Summary of findings 1. PROM feedback compared to usual care for improve processes and outcomes of care.
| PROM feedback compared to usual care for improve processes and outcomes of care | ||||||
| Patient or population: ambulatory adult patients. Setting: primary and secondary care settings in North America and Europe. Intervention: PROM feedback reported to physicians or both patients and physicians. Comparison: usual care. | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual care | Risk with PROM feedback | |||||
| Quality of life | SMD 0.15
(0.05 to 0.26) favouring PROM feedback vs usual care |
‐ | 2687 (11 randomised trials) | ⊝⊕⊕⊕
Moderate 1 |
PROM feedback probably slightly improves quality of life. Quality of life was assessed using the EuroQoL‐5D (EQ‐5D) KIDSCREEN‐10, Manchester Short Assessment for Quality of Life (MSAQ) , Short Form‐36 (SF‐36), and the Functional Assessment of Cancer Therapy (FACT) PROMs. Three additional studies also measured overall quality of life; one favoured the intervention and for the other two there was little or no difference between groups. |
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| General health perceptions | SMD 0.04
(‐0.17 lower to 0.24) indicating little or no difference between PROM feedback and usual care. |
‐ | 552 (2 randomised trials) | ⊕⊕⊝⊝ Low 1, 2 | PROM feedback may make little or no difference to general health perceptions. |
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| Functioning | Physical functioning | |||||
| SMD ‐0.10 (‐0.30 to 0.10) indicating little or no difference between PROM feedback and usual care. | ‐ | 2788 (14 randomised trials) | ⊕⊝⊝⊝ Very low 3, 4 | The evidence is very uncertain about the effect of PROM feedback on physical functioning. Physical functioning was assessed using the physical functioning subscales of the Short Form‐12 (SF‐12), Short form‐36 (SF‐36) Patient‐Physican Communication on HRQOL, European Organization for Research and Treatment of Cancer (EORTC‐QLQ‐30) physical functioning, KIDSCREEN‐10, Functional Living Index ‐ Cancer (FLIC) PROMs. |
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| Mental functioning | ||||||
| SMD 0.16 (0.06 to 0.27) favouring PROM feedback vs usual care | ‐ | 7782 (34 randomised trials) | ⊕⊝⊝⊝ Very low 1, 4 | The evidence is very uncertain about the effect of PROM feedback on mental functioning. Mental functioning was assessed using the Outcomes Questionnaire ‐ 45 (OQ‐45), the Outcomes Rating Scale (ORS), General Health Questionnaire (GHQ), Short Form ‐ 12 (SF‐12), Patient‐physician communication on HRQOL, European Organization for Research and Treatment of Cancer (EORTC‐QLQ‐30) mental functioning, World Health Organization ‐ 5 (WHO‐5), Beth Isreal‐UCLA Functional Status, Functional Living Index ‐ Cancer (FLIC) PROMs. Six other studies also reported mental functioning, for five studies there was little or no difference between groups and for the sixth study it was not possible to ascertain the direction of the effect. |
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| Social functioning | ||||||
| SMD 0.02 (‐0.06 to 0.09) indicating little or no difference between PROM feedback and usual care. | ‐ | 2632 (15 randomised trials) | ⊕⊕⊕⊝ Moderate 1 | PROM feedback probably makes little or no difference to social functioning. Social functioning was assessed using the Community‐Oriented Programs Environment Scale (COPES), the Functional Assessment of Cancer Therapy (FACT), Work and Social Adjustment Scale (WSAS), Short Form‐12 (SF‐12), Short Form‐36 (SF‐36), KIDSCREEN‐27, Beth Isreal‐UCLA Functional Status, Functional Living Index ‐ Cancer (FLIC) PROMs. One study also reported social functioning, finding little or no difference between groups. |
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| Symptoms | Pain | |||||
| SMD ‐0.00 (‐0.09 to 0.08) indicating little or no difference between PROM feedback and usual care. | ‐ | 2386 (9 randomised trials) | ⊕⊕⊕⊝ Moderate 1 | PROM feedback probably makes little or no difference for pain. Pain was assessed using the Short‐Form 36 (SF‐36), European Organization for Research and Treatment of Cancer (EORTC‐QLQ‐30) pain module, Symptom Monitor, and the Roland‐Morris Disability Questionnaire |
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| Fatigue | ||||||
| SMD 0.03 (‐0.29 to 0.36) indicating little or no difference between PROM feedback and usual care. | ‐ | 741 (4 randomised trials) | ⊕⊝⊝⊝ Very low 1, 2, 4 | The evidence is very uncertain about the effect of PROM feedback on fatigue. Fatigue was assessed using the Chronic Heart Failure Questionnaire, Symptom Monitor, and the European Organization for Research and Treatment of Cancer (EORTC‐QLQ‐30) fatigue module. |
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| Patient‐physician communication | SMD 0.36 (0.21 to 0.52) favouring PROM feedback vs usual care | ‐ | 658 (5 randomised trials) | ⊕⊕⊕⊝ Moderate 1 | PROM feedback probably increases patient‐physician communication. Communcation was assessed using patient‐physician communication on HRQOL, Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CAHPS) PROM, number of topics discussed. One study not included in the pooled analysis indicated that participants allocated to the intervention rated communication with their physician better than those allocated to usual care. |
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| Diagnosis and notation | Study population | RR 1.73 (1.44 to 2.08) | 7223 (21 randomised trials) | ⊕⊕⊕⊝ Moderate 4 | PROM feedback probably increases diagnosis and notation. Diagnosis and notation was assessed using chart review. |
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| 172 per 1,000 | 347 per 1,000 (278 to 423) | |||||
| Disease control | Study population | RR 1.25 (1.10 to 1.41) | 2806 (14 randomised trials) | ⊕⊕⊕⊝ Moderate1 | PROM feedback probably leads to an increase in disease control. Disease control was assessed using both PROMs and chart‐based assessments including Partners for Change Outcome Measurement System (PRCOMS), Outcomes Questionnaire ‐ 45 (OQ‐45), Outcomes Rating Scale (ORS), Primary Care Screener for Affective Disorders, Cutting down; Annoyance by criticism, Guilty feeling, and Eye‐openers (CAGE) questionnaire; New York Heart Association class, Geriatric Depression Scale (GDS), Beck Depression Inventory (BDI), and Diagnostic and Statistical Manual (DSM; depression symptoms >= 1). |
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| 300 per 1,000 | 400 per 1,000 (345 to 458) | |||||
| Adverse effects | ‐‐ | ‐‐ | ‐‐ | ‐‐ | ‐‐ | We did not find studies reporting on adverse effects. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio;SMD: Standardised mean difference. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1 We downgraded one point for risk of unblinding due to the nature of the intervention in the majority of studies.
2 We downgraded one point for imprecision due to the small number of studies with wide confidence intervals included in meta‐analysis.
3 We downgraded one point for high risk of bias in multiple studies.
4 We downgraded one point for inconsistency due to statistical heterogeneity.