Modern cancer treatments have improved survival rates and changed the nature of cancer care. Even advanced cancers (such as breast, colorectal, ovarian) can be treated as chronic diseases, achieving disease and symptom control. Monitoring of patients’ physical, functional and psychological problems during and after cancer treatment becomes essential in oncology practice. Its importance is recognised by clinicians and endorsed by national and international practice guidelines. Traditional methods of history-taking can be supplemented by patients’ self-reported experiences, using validated questionnaires, known as Patient-Reported Outcomes (PROs) measures (including screening instruments for psychological distress, symptom questionnaires and Health-Related Quality-of-Life measures). Incorporating PROs in the routine care of individual patients can help screen and identify psychological and physical problems, monitor them over time, facilitate communication and engage patients in decision-making. However, evidence that this approach is truly beneficial for patients is still accumulating.
The introduction of formal measurement of PROs in clinical practice is a complex health care innovation requiring careful planning, design and successful implementation of a number of essential components. These include:
· choosing suitable, disease-specific validated, yet brief questionnaires for patient self-reporting;
· introducing automated electronic methods for patient self-reporting both from the hospital and remotely from their homes.
· engaging oncologists by training them to interpret , communicate and discuss the results with the patients, and how act on them;
· planning a staged implementation of the above changes into the patient care pathways, taking into consideration local procedures and involving clinicians and managers throughout the process.
This presentation will provide an overview and examples of these essential components, based on existing evidence and our research experience in Leeds of over 15 years. The focus will be on:
· showing the impact of PROs on doctor-patient communication;
· approaches to clinician training;
· recent developments of web-based self-reporting system integrated with Electronic Patient Records;
· an example of a nurse-led pilot approach to routine Holistic Needs Assessment of patients using the web-based system and the Distress Thermometer.