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The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory?

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  • Greenhalgh, Joanne
  • Long, Andrew F
  • Flynn, Rob

Abstract

This paper applies a theory-driven approach to explore why the use of patient-reported outcome (PRO) measures in clinical practice, in particular, health-related quality of life (HRQoL) instruments, has little or no apparent influence on clinical decision making. A theory-driven approach involves combining knowledge of whether and how an intervention works. It is argued that such an approach is currently lacking within the literature evaluating the effectiveness of feeding back HRQoL information to clinicians. The paper identifies a number of mechanisms that might give rise to the expected outcomes that are currently implicit within the design of the intervention and hypotheses specified within the trials evaluating the use of HRQoL measures in clinical practice. It then examines how far current clinical practice matches these mechanisms and in doing so, a number of possible explanations for the lack of impact of HRQoL on clinical decision making are reviewed. The influence of HRQoL information on clinical decision making depends on a large number of factors related to the design of the intervention, patients' and clinicians' desire to discuss HRQoL issues within the consultation and the legitimacy that clinicians give to HRQoL instruments. To date, knowledge of how the feedback of HRQoL information to clinicians might improve doctor-patient communication or clinical decision making has yet to sufficiently inform an assessment of whether these aspects of patient care are improved. The paper concludes by specifying how the feedback of HRQoL information to clinicians might be modified to maximise its impact on clinical decision making.

Suggested Citation

  • Greenhalgh, Joanne & Long, Andrew F & Flynn, Rob, 2005. "The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory?," Social Science & Medicine, Elsevier, vol. 60(4), pages 833-843, February.
    • Handle: RePEc:eee:socmed:v:60:y:2005:i:4:p:833-843
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    References listed on IDEAS

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    1. Cox, Karen, 2003. "Assessing the quality of life of patients in phase I and II anti-cancer drug trials: interviews versus questionnaires," Social Science & Medicine, Elsevier, vol. 56(5), pages 921-934, March.
    2. Allison, P. J. & Locker, D. & Feine, J. S., 1997. "Quality of life: A dynamic construct," Social Science & Medicine, Elsevier, vol. 45(2), pages 221-230, July.
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    Cited by:

    1. Daniel Miller & Carolyn Steele Gray & Kerry Kuluski & Cheryl Cott, 2015. "Patient-Centered Care and Patient-Reported Measures: Let’s Look Before We Leap," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 8(4), pages 293-299, August.
    2. A. Awad & Lakshmi Voruganti, 2012. "Measuring Quality of Life in Patients with Schizophrenia," PharmacoEconomics, Springer, vol. 30(3), pages 183-195, March.
    3. Gro Hilde Ramsdal & Rolf Wynn, 2022. "Theoretical Basis for a Group Intervention Aimed at Preventing High School Dropout: The Case of ‘Guttas Campus’," IJERPH, MDPI, vol. 19(24), pages 1-14, December.
    4. Sophie Staniszewska & Kirstie Haywood & Jo Brett & Liz Tutton, 2012. "Patient and Public Involvement in Patient-Reported Outcome Measures," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 5(2), pages 79-87, June.
    5. Mohamed Boucekine & Laurent Boyer & Karine Baumstarck & Aurelie Millier & Badih Ghattas & Pascal Auquier & Mondher Toumi, 2015. "Exploring the Response Shift Effect on the Quality of Life of Patients with Schizophrenia," Medical Decision Making, , vol. 35(3), pages 388-397, April.
    6. Kirstie L. Haywood & Roger Wilson & Sophie Staniszewska & Sam Salek, 2016. "Using PROMs in Healthcare: Who Should Be in the Driving Seat—Policy Makers, Health Professionals, Methodologists or Patients?," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 9(6), pages 495-498, December.
    7. Yining Xu & Xin Li & Zhihong Sun & Yang Song & Julien S. Baker & Yaodong Gu, 2021. "Adjusted Indirect and Mixed Comparisons of Interventions for the Patient-Reported Outcomes Measures (PROMs) of Disabled Adults: A Systematic Review and Network Meta-Analysis," IJERPH, MDPI, vol. 18(5), pages 1-29, March.
    8. Greenhalgh, Joanne & Flynn, Rob & Long, Andrew F. & Tyson, Sarah, 2008. "Tacit and encoded knowledge in the use of standardised outcome measures in multidisciplinary team decision making: A case study of in-patient neurorehabilitation," Social Science & Medicine, Elsevier, vol. 67(1), pages 183-194, July.
    9. Rosalba Rosato & Silvia Testa & Antonio Bertolotto & Paolo Confalonieri & Francesco Patti & Alessandra Lugaresi & Maria Grazia Grasso & Anna Toscano & Andrea Giordano & Alessandra Solari, 2016. "Development of a Short Version of MSQOL-54 Using Factor Analysis and Item Response Theory," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-15, April.
    10. Annie Madden & Max Hopwood & Joanne Neale & Carla Treloar, 2019. "Acceptability of Patient-Reported Outcome and Experience Measures for Hepatitis C Treatment Among People Who Use Drugs," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 12(2), pages 259-265, April.

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