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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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1877-8879
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Volume 13, Issue 1

Issues

Using patient reported outcomes in oncology clinical practice

Sarah A. Kelleher
  • Corresponding author
  • Department Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Tamara J. Somers
  • Department Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Tracie Locklear
  • Center for Learning Health Care, Duke University Medical Center, Durham, NC 27705, United States
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Alexandra D. Crosswell
  • Center for Health and Community, University of California San Francisco, San Francisco, CA 94143, United States
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Amy P. Abernethy
  • Center for Learning Health Care, Duke University Medical Center, Durham, NC 27705, United States
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2016-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2016.05.035

Abstract

Background and aims

Patient reported outcomes (PROs) are increasingly being implemented into the care of patients with cancer. The use of a standard set of PROs (e.g., pain) in cancer is becoming established and there is interest in what additional PROs might provide valuable information. The goal of this observational study was to examine how the PROs of self-efficacy for pain and other symptoms assessed at the point of service were associated with pain, symptom severity and distress, and physical and psychosocial functioning in a sample of breast and gastrointestinal patients. We also sought to examine differences in these relationships by cancer type (breast and gastrointestinal) as well as understand differences in self-assessment mode (paper/pencil or electronic tablet).

Methods

178 patients with breast (n = 65) and gastrointestinal cancer (n = 113) completed the Chronic Pain Self Efficacy Scale, M.D. Anderson Symptom Inventory, and Functional Assessment of Cancer Therapy – General questionnaires. Measures were completed with paper and pencil and electronically using a tablet computer while patients waited for their clinical appointment. Responses from the initial completed questionnaires on both the paper and electronic instruments were analyzed.

Results

Patients’ self-efficacy scores for pain and other symptoms correlated positively with pain, symptom severity and distress, and physical and psychosocial functioning; patients with lower levels of self-efficacy reported poorer outcomes and functioning overall. The results were independent of cancer type and mode of assessment. No statistically significant differences were found in the PROs when collected by electronic technology versus paper-pencil mode; patients were very satisfied with using the tablet computer to complete the PRO measures.

Conclusions and implications

Our results suggest that self-efficacy for pain and symptom management may be a beneficial addition to clinic-based PRO assessment batteries for patients with cancer and other chronic diseases. Existing short, validated symptom self-efficacy scales could easily be integrated into clinical practice to help healthcare providers identify patients that might benefit from intervention. Study results also support existing research that suggests electronic approaches are a practical way to collect PRO data, including self-efficacy data, in the clinic. Overall, our data suggest that patients who have particularly low levels of self-efficacy for pain and symptom management may be at risk for higher levels of pain and disability. Thus, if self-efficacy for pain and symptom management were routinely collected at the time of clinical service, psychosocial interventions to improve self-efficacy for pain and symptom management, and in turn overall quality of life, could be implemented in a timely fashion.

Keywords: Self-efficacy for pain; Cancer; Patient reported outcomes; Symptom management

References

  • [1]

    Snyder CF, Jensen RE, Segal JB, Wu AW. Patient-reported outcomes (PROs): putting the patient perspective in patient-centered outcomes research. Med Care 2013;51(Suppl. 3):S73–9.CrossrefWeb of SciencePubMedGoogle Scholar

  • [2]

    Huebner J, Rose C, Geissler J, Gleiter CH, Prott FJ, Muenstedt K, Micke O, Muecke R, Buentzel J, Bottomley A, Hofheinz RD. Integrating cancer patients’ perspectives into treatment decisions and treatment evaluation using patient-reported outcomes – a concept paper. Eur J Cancer Care (Engl) 2013;23:173–9.PubMedGoogle Scholar

  • [3]

    Albrecht TA. Striving to improve patient-reported outcomes for cancer survivors as the war wages on. Ann Oncol 2013;24:2204–5.Web of ScienceCrossrefPubMedGoogle Scholar

  • [4]

    Willke RJ, Burke LB, Erickson P. Measuring treatment impact: a review of patient-reported outcomes and other efficacy endpoints in approved product labels. Control Clin Trials 2004;25:535–52.PubMedCrossrefGoogle Scholar

  • [5]

    Cleeland CS, Sloan JA. Assessing the symptoms of cancer using patient-reported outcomes (ASCPRO): searching for standards. J Pain Symptom Manage 2010;39:1077–85.Web of SciencePubMedCrossrefGoogle Scholar

  • [6]

    Gwaltney CJ, Shields AL, Shiffman S. Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: a meta-analytic review. Value Health 2008;11:322–33.Web of ScienceCrossrefPubMedGoogle Scholar

  • [7]

    Turk DC, Dworkin RH. What should be the core outcomes in chronic pain clinical trials? Arthritis Res Ther 2004;6:151–4.PubMedGoogle Scholar

  • [8]

    Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns 2002;48:177–87.PubMedCrossrefGoogle Scholar

  • [9]

    Jerant A, Franks P, Kravitz RL. Associations between pain control self-efficacy, self-efficacy for communicating with physicians, and subsequent pain severity among cancer patients. Patient Educ Couns 2011;85:275–80.Web of ScienceCrossrefPubMedGoogle Scholar

  • [10]

    Mystakidou K, Parpa E, Tsilika E, Gogou P, Panagiotou I, Galanos A, Kouvaris I, Gouliamos A. Self-efficacy, depression, and physical distress in males and females with cancer. Am J Hosp Palliat Care 2010;27:518–25.PubMedCrossrefGoogle Scholar

  • [11]

    Mystakidou K, Tsilika E, Parpa E, Gogou P, Theodorakis P, Vlahos L. Self-efficacy beliefs and levels of anxiety in advanced cancer patients. Eur J Cancer Care (Engl) 2010;19:205–11.PubMedCrossrefGoogle Scholar

  • [12]

    Porter LS, Keefe FJ, Garst J, McBride CM, Baucom D. Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: associations with symptoms and distress. Pain 2008;137:306–15.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [13]

    Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977;84:191–215.CrossrefGoogle Scholar

  • [14]

    Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman; 1997. p. 604, ix.Google Scholar

  • [15]

    Stanton AL, Luecken LJ, Mackinnon DP, Thompson EH. Mechanisms in psychosocial interventions for adults living with cancer: opportunity for integration of theory, research, and practice. J Consult Clin Psychol 2012;81:318–35.PubMedWeb of ScienceGoogle Scholar

  • [16]

    Abernethy AP, Herndon 2nd JE, Wheeler JL, Day JM, Hood L, Patwardhan M, Shaw H, Lyerly HK. Feasibility and acceptability to patients of a longitudinal system for evaluating cancer-related symptoms and quality of life: pilot study of an e/Tablet data-collection system in academic oncology. J Pain Symptom Manage 2009;37:1027–38.Web of ScienceCrossrefGoogle Scholar

  • [17]

    Abernethy AP, Herndon 2nd JE, Wheeler JL, Patwardhan M, Shaw H, Lyerly HK, Weinfurt K. Improving health care efficiency and quality using tablet personal computers to collect research-quality, patient-reported data. Health Serv Res 2008;43:1975–91.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [18]

    Reese JB, Shelby RA, Keefe FJ, Porter LS, Abernethy AP. Sexual concerns in cancer patients: a comparison of GI and breast cancer patients. Support Care Cancer 2010;18:1179–89.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [19]

    Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum 1989;32:37–44.CrossrefPubMedGoogle Scholar

  • [20]

    Anderson KO, Dowds BN, Pelletz RE, Edwards WT, Peeters-Asdourian C. Development and initial validation of a scale to measure self-efficacy beliefs in patients with chronic pain. Pain 1995;63:77–84.CrossrefPubMedGoogle Scholar

  • [21]

    Porter LS, Keefe FJ, McBride CM, Pollak K, Fish L, Garst J. Perceptions of patients’ self-efficacy for managing pain and lung cancer symptoms: correspondence between patients and family caregivers. Pain 2002;98:169–78.PubMedCrossrefGoogle Scholar

  • [22]

    Campbell LC, Keefe FJ, McKee DC, Edwards CL, Herman SH, Johnson LE, Colvin OM, McBride CM, Donattuci CF. Prostate cancer in African Americans: relationship of patient and partner self-efficacy to quality of life. J Pain Symptom Manage 2004;28:433–44.PubMedCrossrefGoogle Scholar

  • [23]

    Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, Engstrom MC. Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer 2000;89:1634–46.CrossrefGoogle Scholar

  • [24]

    Jensen MP. The validity and reliability of pain measures in adults with cancer. J Pain: Off J Am Pain Soc 2003;4:2–21.CrossrefGoogle Scholar

  • [25]

    Cella D. Manual of the functional assessment of chronic illness therapy (FACIT) measurement system, version 4.1. Evanston, IL: Center on Outcomes, Research, & Education; 2004.Google Scholar

  • [26]

    Porter LS, Keefe FJ, Garst J, Baucom DH, McBride CM, McKee DC, Sutton L, Carson K, Knowles V, Rumble M, Scipio C. Caregiver-assisted coping skills training for lung cancer: results of a randomized clinical trial. J Pain Symptom Manage 2011;41:1–13.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [27]

    Byma EA, Given BA, Given CW, You M. The effects of mastery on pain and fatigue resolution. Oncol Nurs Forum 2009;36:544–52.Web of ScienceCrossrefPubMedGoogle Scholar

  • [28]

    Kurtz ME, Kurtz JC, Given CW, Given BA. Patient optimism and mastery – do they play a role in cancer patients’ management of pain and fatigue? J Pain Symptom Manage 2008;36:1–10.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [29]

    Somers TJ, Wren AA, Shelby RA. The context of pain in arthritis: self-efficacy for managing pain and other symptoms. Curr Pain Headache Rep 2012;16:502–8.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [30]

    Basch E, Abernethy AP. Supporting clinical practice decisions with real-time patient-reported outcomes. J Clin Oncol 2011;29:954–6.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [31]

    Basch E, Abernethy AP, Mullins CD, Reeve BB, Smith ML, Coons SJ, Sloan J, Wenzel K, Chauhan C, Eppard W, Frank ES, Lipscomb J, Raymond SA, Spencer M, Tunis S. Recommendations for incorporating patient-reported outcomes into clinical comparative effectiveness research in adult oncology. J Clin Oncol 2012;30:4249–55.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [32]

    Jagsi R, Chiang A, Polite B, Medeiros B, McNiff K, Abernethy A, Zon R, Loehrer P. Qualitative analysis of practicing oncologists attitudes and experiences regarding collection of patient-reported outcomes. J Oncol Pract 2012;9:e290–7.Google Scholar

  • [33]

    Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract 2001;4:256–62.PubMedGoogle Scholar

About the article

Duke University Medical Center, 2200W. Main Street, Suite 340, Durham, NC 27705, United States. Tel.:+19194163405; fax:+1 9194163458


Received: 2016-03-02

Revised: 2016-05-17

Accepted: 2016-05-19

Published Online: 2016-10-01

Published in Print: 2016-10-01


Sources of funding: This project had various funding elements including the development of the electronic patient reported outcomes data collection system which was funded through an Outcomes Research service agreement with Pfizer, Inc., to evaluate whether e/Tablets are an acceptable and reliable method of patient-reported data collection in the academic oncology setting; Pfizer does not have access to individual data. Computer hardware was funded by Supportive Oncology Services (SOS), Inc. and subsequently by Duke University Hospital and Duke University Health System (DUHS).The wireless system, some programming, and technical support was funded by DUHS. Additionally, this study was funded through an NCI training grant 1KM1CA15668701 awarded to author TJS and internal funds through the Center for Learning Healthcare at Duke Clinical Research Institute.

Conflict of interest: Authors Kelleher, Locklear and Crosswell have no disclosures or financial or personal conflicts of interest to report. Somers was previously supported by an NCI training grant 1KM 1CA15668701. Dr. Abernethy reports board memberships (Advoset, Orange Leaf Associates, Athena Health), consultancies [(Pfizer (2012), Novartis (2011), Helsinn (2009, 2010), Amgen (2009), Bristol-Myers Squibb (pending 2013)], and grants (Pfizer, Helsinn, Amgen, Kanglaite, Alexion, Biovex, DARA, MiCo, NINR). The authors report no other financial or personal conflicts.

Authors’ contributions: All authors have contributed significantly to this manuscript and consent to their names being on the manuscript. All authors have seen and approved the final version of the manuscript.


Citation Information: Scandinavian Journal of Pain, Volume 13, Issue 1, Pages 6–11, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2016.05.035.

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