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Monitoring Quality of Life in the Clinic

Monitoring Quality of Life in the Clinic. Prof. dr. Jan van Busschbach Medical Psychology and Psychotherapy Erasmus MC. Quality of life measurement suggested for use in the clinic. Bradley J, 1999

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Monitoring Quality of Life in the Clinic

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  1. Monitoring Quality of Life in the Clinic Prof. dr. Jan van Busschbach Medical Psychology and Psychotherapy Erasmus MC

  2. Quality of life measurement suggested for use in the clinic • Bradley J, 1999 • The adaptations of a quality of life questionnaire for routine use in clinical practice: the Chronic Respiratory Disease Questionnaire in cystic fibrosis • Backman JW, 2003 • The patient-computer interview: a neglected tool that can aid the clinician. • Adam B, 2007 • Measuring social difficulties in routine patient-centred assessment: a Rasch analysis of the social difficulties inventory

  3. Congresses • Applications of health status assessment measures in clinical practice. • Med Care. 1992 May;30(5 Suppl):MS1-14 • ISOQOL Conference on Patient Reported Outcomes in Clinical Practice • June 24-26, 2007, Budapest, Hungary

  4. An everlasting lasting promise • Budapest Conference • Aaronson & Snyder. ISOQOL Newsletter July 2007 • Improves patient doctor communication • No clear influence on patient management • In fact... little research • Publication bias?

  5. What stops us? • Complex logistics • Does it fit the clinical setting et al? • Molla Donaldson • ….simply urging clinicians to use PROs would not achieve large-scale adoption and that the systems in which clinicians work must be considered • ISOQOL Newsletter July 2007 • Is there no success at all?

  6. Routine screening tools seem to be beneficial in pain

  7. Monitoring psychotherapy

  8. Results in psychotherapy

  9. Monitoring in Quality of Life • De Man, Darlington, Gutteling • Department of Gastroenterology and Hepatology • 162 patients with chronic liver disease • Computerised administration • SF-12 • Disease specific instrument • 11 physicians randomly assigned • Feedback, no feedback

  10. Real Time Feedback

  11. Patients No direct effect of feedback …on quality of life No difference in patient satifaction But with feedback Older patients with feedback held better scores Interaction effect on mental health and disease specific Male patients Interaction effect on mental health Physicians Altered treatment policy more often Were positive about feedback Results

  12. Limitation • Difficulty recruiting patients • 1850 patients invited • 1263 turned invitation down • Logistic complications • 244 did not show up at the computer (in time) • 146 only 1 administration • Subgroup results...

  13. Lessons learned • Logistics is everything! • RCT hampers clinical logistics • Replace by routine outcome monitor • But it might work… • Quality of Life • Treatment policy

  14. New investigation • Inflammatory bowel disease • Zuzana Zelinkova • Dr. Janneke van der Woude • Feedback on Quality of life • Inflammatory Bowel Disease Questionnaire (IBDQ]? • SF-36? • Or make disease specific questionnaire? • What is important for the patients? • Outcome • Influence on treatment policy • Patient doctor communication

  15. Conclusions • Feedback seems useful • From theory • From empirical evidence • Logistics are an obstacle • But somewhere out there is the future…

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