Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: main results of a cluster preference randomised controlled trial

Simon Rogers, Christine Allmark, Fazilet Bekiroglu, Rhiannon Tudor Edwards, Gillon Fabbroni, Robert Flavel, Victoria Highet, Michael W S Ho, Gerald M. Humphris, Terry M. Jones, Owais Khattak, Jeffrey Lancaster, Christopher Loh, Derek Lowe, Cher Lowies, Dominic Macareavey, James Moor, T. K. Ong, A Prasal, Nicholas RolandCherith Semple, Lllnos Haf Spenser, Sank Tandon, Steven J Thomas, Andrew Schache, Richard J. Shaw, Anastasios Kanatas

Research output: Contribution to journalArticlepeer-review

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Abstract

Purpose The patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss
issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics
for one year after treatment on health-related QOL (HRQOL).
Methods A pragmatic cluster preference randomised control trial with 15 consultants, 8 ‘using’ and 7 ‘not using’ the PCI
intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible.
Results Consultants saw a median (inter-quartile range) 16 (13–26) patients, with 140 PCI and 148 control patients. Of the
pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) socialemotional
subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full
adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary
outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (− 2.9%, 12.9%) but
without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant
level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected
decreased over time.
Conclusion This novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means
of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.
Original languageEnglish
Pages (from-to)3435-3449
Number of pages15
JournalEuropean Archives of Oto-Rhino-Laryngology
Volume278
Issue number9
Early online date21 Dec 2020
DOIs
Publication statusPublished - 1 Sep 2021

Keywords

  • Head and neck cancer
  • Patient concerns inventory
  • quality of life
  • patient-reported outcome
  • intervention
  • randomised trial

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