In Reply Dr Thombs and colleagues make 2 overarching points. The first is that a system of active PRO alert monitoring is tantamount to screening, and second, that in the specific case of depression, screening is unlikely to be of benefit and may cause harm.
They conclude that, in line with the principles of the Declaration of Helsinki,1 PRO alert monitoring should only be implemented when the potential benefits outweigh the potential harms and these potential harms are minimized. We agree with this conclusion. The purpose of our Viewpoint was to draw attention to this obligation in the context of PRO alerts and to open debate about how best to achieve this.
Calvert M, Draper H, Kyte D. Patient-Reported Outcome Alert Monitoring—Reply. JAMA. 2014;311(4):420-421. doi:10.1001/jama.2013.284330