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Detmar SB, Muller MJ, Schornagel JH, Wever LDV, Aaronson NK. Health-Related Quality-of-Life Assessments and Patient-Physician Communication: A Randomized Controlled Trial. JAMA. 2002;288(23):3027–3034. doi:10.1001/jama.288.23.3027
Author Affiliations: Division of Psychosocial Research and Epidemiology (Drs Detmar and Aaronson, Mr Muller, and Ms Wever) and Department of Medical Oncology (Dr Schornagel), the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam.
The Patient-Physician Relationship Section Editor: Richard M. Glass, MD, Deputy Editor.
Context There has been increasing interest in the use of health-related quality-of-life
(HRQL) assessments in daily clinical practice, yet few empirical studies have
been conducted to evaluate the usefulness of such assessments.
Objective To evaluate the efficacy of standardized HRQL assessments in facilitating
patient-physician communication and increasing physicians' awareness of their
patients' HRQL-related problems.
Design Prospective, randomized crossover trial.
Setting Outpatient clinic of a cancer hospital in the Netherlands.
Participants Ten physicians and 214 patients (76% women; mean age, 57 years) undergoing
palliative chemotherapy who were invited to participate between June 1996
and June 1998.
Intervention At 3 successive outpatient visits, patients completed an HRQL questionnaire
(European Organization for Research and Treatment of Cancer Quality of Life
Questionnaire-Core 30). The responses were computer scored and transformed
into a graphic summary. Physicians and patients received a copy of the summary
before the consultation.
Main Outcome Measures Audiotapes of the consultations were content analyzed to evaluate patient-physician
communication. Physicians' awareness of their patients' health problems was
assessed by comparing physicians' and patients' ratings on the Dartmouth Primary
Care Cooperative Information Functional Health Assessment (COOP) and the World
Organisation Project of National Colleges and Academics (WONCA) charts.
Results The HRQL-related issues were discussed significantly more frequently
in the intervention than in the control group (mean [SD] communication composite
scores: 4.5 [2.3] vs 3.7 [1.9], respectively (P =
.01). Physicians in the intervention group identified a greater percentage
of patients with moderate-to-severe health problems in several HRQL domains
than did those in the control group. All physicians and 87% of the patients
believed that the intervention facilitated communication and expressed interest
in its continued use.
Conclusion Incorporating standardized HRQL assessments in daily clinical oncology
practice facilitates the discussion of HRQL issues and can heighten physicians'
awareness of their patients' HRQL.
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