Role of patient-reported symptoms and functioning in the care of patients with metastatic colorectal cancer

Introduction:
Regular assessment of patients’ health related quality of life (HRQoL) with feedback to clinicians can play an important role in patient-doctor communication, problem detection and monitoring. Many cancer specific HRQoL instruments are available but their clinical utility in routine practice has not been systematically evaluated. The aim was to develop a HRQoL questionnaire for patients with advanced colorectal cancer (CRC) for use in routine practice and to explore ways to increase its’ clinical utility.

Methods and results:
A comprehensive development strategy was used to create CRC specific questionnaire for clinical practice. The strategy involved exploration of issues discussed in consultations of 17 CRC patients (68 consultations), review of literature, interviews with 7 oncologists and 10 patients, validation of the questionnaire in a sample of 155 CRC patients and validation in 448 patients as part of a wider study. A 55 item questionnaire, QuEST-Cr was created. Exploratory work was performed to examine the longitudinal impact of patient reported HRQoL collection with feedback using data from 198 patients’ oncology consultations over 4 consecutive visits. Impact of intervention on consultation content and communication preferences of patients and doctors were examined. Findings highlight lack of discussions about psychosocial issues even when patients reported poor functioning. Repeated assessment helped to maintain discussions of patients’ symptoms over time but not psychosocial issues.
Training oncologists was considered a way of increasing the impact of patient reported HRQoL intervention. Review of literature identified barriers that needed to overcome. Conceptual models of adult learning guided the choice of teaching methods. Development of trigger DVDs provided valuable experiential learning opportunity.

Conclusion:
I developed and evaluated an instrument for screening and identifying the needs of CRC patients in routine clinical practice. I developed a training programme for oncologists which may help increase the clinical utility of patient reported HRQoL data.