B138
Patients report improvements in continuity of care when quality of life assessments are used routinely in oncology practice: secondary outcomes of a randomised controlled trial
Galina Velikova1, Ada Keding1, Clare Harley1, Kim Cocks2, Adam Smith3, Laura Booth1, Penny Wright1, Peter Selby1, Julia Brown2
1St James's Institute of Oncology, University of Leeds, UK, 2Clinical Trials research Unit, University of Leeds, UK, 3Centre for Health & Social Care, University of Leeds, UK
Background
Regular use of patient-reported outcome measures (PROMS) including health-related quality of life (HRQOL) in clinical practice can have a positive impact on doctor-patient communication, but less consistent effect on patient health outcomes. In a randomised trial in oncology we reported an improvement in communication (objective analysis of recorded consultations) and better patient well-being. The secondary aim of the trial was to investigate possible mechanisms underlying changes in patient care, including exploration of patients perspectives on continuity and satisfaction with care.
Method
In a prospective trial involving 28 oncologists, 286 cancer patients were randomised to: 1) Intervention arm: regular touch-screen completion of HRQOL with feedback to physicians; 2) Attention-control arm: completion of HRQOL without feedback; 3) Control arm: no HRQOL assessment. Secondary outcomes were patients experience of continuity of care (Medical Care Questionnaire) including Communication Coordination and Preferences (to see usual doctor) subscales, patients satisfaction, and patients and physicians evaluation of the intervention. Analysis employed mixed-effects modelling, multiple regression and descriptive statistics.
Results
Patients in the intervention arm rated their continuity of care as better than the control group for Communication subscale (p=.03). No significant effects were found for Coordination or Preferences to see usual doctor. Patients evaluation of the intervention was positive. More patients in the intervention group rated the HRQOL assessment as useful compared to the attention-control group (86% vs 29%), and reported their doctors considered daily activities, emotions and quality of life whilst treating them.
Conclusion
Regular use of HRQOL measures in oncology practice brought changes to doctor-patient communication of sufficient magnitude and importance to be noticed by patients. HRQOL data may improve care through facilitating rapport and building interpersonal relationships.
