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

Velikova, Galina; Keding, Ada; Harley, Clare; Cocks, Kim; Booth, Laura; Smith, Adam B.; Wright, Penny; Selby, Peter J.; Brown, Julia M.

doi:10.1016/j.ejca.2010.04.030

« Previous Next »European Journal of Cancer
Volume 46, Issue 13 , Pages 2381-2388, September 2010

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 Velikova
- St James’s Institute of Oncology, University of Leeds, Cancer Research UK Clinical Centre – Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
- Corresponding author at: St James’s Institute of Oncology, Cancer Research UK Centre, Bexley Wing (Level 4), St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK. Tel.: +44 0113 2067917; fax: +44 0113 2068512.
Ada Keding
- St James’s Institute of Oncology, University of Leeds, Cancer Research UK Clinical Centre – Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
Clare Harley
- St James’s Institute of Oncology, University of Leeds, Cancer Research UK Clinical Centre – Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
Kim Cocks
- Clinical Trials Research Unit, University of Leeds, Clinical Trials Research House, 71–75 Clarendon Road, Leeds LS2 9PH, United Kingdom
Laura Booth
- St James’s Institute of Oncology, University of Leeds, Cancer Research UK Clinical Centre – Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
Adam B. Smith
- St James’s Institute of Oncology, University of Leeds, Cancer Research UK Clinical Centre – Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
- Centre for Health & Social Care, University of Leeds, Leeds LS2 9LJ, United Kingdom
Penny Wright
- St James’s Institute of Oncology, University of Leeds, Cancer Research UK Clinical Centre – Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
Peter J. Selby
- St James’s Institute of Oncology, University of Leeds, Cancer Research UK Clinical Centre – Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
- Joint senior authors.
Julia M. Brown
- Clinical Trials Research Unit, University of Leeds, Clinical Trials Research House, 71–75 Clarendon Road, Leeds LS2 9PH, United Kingdom
- Joint senior authors.

Received 23 December 2009; received in revised form 26 April 2010; accepted 29 April 2010. published online 31 May 2010.

Abstract

Introduction and aim

In a randomised trial investigating the effects of regular use of health-related quality of life (HRQOL) in oncology practice, we previously reported an improvement in communication (objective analysis of recorded encounters) and patient well-being. The secondary aims of the trial were to measure any impact on patient satisfaction and patients’ perspectives on continuity and coordination of their care.

Methods

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; and (3) control arm: no HRQOL assessment. Secondary outcomes were patients’ experience of continuity of care (Medical Care Questionnaire, MCQ) 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=0.03). 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% versus 29%), and reported their doctors considered daily activities, emotions and quality of life.

Conclusion

Regular use of HRQOL measures in oncology practice brought changes to doctor-patient communication of sufficient magnitude and importance to be reported by patients. HRQOL data may improve care through facilitating rapport and building inter-personal relationships.

Keywords: Patient-reported outcomes, Continuity of care, Communication, Health-related quality of life, Oncology