rehabilitation service provision [3]. It is possible to augment the PCI with feedback from the patient as to their HRQOL outcome and one example of this is through the use of the University of Washington questionnaire (UW-QOLv4) [12, 13]. The combination of the PCI and UW-QOL has been shown to be feasible in routine practice and early evidence would suggest that their use in consultations could have a beneficial impact on quality of life [14, 15]. This information sheet showed the PCI items flagged, domains of UW-QOL dysfunction, overall QOL, distress thermometer (DT) score and number of health professionals that patients identified as possibly wishing to see, were taken into the consultation with the patient
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