Value Of Patient-reported Outcome Measures Research Articles

Patient-reported outcome measures for systemic lupus erythematosus: an expert Delphi consensus to guide implementation in routine care

BackgroundSystemic lupus erythematosus (SLE) may result in great impact on patients’ quality of life, social relationships, and work productivity. The use of patient-reported outcome measures (PROMs) in routine care could help capture disease burden to guide SLE management and optimize disease control. We aimed to explore the current situation, appropriateness, and feasibility of PROMs to monitor patients with SLE in routine care, from healthcare professionals’ and patients’ perspectives.MethodsA scientific committee developed a Delphi questionnaire, based on a focus group with patients and a literature review, including 22 statements concerning: 1) Use of PROMs in routine care (n = 2); 2) PROMs in SLE management (n = 13); 3) Multidisciplinary management of patients with SLE (n = 4), and 4) Aspects on patient empowerment (n = 3). Statements included in Sects. 2–4 were assessed from three perspectives: current use, appropriateness, and feasibility (with currently available resources). For each statement, panellists specified their level of agreement using a 7-point Likert scale. A consensus was reached when ≥ 70% of the panellists agreed (6,7) or disagreed (1,2) on each statement.ResultsFifty-nine healthcare professionals and 16 patients with SLE participated in the Delphi-rounds. A consensus was reached on the value of PROMs to improve SLE management (83%) and the key role of healthcare professionals (77%) and the need for a digital tool connected to the electronic medical record (85%) to promote and facilitate PROMs collection. PROMs most frequently used in clinical practice are pain (56%), patient’s global assessment (44%) and fatigue (39%), all on visual analogue scales. Panellists agreed on the need to implement multidisciplinary consultation (79%), unify complementary tests (88%), incorporate pharmacists into the healthcare team (70%), and develop home medication dispensing and informed telepharmacy programmes (72%) to improve quality of care in patients with SLE. According to panellists, patient associations (82%) and nurses (80%) are critical to educate and train patients on PROMs to enhance patient empowerment.ConclusionsAlthough pain, fatigue, and global assessment were identified as the most feasible, PROMs are not widely used in routine care in Spain. The present Delphi consensus can provide a road map for their implementation being key for SLE management.

The Influence of Social Support in PROMs of Patients with COPD in Primary Care: A Scoping Review.

Chronic obstructive pulmonary disease (COPD) is a prevalent and multidimensional disease with symptoms that greatly influence patients' health. Healthcare professionals utilize patient-reported outcome measures (PROMs) to classify and better manage the disease. Despite the value of PROMs, they inadequately represent some important dimensions of COPD, like social support and healthcare access/utilization. This is important, especially for social support, since it can positively influence PROMs results and the overall health of patients with COPD. Therefore, a scoping review was conducted to determine how social support affects PROMs of patients with COPD in primary care. The PRISMA-Scoping approach was adopted, and we sought articles published in MEDLINE and COHRANE. We screened 2038 articles for inclusion and finally included a total of 10 articles. Most of the articles were conducted in the U.S. and Norway. Social support had a strong positive impact on PROMs. Additionally, different types of social support were observed. Moreover, higher levels of social support were linked to better quality of life, mental health, self-care behaviors, self-management, functionality, and less severe COPD. Consequently, this scoping review highlights the value of social support in patients with COPD and its underrepresentation and misrepresentation in PROMs literature.

Assessing The Predictive Value Of Patient-reported Outcome Measures On Performance-based Functional Tests

Assessing The Predictive Value Of Patient-reported Outcome Measures On Performance-based Functional Tests

Value of patient-reported outcome measures for evaluating the benefit of speech processor upgrading in patients with cochlear implants.

Patients with acochlear implant (CI) should be evaluated for anew speech processor every 6years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades. Speech understanding and subjective benefit were analyzed in 99patients with the old and the new speech processor after 4weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction. The speech processor upgrade resulted in asignificant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dBsignal-to-noise ratio [S/N], p = 0.006). Using the APHAB, asignificant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006).A comparative assessment of the benefit based on subjective and speech audiometric results identified aproportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry. There was asignificant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only asmall improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.

Cognitive trajectories in relapsing-remitting multiple sclerosis: Evidence of multiple evolutionary trends.

Cognitive impairment (CI) frequently occurs in multiple sclerosis (MS) and is assumed to increase over time. However, recent studies have suggested that the evolution of cognitive status in patients with MS may be more heterogeneous than expected. Predicting CI remains also challenging, and longitudinal studies exploring the baseline determinants of cognitive performances are limited. No studies have explored the predictive value of patient-reported outcome measures (PROMs) regarding future CI. To explore the evolutionary patterns of cognitive status in a cohort of RRMS patients initiating a new disease modifying treatment (DMT), and to determine whether PROMs may have a predictive value for future CI. The present prospective study is a 12-month follow-up of a cohort of 59 RRMS patients who underwent yearly a comprehensive, multiparametric assessment combining clinical (with EDSS assessment), neuropsychological (BVMT-R, SDMT, CVLT-II), MRI-derived metrics and a set of self-reported questionnaires. Lesion and brain volumes were analyzed and processed by the automated MSmetrix® software (Icometrix®, Leuven, Belgium). Spearman's correlation coefficient was used to evaluate the association of collected variables. A longitudinal logistic regression analysis was performed to find baseline correlates of CI at 12 months (T1). A total of 33 patients (56%) were defined as cognitively impaired at baseline, and 20 (38%) were defined as impaired at follow-up after 12 months. The mean raw scores and Z-scores of all the cognitive tests were significantly improved at T1 (p<0.05). There was a statistically significant improvement in most PROM scores at T1 (p<0.05) in comparison with baseline scores. Among the variables assessed, lower education and physical disability level at baseline correlated with impaired SDMT (OR: 1.68, p=0.01; OR: 3.10, p=0.02, respectively) and impaired BVMT-R (OR: 4.08, p=<0.001; OR: 4.82, p=0.001, respectively) at T1. Neither baseline PROMs nor MRI volumetric parameters were predictive of cognitive performances at T1. These findings provide additional evidence that evolution of CI in MS may be a dynamic phenomenon and will not usually follow an inevitable, declining trajectory, and do not support the utility of PROMs in predicting CI in RRMS. The present study is still ongoing to determine whether our findings are confirmed at 2 and 3 years of follow-up.

Value of patient-reported outcome measures for evaluating the benefit of speech processor upgrading in patients with cochlear implants. German version

Patients with acochlear implant (CI) should be evaluated for anew speech processor every 6years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades. Speech understanding and subjective benefit were analyzed in 99patients with the old and the new speech processor after 4weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction. The speech processor upgrade resulted in asignificant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dBsignal-to-noise ratio [S/N], p = 0.006). Using the APHAB, asignificant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006).A comparative assessment of the benefit based on subjective and speech audiometric results identified aproportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry. There was asignificant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only asmall improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.

Developing machine learning algorithms incorporating patient reported outcome measures to predict acute care events among patients with cancer.

1516 Background: Clinical trials have shown that collecting patient-reported outcome measures (PROMs) can improve outcomes among oncology patients. However, there remains uncertainty about how to best collect and use PROMs in routine clinical care. Since 2016 we have collected PROMs for patients receiving cancer treatment within a large health system containing academic and community sites. We sought to examine whether combining PROMs with electronic health record (EHR) data improves the performance of machine learning algorithms predicting patients’ risk of 30-day acute care events. Methods: The sample included patients with solid tumors receiving curative- or palliative-intent systemic therapy between 9/1/20 and 7/31/22 who completed at least one PROMs survey. PROMs were collected via a 12-item questionnaire based on the Common Terminology Criteria for Adverse Events measurement system. Patients completed questionnaires via the EHR’s patient portal or on tablets in waiting rooms. EHR data included 176 variables describing demographics, laboratory values, vital signs, diagnoses, medications, and prior healthcare encounters. A binomial outcome was calculated for each patient encounter to indicate whether the patient had an acute care event (ED visit or hospitalization) in the subsequent 30 days. Data were randomly assigned to training (70%) and test (30%) sets and were used to train and test four models: EHR + PROMs, EHR alone, PROMs alone, and ‘PROMs plus,’ which included PROMs and minimal EHR data such as age, sex, and site of cancer treatment, which served as an accessible proxy for cancer type. For each model, we compared multiple architectures and selected the best-performing model for comparison. Results: Between September 2020 and June 2022, 4,193 patients completed 20,359 PROM surveys during outpatient encounters. There were 2,118 30-day acute care events within the cohort. The area under the receiver operating curves (AUCs) were 0.84 (95% CI 0.81 to 0.86) for the EHR + PROMs model, 0.82 (95% CI 0.80 to 0.84) for the EHR alone model, 0.67 (95% CI 0.65 to 0.69) for the PROMs alone model, and 0.79 (95% CI 0.77 to 0.82) for the PROMs plus model. In the EHR alone and EHR + PROMs models, the most important variables were last albumin, white blood cell count and hemoglobin. In the PROMs plus model, the most important variables were age, treatment site, patient-reported pain, and patient-reported fatigue. Conclusions: Incorporating PROMs into machine learning models to predict risk of acute care events can improve model performance. Notably, the model combining PROMs with a small number of easily accessible EHR variables performed nearly as well as models including all EHR data. These models demonstrate the predictive value of PROMs in oncology patients and they lay the foundation for future interventions aiming to reduce acute care events among high-risk patients.

Patients’ and Healthcare Professionals’ Perspectives on Better Use of Patient-Reported Outcome Measures in Head and Neck Cancer

ObjectivesPatients with head and neck cancer (HNC) are often highly affected by disease and treatment, resulting in impaired physical functioning and quality of life. Therefore, evaluation of patients’ psychosocial and functional outcomes can be facilitated by patient-reported outcome measures (PROMs). By providing the patients’ own perspectives, PROMs are crucial to improving patient-centered care. This study aimed to improve understanding of the perceived value of PROMs in HNC care and how to optimize their clinical value based on patients’ and multidisciplinary healthcare professionals’ (HCPs) perspectives. MethodsPopulation-based surveys among patients with HNC through their patient association and among HCPs nationwide through the Dutch Head and Neck Audit. ResultsA total of 54 patients and 40 multidisciplinary HCPs from all 14 nationwide HNC centers (100%) responded. For patients, the most important element of patient-reported outcome collection systems was including a call to action for those with worse-than-average scores (28%), whereas clinicians found discussing scores during clinical visits the most important (39%). Although 16% of clinicians found short completion time the most important element, none of the patients selected completion time as most important. Additionally, 17% of patients stated completion time was not an issue, provided clinicians would use the outcomes for clinical purposes. ConclusionsAlthough patients and clinicians acknowledged the value of patient-reported outcomes, patients would like to be more involved in the clinical implications of their outcomes. Enhancing patients’ involvement by a call to action and providing feedback on their scores during outpatient clinic visits may improve the clinical value of PROMs.

Patient-reported outcome measurements in a selective cohort of relapsing-remitting multiple sclerosis patients: relationships with physical disability, cognitive impairment, and MRI-derived metrics.

The added value of patient-reported outcome measures (PROMs) in addition to standard clinical outcome tools in the assessment of relapsing-remitting multiple sclerosis (RRMS) patients' status is increasingly recognized. PROMs facilitate the detection of hidden aspects of MS and help to integrate the patient's subjective experience of health-related quality of life (HRQoL) status and treatment satisfaction in a holistic way. However, the relationship between PROMs and clinical and cognitive status has been scarcely investigated up to now. To investigate the association of PROMs with physical and cognitive disability in a cohort of RRMS patients at initiation of a new disease-modifying treatment. In this cross-sectional bicenter study, 59 consecutive RRMS patients underwent neurological examination with EDSS assessment, comprehensive cognitive tests (BVMT-R, SDMT, CVLT-II) and a set of self-reported questionnaires. Lesion and brain volumes were analyzed and processed by the automated MSmetrix® software (Icometrix®, Leuven, Belgium). Spearman's correlation coefficient was used to evaluate the association of collected variables. A cross-sectional logistic regression analysis was performed to find baseline correlates of cognitive impairment. Of the 59 RRMS patients (mean age 39 ± 9.8years, 79.7% female, median EDSS 2.0), 33 (56%) had cognitive impairment. While almost all dimensions of health, explored by PROMs, were impacted in the overall sample, no significant difference was observed in patients with and without cognitive impairment. All PROMs were significantly associated with EDSS (R = 0.37-0.55; p < 0.05), except for the psychological component of MSIS-29, BDI and DEX-Q scores. No significant correlation was found between PROMs and cognitive performances. The cross-sectional logistic regression analysis included age, gender (female), education, EDSS, hippocampus and FLAIR lesion volumes as significant predictors of cognitive impairment. The data highlight that PROMs provide valuable information on the well-being of PwMS closely paralleling the extent of MS-related disability, as measured by the EDSS. Additional research should determine the relevance of PROMs as longitudinal outcome measures.

Strategies for spine surgeons to enhance a clinical practice and research program: stepping stones for practice management.

In this review, the value of patient-reported outcome measures, immersive technology, and patient review systems is discussed, and these strategies are presented as ways to enhance both the research and clinical aspects of a practice. The value of a research team and open access research databases is also discussed. Establishing a research program does not need elaborate resources to sustain efforts. The aforementioned simple yet effective strategies can enhance the clinical and research experience for surgeons in both academic and private practice settings.

Redefining Disability: Patient-Reported Outcome Measures After Minor Stroke and Transient Ischemic Attack.

Long-term outcome assessment patients with stroke is not fully captured by usual clinical scales such as the modified Rankin Scale (mRS). Patient-reported outcome measures (PROMs) are standardized and validated assessments that consider clinical outcomes from the patient perspective. We aim to analyze the added value of PROMs in patients with transient ischemic attack and minor stroke. We included consecutive patients with minor stroke or transient ischemic attack (National Institutes of Health Stroke Scale score 0-5) from April 2020 to October 2021 that participated in the PROMs-through-App program (NORA, NoraHealth Barcelona Spain). Clinician and self-evaluated outcomes were assessed at 90 days: clinician-evaluated mRS, self-reported mRS, the 10-item patient-reported outcome measures questionnaire global health survey (v1.2), Hospital Anxiety and Depression Scale, and the Fatigue Assessment Scale. We evaluated the acceptability (response rate), reliability (internal consistency), and construct validity (correlation with mRS and between scales) of each questionnaire. We included 355 patients in the analysis, response rate was patient-reported outcome measures questionnaire 71.3% (253), Hospital Anxiety and Depression Scale 70.7% (251), Fatigue Assessment Scale 71.8% (255), and self-assessed mRS 66.8% (237). PROMS internal consistency was good or excellent, while agreement between clinician and self-reported mRS was fair (k=0.34). Rate of abnormal PROMS scores were as follows (all responders versus clinician-reported mRS score 0-2): patient-reported outcome measures questionnaire mental health (43.1% versus 36.3%), physical health (48.6% versus 43.6%); Hospital Anxiety and Depression Scale-anxiety (21.9% versus 17.7%) and depression (17.1% versus 13.3%); and Fatigue Assessment Scale (40.8% versus 36.4%). PROMs scores correlated with clinician and self-reported mRS at 90 days. Evaluation of PROMs using a mobile-app-based communication system is a reliable and valid strategy to assess the outcome of patients from their perspective after a mild stroke or transient ischemic attack.

Prognostic value of patient-reported outcome measures (PROMs) in adults with non-small cell Lung Cancer: a scoping review

BackgroundThere is growing interest in the collection and use of patient-reported outcome measures (PROMs) to support clinical decision making in patients with non-small cell lung cancer (NSCLC). However, an overview of research into the prognostic value of PROMs is currently lacking.AimTo explore to what extent, how, and how robustly the value of PROMs for prognostic prediction has been investigated in adults diagnosed with NSCLC.MethodsWe systematically searched Medline, Embase, CINAHL Plus and Scopus for English-language articles published from 2011 to 2021 that report prognostic factor study, prognostic model development or validation study. Example data charting forms from the Cochrane Prognosis Methods Group guided our data charting on study characteristics, PROMs as predictors, predicted outcomes, and statistical methods. Two reviewers independently charted the data and critically appraised studies using the QUality In Prognosis Studies (QUIPS) tool for prognostic factor studies, and the risk of bias assessment section of the Prediction model Risk Of Bias ASsessment Tool (PROBAST) for prognostic model studies.ResultsOur search yielded 2,769 unique titles of which we included 31 studies, reporting the results of 33 unique analyses and models. Out of the 17 PROMs used for prediction, the EORTC QLQ-C30 was most frequently used (16/33); 12/33 analyses used PROM subdomain scores instead of the overall scores. PROMs data was mostly collected at baseline (24/33) and predominantly used to predict survival (32/33) but seldom other clinical outcomes (1/33). Almost all prognostic factor studies (26/27) had moderate to high risk of bias and all four prognostic model development studies had high risk of bias.ConclusionThere is an emerging body of research into the value of PROMs as a prognostic factor for survival in people with NSCLC but the methodological quality of this research is poor with significant bias. This warrants more robust studies into the prognostic value of PROMs, in particular for predicting outcomes other than survival. This will enable further development of PROM-based prediction models to support clinical decision making in NSCLC.

Added value of patient-reported outcome measures (PROMs) after an acute stroke and early predictors of 90 days PROMs

IntroductionValue-based health care represents a patient-centered approach by valuing Patient-Reported Outcome Measures (PROMs). Our aim was to describe the additional value of PROMs after an acute stroke over conventional outcome measures and to identify early predictors of poor PROMs.MethodsAcute stroke patients discharged from a tertiary care hospital followed by a web/phone-based PROMs collection program in the post hospitalization phase. Main PROMs involve anxiety and depression (HADS) (each defined by HADS ≥ 10) and global physical (PHY-) and mental (M-) health (PROMIS-10). PROMIS cut-off raw values of normality were: PHY-PROMIS ≥ 13 and M-PROMIS ≥ 11. An overall health status (OHS) from 0 to 100 was also determined. PROMs related to the different modified Rankin Scale (mRS) grades were defined. Early predictors of PROMs were evaluated.ResultsWe included 1321 stroke patients, mean age 75 (± 8.6) and 55.7% male; 77.7% returned home. Despite a favorable mRS at 3 months (< 3), a relevant rate of patients considered without symptoms or with mild disability showed unfavorable results in the measured PROMs (8% unfavorable OHS, 15% HAD-depression, 12.1% HAD-anxiety, 28.7% unfavorable M-PROMIS and 33.1% unfavorable PHY-PROMIS results). Along follow-up, only PHY-PROMIS and OHS showed significant improvement (p < 0.01 and 0.03, respectively). The multivariate analysis including discharge variables showed that female sex, higher discharge mRS and discharge to socio-rehabilitation-center (SRC) were independent predictors of unfavorable results in PROMs (p < 0.01). When adding 7 days PROMs results, they emerged as the strongest predictors of 3 months PROMs.ConclusionsA high proportion of stroke patients show unfavorable results in PROMs at 3 months, even those with favorable mRS, and most results obtained by PROMs during follow-up continued to indicate alterations. Female sex, mRS and discharge to SRC predicted unfavorable results in PROMs, but the strongest predictors of 3 months PROMs were the results of the 7 days PROMs.

MP01-13 COMPARISON OF TRADITIONAL OUTCOME MEASURES AND SELF-ASSESSED GOAL ACHIEVEMENT IN PATIENTS TREATED SURGICALLY FOR BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 May 2022MP01-13 COMPARISON OF TRADITIONAL OUTCOME MEASURES AND SELF-ASSESSED GOAL ACHIEVEMENT IN PATIENTS TREATED SURGICALLY FOR BENIGN PROSTATIC HYPERPLASIA Manolis Pratsinis, Gautier Müllhaupt, Sabine Güsewell, Patrick Betschart, Valentin Zumstein, Daniel Engeler, Hans-Peter Schmid, and Dominik Abt Manolis PratsinisManolis Pratsinis More articles by this author , Gautier MüllhauptGautier Müllhaupt More articles by this author , Sabine GüsewellSabine Güsewell More articles by this author , Patrick BetschartPatrick Betschart More articles by this author , Valentin ZumsteinValentin Zumstein More articles by this author , Daniel EngelerDaniel Engeler More articles by this author , Hans-Peter SchmidHans-Peter Schmid More articles by this author , and Dominik AbtDominik Abt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recently, a multitude of novel treatment options for men suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) have been introduced. Current research often compares treatments using peak urinary flow rate (Qmax), post-void residual urine (PVR) and the International Prostate Symptom Score (IPSS). This study compares these outcomes with self-assessed goal achievement (SAGA) and satisfaction with the procedure in patients treated with different modalities for LUTS/BPH. METHODS: Patients requiring surgical/interventional treatment for LUTS were enrolled in a prospective cohort, with assessment of individual goals at baseline. Follow-up was performed six to twelve weeks after treatment and included SAGA and satisfaction with the procedure as well as Qmax, PVR and IPSS. Statistical analysis was performed to assess the correlation between the different outcomes. RESULTS: Sixty-eight patients completed the goal formulation at baseline. At follow-up SAGA and satisfaction with the procedure were significantly correlated (Spearman rank correlation rho = 0.78, p < 0.001). There was a statistically significant correlation between IPSS and SAGA (rho = -0.70, p < 0.001) as well as IPSS and satisfaction with the procedure (rho = -0.52, p < 0.001) (Figure 1). There was no statistically significant correlation between SAGA and Qmax (rho = 0.20, p = 0.310) or PVR (rho = 0.27, p = 0.07) nor between satisfaction with the procedure and Qmax (rho = 0.19, p = 0.322) or PVR (rho = 0.08, p = 0.584) (Figure 2). CONCLUSIONS: This study demonstrates a significant correlation of SAGA and satisfaction with the procedure and IPSS, while failing to demonstrate a correlation of SAGA and satisfaction with the procedure and Qmax or PVR. These findings highlight the value of patient-reported outcome measures and further support the inclusion of self-assessed goal achievement in clinical practice and comparative LUTS/BPH research. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e6 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manolis Pratsinis More articles by this author Gautier Müllhaupt More articles by this author Sabine Güsewell More articles by this author Patrick Betschart More articles by this author Valentin Zumstein More articles by this author Daniel Engeler More articles by this author Hans-Peter Schmid More articles by this author Dominik Abt More articles by this author Expand All Advertisement PDF DownloadLoading ...

Update on penile sparing surgery for penile cancer.

Penile sparing surgery (PSS) is considered the standard of care in penile cancer where appropriate, as preservation of the penis may enable the patient to maintain urinary and sexual function. This review will focus on the latest developments over the past two years. In this review, we discuss the latest findings in oncological outcomes in PSS, specifically glansectomy. We also introduce technology that may be useful in improving the precision of surgical resection margins in PSS. Finally, we consider the value of patient-reported outcome measures (PROMs) and consider how research in this area can be improved. A recent study has found a correlation between local recurrences (LR) and worse overall and cancer-specific survival in glansectomy, which challenges the belief that LR do not confer worse oncological outcomes. Despite numerous studies evaluating PROMs in penile cancer/PSS, few of these studies provide quality evidence of the 'supportive care needs'. A shift in research is required to identify those men at most risk of distress and to identify ways to support men diagnosed with penile cancer.

Clinicians\u2019 perceived value and demographic factors that predict the utilisation of patient reported outcome measures for low back pain amongst chiropractors in Australia

BackgroundFactors that influence utilisation rates of patient reported outcome measures (PROMs) for low back pain (LBP) within the chiropractic profession of Australia are currently unknown. This study aimed to examine whether factors, including age, sex, experience level, clinical title (principal vs associate), or a clinicians’ perceived value of PROMs, are predictive of the frequency and/or type of PROMs used by chiropractors in the management of LBP.MethodsA cross sectional online survey was distributed to members of the Chiropractic Association of Australia (CAA now known as Australian Chiropractors Association-ACA) and Chiropractic Australia (CA). 3,014 CAA members and 930 CA members were invited to participate totaling 3,944, only respondents that were using PROMs were included in the analysis (n = 370). Ordinal logistic regression was used to examine associations between clinician demographics and perceived value of PROMs, and the frequency of pain, health, and functional patient reported outcome measure (PROM) usage by chiropractors.ResultsPrincipal chiropractors were more likely (Wald = 4.101, p = 0.04, OR = 1.4 (1.0–2.1)) than associate chiropractors to frequently use pain-related PROMs for the management of patients with LBP. The remaining demographic factors (age, sex, and experience level) were not associated with the frequency of PROM usage; nor were the perceived value clinicians place on PROMs in clinical practice.ConclusionPrincipal chiropractors were more likely to frequently use pain-related PROMs for the management of patients with LBP when compared to associate chiropractors. Demographic factors, appear to have little influence on PROM usage. While chiropractors place high value on PROMs, these beliefs are not associated with increased frequency of PROM usage for the management of LBP.

Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies.

Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.

The Surgeon's Perceived Value of Patient-reported Outcome Measures (PROMs): An Exploratory Qualitative Study of 5 Different Surgical Subspecialties.

To understand the surgeon's perceived value of PROMs in 5 different surgical subspecialties. PROMs are validated questionnaires that assess the symptoms, function, and quality of life from the patient's perspective. Despite the increasing support for use of PROMs in the literature, there is limited uptake amongst surgeons. Furthermore, there is insufficient understanding of the surgeons' perceived value of PROMs. The aim of this study is to understand how surgeons perceive value in PROMs. We conducted an exploratory qualitative study to understand the perceived value of PROMs from the perspective of surgeons in various subspecialties. Per convenience sampling, we conducted semi-structured interviews with 30 surgeons from 5 subspecialties across 3 academic medical centers. The surgical subspecialties included bariatric surgery, breast oncologic surgery, orthopedic surgery, plastic and reconstructive surgery, and rhinology. Interviews were transcribed, coded, and evaluated with thematic analysis. Surgeons endorsed that PROMs can be used to enhance clinical management, counsel patients in the preoperative and postoperative settings, and elicit sensitive information from patients that otherwise may go undetected. Obstacles to PROMs use include failure to generate actionable data, implementation obstacles, and inappropriate use of PROMs as a performance metric, with concerns regarding inadequate risk adjustment. Establishing an effective PROMs program requires an understanding of the surgeon's perspective of PROMs. Despite obstacles, different subspecialty surgeons find PROMs to be valuable in different settings, depending on the specialty and clinical context.

"Unspoken Questions": A Qualitative Study of Rheumatologists' Perspectives on the Clinical Implementation of Patient-reported Outcome Measures.

To identify rheumatologists' views on perceived barriers and facilitators to the clinical implementation of patient-reported outcome measures (PROM). Semistructured interviews were conducted with academically affiliated clinical rheumatologists. Interviews were audio-recorded and transcribed. Deidentified transcripts were independently coded and analyzed for themes. Fifteen attending rheumatologists, 8 women (53%) and 7 men (47%) with a mean of 17.3 years in practice (range 5-43) at 2 urban academic medical centers, participated in interviews. Rheumatologists identified several barriers to integrating PROM in clinical care, highlighting physician buy-in and culture change as significant challenges beyond logistical considerations. They further underscored the lack of effective interventions and resources for addressing the domains of most interest to patients. Physicians also recognized significant benefits of PROM in clinical care, including contributing to the clinical impression by providing the patient perspective, and promoting agenda setting by uncovering "unspoken questions." They additionally noted that PROM could support treatment planning, build patient-physician relationships, and facilitate patient engagement. Participants suggested that technology, physician education, and team-based care could facilitate the effective implementation of PROM. Rheumatologists identified multiple mechanisms through which PROM could augment clinical care, but also noted several obstacles to implementation, questioning the added value of PROM and the limited availability of interventions to improve patient-centered outcomes. Programs seeking to successfully integrate PROM to enhance patient-centered care and meet quality benchmarks should prioritize physician buy-in and training, and provide resources to address the outcomes that are measured.

Integrating Spinal Cord Injury – Quality of Life instruments into rehabilitation: Implementation science to guide adoption of patient-reported outcome measures

Context/objective: This study describes a development strategy for integrating the Spinal Cord Injury – Quality of Life (SCI-QOL) item banks into inpatient spinal cord injury (SCI) rehabilitation and recommendations for protocol implementation. Design: We adopted an implementation science approach to develop a strategy for adapting and contextualizing SCI-QOL use during SCI rehabilitation. We conducted focus groups and stakeholder meetings with clinical assessment champions to (1) identify barriers and supports to SCI-QOL adoption; (2) reduce barriers and emphasize supports; (3) evaluate and select relevant SCI-QOL domains and item banks; (4) develop administration and reporting guidelines; and (5) identify hospital roles to alert with SCI-QOL results. Setting: A regional inpatient rehabilitation hospital. This study focuses on clinicians providing inpatient rehabilitation to patients with SCI. Participants: Fifty-nine clinicians, including physicians, speech language pathologists, occupational and physical therapists, nurses, and social workers providing care to SCI inpatients. Interventions: N/A. Outcome measures: N/A. Results: Clinicians identified the SCI-QOL domains that were most relevant to inpatient care; when SCI-QOL should be administered; what hospital roles were best suited for administering SCI-QOL; how results should be displayed in the electronic medical record; and which clinical roles needed notification of SCI-QOL results. Conclusions: Clinicians acknowledge the value of patient-reported outcome measures in inpatient SCI rehabilitation, but noted barriers to adoption. Engaging clinicians in the decision-making process for developing an implementation and administration protocol can inform strategies to overcome barriers and emphasize supports.