1 monitoring quality of life in the clinic prof. dr. jan van busschbach medical psychology and...
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Monitoring Quality of Life in the Clinic
Prof. dr. Jan van Busschbach
Medical Psychology and Psychotherapy
Erasmus MC
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Quality of life measurement suggested for use in the clinic
Bradley J, 1999 The adaptations of a quality of life questionnaire for routine
use in clinical practice: the Chronic Respiratory Disease Questionnaire in cystic fibrosis
Backman JW, 2003 The patient-computer interview: a neglected tool that can aid
the clinician.
Adam B, 2007 Measuring social difficulties in routine patient-centred
assessment: a Rasch analysis of the social difficulties inventory
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Congresses
Applications of health status assessment measures in clinical practice. Med Care. 1992 May;30(5 Suppl):MS1-14
ISOQOL Conference on Patient Reported Outcomes in Clinical Practice June 24-26, 2007, Budapest, Hungary
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An everlasting lasting promise
Budapest Conference Aaronson & Snyder. ISOQOL Newsletter July 2007
Improves patient doctor communication No clear influence on patient management In fact... little research
Publication bias?
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What stops us?
Complex logistics Does it fit the clinical setting et al? Molla Donaldson
….simply urging clinicians to use PROs would not achieve large-scale adoption and that the systems in which clinicians work must be considered
• ISOQOL Newsletter July 2007
Is there no success at all?
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Routine screening tools seem to be beneficial in pain
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Monitoring psychotherapy
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Results in psychotherapy
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55
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First measurement Last measurement
Feedback
No Fb
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Monitoring in Quality of Life
De Man, Darlington, Gutteling Department of Gastroenterology and Hepatology
162 patients with chronic liver disease Computerised administration
SF-12
Disease specific instrument
11 physicians randomly assigned Feedback, no feedback
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Real Time Feedback
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Results
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Patients No direct effect of feedback
• …on quality of life No difference in patient satifaction
But with feedback Older patients with feedback held better scores
• Interaction effect on mental health and disease specific Male patients
• Interaction effect on mental health
Physicians Altered treatment policy more often Were positive about feedback
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Limitation
Difficulty recruiting patients 1850 patients invited
1263 turned invitation down
Logistic complications 244 did not show up at the computer (in time)
146 only 1 administration
Subgroup results...
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Lessons learned
Logistics is everything! RCT hampers clinical logistics
Replace by routine outcome monitor
But it might work… Quality of Life
Treatment policy
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New investigation
Inflammatory bowel disease Zuzana Zelinkova
Dr. Janneke van der Woude
Feedback on Quality of life Inflammatory Bowel Disease Questionnaire (IBDQ]?
SF-36?
Or make disease specific questionnaire? What is important for the patients?
Outcome Influence on treatment policy
Patient doctor communication
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Conclusions
Feedback seems useful From theory
From empirical evidence
Logistics are an obstacle But somewhere out there is the future…
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