Evaluation: Discovering what works Jana Witt oacc@kcl.ac.uk or - - PowerPoint PPT Presentation

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Evaluation: Discovering what works

Jana Witt

• acc@kcl.ac.uk or jana.witt@kcl.ac.uk

27 June 2014

• A number of studies have investigated the

effects of measuring outcomes on processes and outcomes of care

• A recent systematic review at the CSI collated

the existing evidence of the effects of feedback of outcomes data on processes and

• utcomes of palliative care

The evidence to date

Effects on processes of care

Feedback allows more comprehensive identification of symptoms in palliative care populations (moderate evidence)

Etkind S, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, Murtagh FEM. Patient-centred outcome measures in palliative care improve professional awareness of unmet needs and benefit patients' emotional and psychological outcomes: a systematic

• review. Journal of Pain and Symptom Management 2014 [Under Review]

Effects on processes of care

Feedback allows more comprehensive identification of symptoms in palliative care populations (moderate evidence) Feedback facilitates discussion of HRQOL, and increases congruence of patient and professional health- related quality of life ratings (strong evidence)

Etkind S, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, Murtagh FEM. Patient-centred outcome measures in palliative care improve professional awareness of unmet needs and benefit patients' emotional and psychological outcomes: a systematic

• review. Journal of Pain and Symptom Management 2014 [Under Review]

Effects on processes of care

Feedback allows more comprehensive identification of symptoms in palliative care populations (moderate evidence) Feedback facilitates discussion of HRQOL, and increases congruence of patient and professional health- related quality of life ratings (strong evidence)

Etkind S, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, Murtagh FEM. Patient-centred outcome measures in palliative care improve professional awareness of unmet needs and benefit patients' emotional and psychological outcomes: a systematic

• review. Journal of Pain and Symptom Management 2014 [Under Review]

Effects on outcomes of care

Feedback does not lead to improvements in health-related quality of life (strong evidence)

Etkind S, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, Murtagh FEM. Patient-centred outcome measures in palliative care improve professional awareness of unmet needs and benefit patients' emotional and psychological outcomes: a systematic

• review. Journal of Pain and Symptom Management 2014 [Under Review]

Effects on outcomes of care

Feedback does not lead to improvements in health-related quality of life (strong evidence) Feedback does not lead to improvements in symptom burden (low to moderate quality evidence)

Etkind S, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, Murtagh FEM. Patient-centred outcome measures in palliative care improve professional awareness of unmet needs and benefit patients' emotional and psychological outcomes: a systematic

• review. Journal of Pain and Symptom Management 2014 [Under Review]

Effects on outcomes of care

Feedback does not lead to improvements in health-related quality of life (strong evidence) Feedback does not lead to improvements in symptom burden (low to moderate quality evidence) Feedback has a positive effect on patients’ mental health and distress (moderate evidence)

Etkind S, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, Murtagh FEM. Patient-centred outcome measures in palliative care improve professional awareness of unmet needs and benefit patients' emotional and psychological outcomes: a systematic

• review. Journal of Pain and Symptom Management 2014 [Under Review]

Effects on outcomes of care

Feedback does not lead to improvements in health-related quality of life (strong evidence) Feedback does not lead to improvements in symptom burden (low to moderate quality evidence) Feedback has a positive effect on patients’ mental health and distress (moderate evidence) Feedback has a positive effect on caregiver distress (low quality evidence)

Etkind S, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, Murtagh FEM. Patient-centred outcome measures in palliative care improve professional awareness of unmet needs and benefit patients' emotional and psychological outcomes: a systematic

• review. Journal of Pain and Symptom Management 2014 [Under Review]

Improved patient (and possibly caregiver) emotional and psychological health-related quality of life No benefit to physical or overall health-related quality of life

Patients with unaddressed needs

Outcome data allows: 1. Improved patient-professional discussion of health-related quality of life 2. Increased congruence between patient and clinician quality of life scoring Outcome data allows: 1. More comprehensive sharing of symptoms 2. Earlier identification of symptoms 3. Greater awareness of symptoms rated severe By improving identification of need, these data allow professionals to take more actions to address needs

• Although there is some evidence of effects, it is not

understood how such effects come about

• Although there is good quality evidence of effects on

processes of care, there is only lower quality evidence on effects on outcomes of care

• Most of the evidence to date comes from oncology
• utpatient settings

The gaps

• Two research strands are planned to run alongside

the OACC implementation project: Qualitative work with stakeholders to explore how

• utcome measures do or don’t work

Feasibility study to assess whether a larger scale trial on implementing outcome measures into practice would work

Evaluation within OACC

• Further study of effectiveness (phase III trial) to

address gaps in the evidence

• Further study focused on use of outcome measures

with under-researched populations (including those with non-cancer diagnoses, those who cannot speak English etc.)

Future evaluation and research