Abstract
CIC Cancer Project – early PROMs findings reveal striking variations in patients' outcomes of colorectal cancer care between two sites in Western Australia
Angela Ives, Lesley Millar, Mary Theophilus, Christobel Saunders
Introduction
The Continuous Improvement in Care – Cancer (CIC Cancer) Project is a multi-institutional program of research that seeks to bring value-based health care (VBHC) to public and private healthcare settings in Western Australia (WA) across four tumour streams – including colorectal cancer – and five hospital sites. To achieve this aim, patient-reported outcomes (PROMs) based on the ICHOM standard dataset are collected electronically via a bespoke, open source, informatics system embedded within the IT environments of both the public and private sites.
Data visualisation within this informatics system allows PROMS to be used during individual patient consultations to highlight issues and understand how well a patient is coping. De-identified data is also routinely extracted, and in-depth analysis is undertaken to identify trends in patient symptoms and function.
Method
Patients diagnosed with colorectal cancer were recruited to the CIC Cancer project at two sites within WA – one public and the other a private hospital contracted to provide public hospital care as well as private care. The sites commenced data capture at different time points, and this is reflected in the follow-up data points captured.
Clinical teams involved in the CIC project implementation anecdotally reported that when the patient completes PROMs, prior to/during an appointment, these questions start a discussion – particularly when a nurse-led interaction is included within the standard consultation processes. Recent interim analysis of EORTC-QLQ-C30 PROMs collected from these colorectal cancer patients has identified interesting differences that provide evidence of the benefits of these nurse-led interactions at publicly and privately run hospitals.
Results
A total of 218 patients were recruited to the CIC research project at diagnosis (baseline). These were split approximately 2:1 across two sites – Site A (privately operated hospital) and Site B (publicly operated hospital). Approximately half of the participants had completed PROMs at both baseline and six months at each site. The age profile was similar, but Site A had fewer females.
A review of the EORTC-QLQ-C30 scores found that all function scores – physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning scores – for Site A improved at six months compared to Site B. This improvement was seen regardless of the baseline score. In addition, all symptom scores – fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and financial difficulties – for Site A improved at six months when compared to Site B; again, regardless of baseline scores. Overall, despite the global health status being lower at Site A at baseline, the improvement in global health status was greater than at Site B at six months.
We explored variables that may have led to these differences. Stoma rates were comparable between sites (Site A - 28.6% had a stoma in place at six months, Site B -27.3%) and medical personnel largely work across both sites; thus, these factors are unlikely to be the cause of variation. The key difference appeared to be the increased involvement of nurse specialists in the review and assessment of patient’s wellbeing at Site A, where they can provide continuous support as well as coordinate care and navigate healthcare systems. Nurse specialists asking their patients the PROMs questions potentially allowed provision of immediate support and ongoing identification and management of patient’s needs.
Conclusions
This analysis of PROMs completed by patients with colorectal cancer is exploratory, and further information is required. It is hoped, however, that this information is sufficiently indicative of the potential benefits of nurse-led interactions in patients’ completing PROMS at clinic appointments that a trial can be commenced at Site B to further elucidate this effect.
Angela Ives, Lesley Millar, Mary Theophilus, Christobel Saunders
Introduction
The Continuous Improvement in Care – Cancer (CIC Cancer) Project is a multi-institutional program of research that seeks to bring value-based health care (VBHC) to public and private healthcare settings in Western Australia (WA) across four tumour streams – including colorectal cancer – and five hospital sites. To achieve this aim, patient-reported outcomes (PROMs) based on the ICHOM standard dataset are collected electronically via a bespoke, open source, informatics system embedded within the IT environments of both the public and private sites.
Data visualisation within this informatics system allows PROMS to be used during individual patient consultations to highlight issues and understand how well a patient is coping. De-identified data is also routinely extracted, and in-depth analysis is undertaken to identify trends in patient symptoms and function.
Method
Patients diagnosed with colorectal cancer were recruited to the CIC Cancer project at two sites within WA – one public and the other a private hospital contracted to provide public hospital care as well as private care. The sites commenced data capture at different time points, and this is reflected in the follow-up data points captured.
Clinical teams involved in the CIC project implementation anecdotally reported that when the patient completes PROMs, prior to/during an appointment, these questions start a discussion – particularly when a nurse-led interaction is included within the standard consultation processes. Recent interim analysis of EORTC-QLQ-C30 PROMs collected from these colorectal cancer patients has identified interesting differences that provide evidence of the benefits of these nurse-led interactions at publicly and privately run hospitals.
Results
A total of 218 patients were recruited to the CIC research project at diagnosis (baseline). These were split approximately 2:1 across two sites – Site A (privately operated hospital) and Site B (publicly operated hospital). Approximately half of the participants had completed PROMs at both baseline and six months at each site. The age profile was similar, but Site A had fewer females.
A review of the EORTC-QLQ-C30 scores found that all function scores – physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning scores – for Site A improved at six months compared to Site B. This improvement was seen regardless of the baseline score. In addition, all symptom scores – fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and financial difficulties – for Site A improved at six months when compared to Site B; again, regardless of baseline scores. Overall, despite the global health status being lower at Site A at baseline, the improvement in global health status was greater than at Site B at six months.
We explored variables that may have led to these differences. Stoma rates were comparable between sites (Site A - 28.6% had a stoma in place at six months, Site B -27.3%) and medical personnel largely work across both sites; thus, these factors are unlikely to be the cause of variation. The key difference appeared to be the increased involvement of nurse specialists in the review and assessment of patient’s wellbeing at Site A, where they can provide continuous support as well as coordinate care and navigate healthcare systems. Nurse specialists asking their patients the PROMs questions potentially allowed provision of immediate support and ongoing identification and management of patient’s needs.
Conclusions
This analysis of PROMs completed by patients with colorectal cancer is exploratory, and further information is required. It is hoped, however, that this information is sufficiently indicative of the potential benefits of nurse-led interactions in patients’ completing PROMS at clinic appointments that a trial can be commenced at Site B to further elucidate this effect.
| Original language | English |
|---|---|
| Publication status | Published - 21 Oct 2024 |
