Abstract
Purpose
We conducted a secondary qualitative analysis of consultations between oncologists and their patients to explore how patient-reported
outcome measures (PROMs) data were referred to in the process of (1) eliciting and exploring patients’ concerns; (2) making
decisions about supportive treatment and (3) making decisions about chemotherapy and other systemic treatments.
outcome measures (PROMs) data were referred to in the process of (1) eliciting and exploring patients’ concerns; (2) making
decisions about supportive treatment and (3) making decisions about chemotherapy and other systemic treatments.
Methods
We purposively sampled audio recordings of 18 consultations from the intervention arm and 4 from the attention control arm
of a previous UK randomised controlled trial of the feedback of PROMs data to doctors (Velikova et al. in J Clin Oncol 22(4):714–724
[1]). We used a combination of content and conversation analysis to examine how opportunities for discussion of health-related
quality of life issues are opened up or closed down within the consultation and explore why this may or may not lead to changes
in patient management.
of a previous UK randomised controlled trial of the feedback of PROMs data to doctors (Velikova et al. in J Clin Oncol 22(4):714–724
[1]). We used a combination of content and conversation analysis to examine how opportunities for discussion of health-related
quality of life issues are opened up or closed down within the consultation and explore why this may or may not lead to changes
in patient management.
Findings
Explicit reference to the PROMs data provided an opportunity for the patient to clarify and further elaborate on the side
effects of chemotherapy. High scores on the PROMs data were not explored further if the patient indicated they were not a
problem or were not related to the cancer or chemotherapy. Symptomatic treatment was more often offered for problems like
nausea, constipation, pain and depression but much less so for fatigue. Doctors discussed fatigue by providing a cause for
the fatigue (e.g. the chemotherapy), presenting this as ‘something to be expected’, minimising its impact or moving on to
another topic. Chemotherapy regimens were not changed on the basis of the PROMs data alone, but PROMs data were sometimes
used to legitimise changes.
effects of chemotherapy. High scores on the PROMs data were not explored further if the patient indicated they were not a
problem or were not related to the cancer or chemotherapy. Symptomatic treatment was more often offered for problems like
nausea, constipation, pain and depression but much less so for fatigue. Doctors discussed fatigue by providing a cause for
the fatigue (e.g. the chemotherapy), presenting this as ‘something to be expected’, minimising its impact or moving on to
another topic. Chemotherapy regimens were not changed on the basis of the PROMs data alone, but PROMs data were sometimes
used to legitimise changes.
Conclusions
Explicit mention of PROMs data in the consultation may strengthen opportunities for patients to elaborate on their problems,
but doctors may not always know how to do this. Our findings have informed the development of a training package to enable
doctors to optimise their use of PROMs data within the consultation.
but doctors may not always know how to do this. Our findings have informed the development of a training package to enable
doctors to optimise their use of PROMs data within the consultation.
- Content Type Journal Article
- Pages 1-12
- DOI 10.1007/s11136-012-0218-3
- Authors
- Joanne Greenhalgh, School of Sociology and Social Policy, University of Leeds, Leeds, LS2 9JT UK
- Purva Abhyankar, NMAHP Research Unit, University of Stirling, Iris Murdoch Building, Stirling, FK9 4LA UK
- Serena McCluskey, Centre for Health and Social Care Research, Human and Health Research Building, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH UK
- Elena Takeuchi, St James’s Institute of Oncology, St James’s Hospital, Beckett Street, Leeds, LS9 7TF UK
- Galina Velikova, St James’s Institute of Oncology, St James’s Hospital, Beckett Street, Leeds, LS9 7TF UK
- Journal Quality of Life Research
- Online ISSN 1573-2649
- Print ISSN 0962-9343