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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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Volume 13, Issue 1


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


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).


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.


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


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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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