The impact of individual quality of life assessment on psychosocial attention in patients with chest malignancies: a randomized study

Our plain-English summary of The impact of individual quality of life assessment on psychosocial attention in patients with chest malignancies: a randomized study, by M. Nicklasson, M.L. Elfström, J. Olofson, et al (Supportive Care in Cancer, 2013).

The study

• Authors: M. Nicklasson, M.L. Elfström, J. Olofson, B. Bergman
• Journal: Supportive Care in Cancer
• Published: 2013;21(1):87-95
• Type of article: Randomized trial
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: The aims of this study were to investigate the impact of individual health-related quality of life (HRQL) evaluation on the attention towards symptom control and psychosocial function in advanced cancer patients.

Methods: Patients with advanced lung cancer or mesothelioma who attended a pulmonary oncology outpatient clinic were randomized to either of two strategies for HRQL assessment. The experimental group (EG) answered the EORTC QLQ-C30 + LC13 questionnaire using a digital table interface, with outprint of aggregated scale scores presented to the consulting physician as a support for evaluation. The control group (CG) answered a paper version of the same questionnaire, which was stored for later analysis. Consultations were audio-recorded. Outcome measures were a quantitative content analysis of audio-recorded consultations and medical and psychosocial interventions abstracted from clinical records.

Results: One hundred seventy-one patients were randomized and participated in the study. Issues regarding emotional function were more frequently discussed during consultations in the EG (p < 0.05). Similarly, interventions directed to emotional and social concerns were more frequent in the EG (p = 0.013 and p = 0.0036, respectively). HRQL measures over time were similar across the groups.

Conclusion: Individual HRQL assessment increased the attention to psychosocial functioning in patients with chest malignancies.

In plain English

This randomized study ran at Sahlgrenska University Hospital, Gothenburg, Sweden, from December 2002 to March 2005. It analyzed 171 patients with lung cancer or pleural mesothelioma (14 with mesothelioma); most had advanced disease, but three had inoperable stage I tumors. It did not look at asbestos exposure. Both groups were asked to complete a standard quality-of-life questionnaire at planned visits, and did so at 91.5% of them. Experimental-group answers (84 patients) were computerized, and a printed score summary went to the doctor beforehand. Control-group paper answers (87 patients) were stored, not shown to the doctor. Experimental-group consultations had more doctor statements about emotional functioning (mean 1.5 versus 0.9 per patient) and fewer about medical or technical matters. These patients also received more interventions for emotional concerns (mean 0.43 versus 0.15 per patient) and social concerns (1.17 versus 0.74). Recorded conversations were similar in length across groups. The authors concluded the approach was feasible and may increase attention to psychosocial issues and symptom control. They noted the study was open and doctors had limited training in reading the scores.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Randomized study comparing two ways of assessing health-related quality of life (HRQL) in clinical practice
• Who was studied: 171 analyzed patients with lung cancer or pleural mesothelioma at the outpatient department of pulmonary oncology, Sahlgrenska University Hospital, Gothenburg, Sweden, recruited December 2002 to March 2005. There were 84 in the experimental group and 87 in the control group. Fourteen had mesothelioma (5 experimental, 9 control). Most had advanced disease, but three patients with stage I tumors who were inoperable because of poor lung function were included. One experimental-group patient who had had radical lung cancer surgery and adjuvant chemotherapy was also included because of significant recurrence risk.
• Exposure: Not an asbestos exposure study. The intervention was a computerized EORTC QLQ-C30 plus LC13 quality-of-life questionnaire, with a printed summary of scores given to the consulting physician before the visit. Controls completed a paper version that was stored and not shown to the physician.
• Main results:
  • 595 questionnaire sets were completed at 650 planned outpatient visits, an overall compliance rate of 91.5% (experimental group 91.7%, control group 91.3%).
  • Emotional functioning was discussed more in the experimental group. Doctors' statements averaged 1.5 versus 0.9 per patient (p = 0.018). Doctors' and patients' statements together averaged 3.9 versus 2.4 (p = 0.015).
  • The sum of function-related statements was higher in the experimental group: 3.7 versus 2.9 by doctors (p = 0.049) and 9.2 versus 6.9 by doctors or patients (p = 0.0096).
  • Medical/technical statements were more frequent in the control group: 21.0 versus 19.3 by doctors (p = 0.033) and 34.3 versus 31.6 by doctors or patients (p = 0.05).
  • Statements about specific symptoms (pain, dyspnea, fatigue, anorexia) were somewhat more frequent in the experimental group, but the differences were not statistically significant.
  • Interventions directed at emotional concerns averaged 0.43 versus 0.15 per patient (p = 0.0036). Interventions directed at social concerns averaged 1.17 versus 0.74 (p = 0.013). Both were higher in the experimental group.
  • Interventions directed at dyspnea were more frequent in the experimental group (mean 1.08 versus 0.53, p = 0.017).
  • The recorded doctor–patient conversations were of similar length in the two groups (median 20 versus 22 minutes, p = 0.77).
  • There were no group differences in how quality-of-life measures changed over time (data not shown).
• The authors' conclusion: The authors concluded that incorporating a standard HRQL instrument in clinical practice is feasible and may enhance attention to psychosocial issues and symptom control.
• Limitations the authors state:
  • Physicians' training in interpreting HRQL measures was limited, and the authors did not record how far the presented HRQL data were actually used in consultations.
  • Many physicians took part, and the number of patients each saw varied considerably, which may have made interpretation difficult for doctors who saw few patients.
  • Both groups completed the questionnaires, which probably drew attention to HRQL in all patients and may have diluted the group differences.
  • The study was open (not blinded), so doctors given reports may have been prompted to discuss HRQL regardless of the report details.
  • HRQL outcome data are not reported, because the questionnaire was used as the intervention tool rather than as an outcome measure.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Quality of Life, Lung Cancer, Mesothelioma.

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