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Reconceptualising Patient-
Reported Outcome Measures:
why use them and what do
they mean to your patients?
Michelle M Holmes
Patient Reported Outcome Measures
“PROMs are designed to measure either patients'
perceptions of their general health or their
perceptions of their health in relation to specific
diseases or conditions”
Using PROMs in Clinical Practice
Increase knowledge on
disease trajectories
Evaluate the
effectiveness of
treatment
Assess the quality of
care
Influence the
detection of
psychological
problems
Facilitate
communication
Use as a screening tool
Stage One
• Systematic literature review examining the effects of PROMs in clinical practice
Stage Two
• Theoretical review examining the potential mechanisms behind the effects of PROMs
Stage Three
• Feasibility study examining implementing PROMs and a trial into clinical practice
Stage Four
• A mixed-method pilot cluster RCT exploring the effects of using PROMS in clinical practice
What is the potential impact
on the process and outcome
of healthcare after
implementing PROMs in
routine clinical practice for
non-malignant pain?
Methods
Stage 1 • Searching the literature
Stage 2 • Selecting the studies
Stage 3
• Extracting data from the studies
Stage 4
• Synthesising the results together
Stage 5 • Assessing the confidence
Construct: Positive effect
Adverse or no effect
Quantitative
Qualitative
Results
During treatment
Therapeutic
relationship
Tracking progress,
evaluating and
changing treatment
Initial
consultation
Assessment of
patient
Decision-making
Post-treatment
Influencing
outcomes
“
”
“It is important to assess and take
into account the thresholds of
physical pain for each different
individual on different occasions
and how it is impacted by cultural
and physiological factors”
Assessment of Patient
“
”
Getting patients to fill out forms
is grossly inaccurate in my book…
the patient 9 time out of 10
wouldn’t understand what hip
pain is
Assessment of Patient
“
”
This method is of great value in
the performance/assistant of
planning so we can assign a more
expressive care in relation to the
pathology and the patient as a
whole. Thus, seeking to minimise
the patient’s suffering and pain
Decision-Making
“
”
I see the implementation of the
pain scale as a way to humanize
care, where we can stop relying
on machines and turn to the
patient; to what he is saying and
feeling. Giving them an active
voice and a right to express
themselves
Therapeutic Relationship
“
”
This scale is important in the
sense of monitoring the evolution
of the intensification of pain and
even to what point the treatment
is being beneficial to the patient
Tracking progress and evaluating and
changing treatment
“
”
I just think there is a lot of
effort being put in there for
not a lot of surgical gain from
my perspective
Tracking progress and evaluating and
changing treatment
Pain levels Patient
satisfaction
Influencing outcomes
Assessment of Confidence
Review finding Confidence
Assessment of patient Moderate confidence
Decision-making High confidence
Therapeutic relationship Moderate confidence
Tracking progress, evaluating
and changing treatment
Low confidence
Influencing outcomes Very low confidence
Conclusions
More research is needed
During treatment
Therapeutic
relationship
Tracking progress,
evaluating and
changing treatment
Initial
consultation
Assessment of
patient
Decision-making
Post-treatment
Influencing
outcomes
Through what processes might
PROMs influence health
outcomes in routine clinical
practice for non-malignant
pain?
Methods
Stage 1
• Searching the literature
Stage 2
• Selecting the studies
Stage 3
• Extracting data from the studies
Stage 4
• Synthesising the results together
Stage 5
• Apply to psychological theories
Results
Increasing clinician knowledge
Facilitating patient-clinician interaction
Provision of patient-centered care
Monitoring
Informing strategies to improve care
Enhancing the therapeutic relationship
Influencing patient satisfaction
Influencing patient behaviour
Factors influencing clinician behaviour
Psychological Theories
Common-sense model of self-regulation
The extended common-sense model
Fear-avoidance model
Self-efficacy
Protection-motivation theory
Self-regulation control theory
Integrated behavioural model
Concepts
Patient satisfaction
Communication
Shared-decision making
Patient-centered care
Therapeutic relationship
Acknowledgements
Dr. Felicity Bishop, University of Southampton); Professor George Lewith, University of Southampton; Dr David Newell, Anglo-European College of Chiropractic; Jonathan Field, Back2Health;
Funders: University of Southampton, the Anglo-European College of Chiropractic, the Royal College of Chiropractors and Southampton Complementary Medicine Research Trust.
Miss Stephanie Barker, University of Southampton; Mrs. Polly Langdon, University of Southampton
Thank you for listening!
Questions?
References
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