Abstract
Purpose
To introduce the EPIC-CP symptom screening tool in routine ambulatory cancer care, and to evaluate its acceptability and perceived usefulness from the perspective of patients and clinicians.
Methods
Eligible prostate cancer patients from four cancer centres were recruited (November 2014–June 2015) from radiation or surgical oncology clinics. A physician and/or health care professional reviewed the EPIC-CP results as part of the clinical encounter. Patient experience with the tool was evaluated using a nine-item Patient Exit Survey (PES). Clinician experience was evaluated through semi-structured qualitative interviews. Patient and clinician results were compared to identify common themes.
Results
A total of 333 patients were enrolled, of whom, 287 completed the PES. Most patients had one clinical encounter, although the number of EPIC-CP assessments ranged from 1 to 11 per patient, for a total of 937 EPIC-CP questionnaires completed. Item completion rates were high (91–100%), with items addressing sexual health among the lowest (91–92%). On the PES, most patients (70%) agreed with the item: “Completing this questionnaire helped me tell the clinicians about how I have been feeling”. Thematic analysis from clinician interviews revealed that the EPIC-CP captures essential prostate-specific effects that facilitated person-centred communication and customization of interventions. Targeted clinical education and patient resources were seen as necessary for uptake.
Conclusions
EPIC-CP was generally endorsed by clinicians and patients. The implementation of a disease-specific measure in place of a generic symptom screening tool has the potential to improve the quality of the clinical encounter and provide outcome measures for further health services research. Provincial implementation of this tool as a standard of care is recommended.
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References
US FDA. (2009). Guidance for industry. Patient-reported outcomes measures: Use in medical product development to support labeling claims. Federal Registrer, 74(35), 65132–65133.
Acquadro, C., Berzon, R., Dubois, D., et al. (2001). Incorporating the patient’s perspective into drug development and communication: An ad hoc task force report of the Patient-Reported Outcomes (PRO) Harmonization Group meeting at the Food and Drug Administration. Value in Health, 16, 522–531.
Au, H.-J., Ringash, J., Brundage, M., et al. Added value of health-related quality of life measurement in cancer clinical trials: The experience of the NCIC CTG. Expert Review of Pharmacoeconomics & Outcomes Research 10(2), 119–128, 2010.
Till, J. E., Osoba, D., Pater, J. L., & Young, J. R. (1994). Research on health-related quality of life: Dissemination into practical applications. Quality of Life Research, 3, 279–283.
Lipscomb, J., Gotay, C., & Snyder, C. (2005). Outcomes assessment in cancer: Measures, methods, and applications. Cambridge: Cambridge University Press.
Snyder, C. F., & Aaronson, N. K. (2009). Use of patient-reported outcomes in clinical practice. Lancet, 374(9687), 369–370.
Brundage, M., & Snyder, C. (2012). Patient-reported outcomes in clinical practice: Using standards to break down barriers. Clinical Investigation, 2, 343–346.
Greenhalgh, J., & Meadows, K. (1999). The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: A literature review. Journal of Evaluation in Clinical Practice, 5, 401–416.
Marshall, S., Haywood, K., Fitzpatrick, R.. Haywood, S., & Fitzpatrick, K. (2006). Impact of patient-reported outcome measures on routine practice [abstract] Marshall. Journal of Evaluation in Clinical Practice, 12, 559–568.
Howell, D., Molloy, S., Wilkinson, K., et al. (2015). Patient-reported outcomes in routine cancer clinical practice: A scoping review of use, impact on health outcomes, and implementation factors. [review]. Annals of Oncology, 26, 1846–1858.
Velikova, G., Booth, L., Smith, A. B., et al. (2004). Measuring quality of life in routine oncology practice improves communication and patient well-being: A randomized controlled trial. Journal of Clinical Oncology, 22, 714–724.
Berry, D. L., Blumenstein, B. A., Halpenny, B., et al. (2011). Enhancing patient-provider communication with the electronic self-report assessment for cancer: A randomized trial. Journal of Clinical Oncology, 29, 1029–1035.
Santana, M. J., Feeny, D., Johnson, J. A., et al. (2010). Assessing the use of health-related quality of life measures in the routine clinical care of lung-transplant patients. Quality of Life Research, 19, 371–379.
Detmar, S. B., Muller, M. J., Schornagel, J. H., Wever, L. D. V., & Aaronson, N. K. (2002). Health related quality of life assessments and patient physician communication. Journal of the American Medical Association, 288, 3027–3034.
Seow, H., Sussman, J., Martelli-Reid, L., Pond, G., & Bainbridge, D. (2012). Do high symptom scores trigger clinical actions? An audit after implementing electronic symptom screening. Journal of Oncology Practice/American Society of Clinical Oncology, 8, e142–e148.
Basch, E., Deal, A. M., Kris, M. G., et al. (2016). Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. Journal of Clinical Oncology, 20(18), 2198.
Basch, E., Deal, A. M., Dueck, A. C., et al. (2017). Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA, 318, 197–198.
Denis, F., Lethrosne, C., Pourel, N., et al. (2017). Randomized trial comparing a web-mediated follow-up with routine surveillance in lung cancer patients. Journal of the National Cancer Institute, 109, 2017.
Wu, A. W., Kharrazi, H., Boulware, L. E., & Snyder, C. F. (2013). Measure once, cut twice–adding patient-reported outcome measures to the electronic health record for comparative effectiveness research. Journal of Clinical Epidemiology, 66, Suppl–S20.
Barbera, L., Sutradhar, R., Howell, D., et al. (2015). Does routine symptom screening with ESAS decrease ED visits in breast cancer patients undergoing adjuvant chemotherapy? Supportive Care in Cancer, 23, 3025–3032.
Barbera, L., Atzema, C., Sutradhar, R., et al. (2013). Do patient-reported symptoms predict emergency department visits in cancer patients? A population-based analysis. Annals of Emergency Medicine, 61, 427–437.
Sanda, M. G., Dunn, R. L., Michalski, J., et al. (2008). Quality of life and satisfaction with outcome among prostate-cancer survivors. The New England Journal of Medicine, 358, 1250–1261.
Litwin, M. S. (1995). Health-related quality of life after treatment for localized prostate cancer. Cancer, 75, 2000–2003.
Madalinska, J. B., Essink-Bot, M. L., de Koning, H. J., Kirkels, W. J., van der Maas, P. J., & Schroder, F. H. (2001). Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer. Journal of Clinical Oncology, 19, 1619–1628.
Rodrigues, G., Yao, X., Loblaw, D. A., Brundage, M., & Chin, J. L., Genitourinary Cancer Disease Site Group (2013). Evidence-based guideline recommendations on low-dose rate brachytherapy in patients with low- or intermediate-risk prostate cancer. Canadian Urological Association Journal, 7, E411–E416.
Berry, D. L., Wang, Q., Halpenny, B., & Hong, F. (2012). Decision preparation, satisfaction and regret in a multi-center sample of men with newly diagnosed localized prostate cancer. Patient Education and Counseling, 88, 262–267.
Bruera, E., Kuehn, N., Miller, M. J., Selmser, P., & Macmillan, K. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7, 6–9.
Pereira, J., Green, E., Molloy, S., et al. (2014). Population-based standardized symptom screening: Cancer Care Ontario’s Edmonton Symptom Assessment System and performance status initiatives. Journal of Oncology Practice/American Society of Clinical Oncology, 10, 212–214.
Pereira, J. L., Chasen, M. R., Molloy, S., et al. (2016). Cancer care professionals’ attitudes toward systematic standardized symptom assessment and the Edmonton Symptom Assessment System after large-scale population-based implementation in Ontario, Canada. Journal of Pain & Symptom Management, 51, 662–672.
Greenhalgh, J., Long, A. F., & Flynn, R. (2005). The use of patient reported outcome measures in routine clinical practice: Lack of impact or lack of theory?. [Review] [59 refs]. Social Science & Medicine, 60, 833–843.
Wei, J. T., Dunn, R. L., Litwin, M. S., Sandler, H. M., & Sanda, M. G. (2000). Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology, 56(6), 899–905.
Korzeniowski, M., Kalyvas, M., Mahmud, A., et al. (2016). Piloting prostate cancer patient-reported outcomesin clinical practice. Supportive Care in Cancer, 24, 1983–1990.
Sandelowski, M., & Barraso, J. (2003). Classifying the findings in qualitative studies. Qualitative Health Research, 13, 905–923.
Neergaard, M. A., Olesen, F., Andersen, R. S., & Sondergaard, J. (2009). Qualitative description: The poor cousin of health research? BMC Medical Research Methodology, 9, 52.
Watanabe, S. M., Nekolaichuk, C. L., & Beaumont, C. (2012). Palliative care providers’ opinions of the edmonton symptom assessment system revised (ESAS-r) in clinical practice. Journal of Pain & Symptom Management, 44, e2–e3.
Chang, P., Szymanski, K. M., Dunn, R. L., et al. (2011). Expanded prostate cancer index composite for clinical practice: Development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer. Journal of Urology, 186, 865–872.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.
Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105–112.
Acknowledgements
The authors thank the EPIC investigators group for their assistance.
Funding
This study was funded by Cancer Care Ontario.
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All authors declare that they have no conflict of interest to disclose.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ontario Cancer Research Ethics Board (OCREB) in 2014, which operates in compliance with and is constituted in accordance with the requirements of TOPS—2nd edition of the Tri-Council Policy Statement: Ethical conduct for Research Involving Humans; The International Conference on Harmonization of Good Clinical Practices: Part C Division 5 of the Food and Drug Regulations of Health Canada; and the provisions of the Ontario Personal Health Information Protection Act 2004 and its applicable regulations. OCREB is registered with the U.S. Department of Health & Human Service under the IRB registration number IRB00003960.
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Informed consent was obtained from all individual participants included in the study.
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Brundage, M.D., Barbera, L., McCallum, F. et al. A pilot evaluation of the expanded prostate cancer index composite for clinical practice (EPIC-CP) tool in Ontario. Qual Life Res 28, 771–782 (2019). https://doi.org/10.1007/s11136-018-2034-x
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DOI: https://doi.org/10.1007/s11136-018-2034-x