‘PRO-cision Medicine’ approach helps personalize care for patients with cancer

Reviewed by James Ives, M.Psych. (Editor)Apr 17 2019

Patient-reported outcomes (PROs) are an important target for efforts to improve healthcare - focusing on the most important problems and outcomes identified by patients themselves. A special supplement to Medical Care presents a toolkit of methods to help personalize care for patients with cancer using a 'PRO-cision Medicine' approach. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Patients are increasingly being asked to complete standardized, validated questionnaires with regard to their symptoms, functioning, and well-being as part of routine care," writes Claire Snyder, PhD, of Johns Hopkins School of Medicine and Kimmel Cancer Center, Baltimore. "These PROs can be used to inform patients' care and management, which we refer to as 'PRO-cision Medicine.'" Dr. Snyder's coauthors are Albert Wu, MD, MPH, and Yonaira Rivera, MPH, also of Johns Hopkins; and Michael Brundage, MD, MSc, of Queen's Cancer Research Institute, Kingston, Ont., Canada.

Methods for Interpreting and Acting on PROs to Improve Cancer Care

For example, in patients with cancer, PRO questionnaires can provide useful information on how the patient is feeling and managing daily activities. That's an important addition, and potentially more meaningful to patients than traditional clinician-assessed outcomes like response and tumor markers. "The use of PROs in clinical practice has the potential to promote patient-centered, personalized care," according to the Guest Editors.

But healthcare providers face challenges in translating PRO responses into meaningful improvements in care. The Guest Editors invited contributions from experts with experience developing effective PRO-cision Medicine approaches. "Together, the 14 papers in this supplement provide a range of options or 'tools' that clinicians and researchers can apply to the use of PROs in clinical practice," Dr. Snyder and coauthors write.

Six papers focus on approaches to interpreting PROs. Some experts report on tools to determine how PRO ratings reflect changes in symptoms or functional status, and how this information can be used to monitor clinical progress and inform decision-making. The papers include discussions of "feedback" approaches applying PRO data to patient groups or populations, as well as "feedforward" approaches providing the patients' perspective to their clinical team.

Eight papers describe methods of acting on PROs to guide clinical care. Several papers describe emerging technologies enabling patients and professionals to access and view PRO results. In cancer care, PRO-cision Medicine provides a valuable approach to monitoring the patient's disease and response to treatment, including changes in symptoms or other scores for which action is needed.

Researchers are also exploring ways of engaging patients and clinicians with symptom reports to promote the use of PROs in clinical practice. "Patients value routine PRO data collection more highly when their clinicians actually use the data to inform their care," the Guest Editors write.

Dr. Snyder and colleagues hope that the expertise and experience shared in the special issue will help to encourage and refine the use of the PRO-cision Medicine approaches for patients with cancer and other conditions. They conclude, "[T]his 'Methods Toolkit' can inform clinicians and researchers aiming to implement routine PRO reporting into clinical practice by providing methodological fundamentals and real-world examples to promote personalized patient care."