Abstract
PurposeA primary objective stated at the Cancer Rehabilitation Symposium at the National Institutes of Health was to improve outcome measurement. The purpose of this project was for the Cancer Rehabilitation Medicine Metrics Consortium (CRMMC) to develop an assessment tool to evaluate function in cancer patients via a data-driven and methodologically sound process. There is no agreed-upon measure of physical and cognitive function for cancer patients, making it difficult to demonstrate the value of rehabilitation interventions. Cancer patients are a particularly challenging population, with many tumor- and treatment-related variables impacting function.MethodsInvestigators from nine different cancer rehabilitation programs participated in a modified-Delphi process to delineate necessary aspects of an ideal patient assessment tool, including instrument type, domains evaluated, applicability across a range of patient traits, clinical feasibility, and item response characteristics. This involved numerous meetings, data review, and analysis of items involved in patient assessment.ResultsThe CRMMC developed a 21-item patient-reported outcome measure based on item response theory. The process by which the short form was developed was documented and provides a framework for other clinicians to follow. ConclusionThis document provides a framework for rehabilitation providers to follow when developing an assessment tool. This process is described in a stepwise fashion for reproducibility even in different, non-cancer populations.
Highlights
There are over 15 million cancer survivors, many of whom are at risk for cancer-related disablement [1]
The need to capture clinical outcomes among cancer rehabilitation providers parallels the drive for transparent outcome reporting, influenced by patient needs and desires, to permit value-based health care purchasing and patient centered outcomes
The Cancer Rehabilitation Medicine Metrics Consortium (CRMMC) used serial modified Delphi processes in which consensus among clinical experts was sought through a series of questions to devise the best recommendation for a given problem
Summary
There are over 15 million cancer survivors, many of whom are at risk for cancer-related disablement [1] Identifying and addressing their rehabilitation needs is essential and, a relatively under-utilized aspect of care [2, 3]. The field of cancer rehabilitation has grown in parallel with the rapid expansion of the cancer survivor population, its expansion has been characterized by programs in large tertiary and quaternary centers that may provide disparate services [4]. This has left a knowledge gap regarding best practices and the individualization of care. Appropriate outcomes will help showcase the value of care while enabling providers to deliver more individualized treatment and measure its effectiveness
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