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A Randomized Controlled Trial

Symone B. Detmar, PhD; Martin J. Muller, MSc; Jan H. Schornagel, MD, PhD; Lidwina D. V. Wever; Neil K. Aaronson, PhD

JAMA. 2002;288:3027-3034.

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.

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.

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