Purpose
We evaluated the utility of the implementation science framework “Integrated Promoting Action on Research Implementation in Health Services” (i-PARIHS) for introducing patient-reported ...outcome measures (PROMs) into a medical oncology outpatient department. The i-PARIHS framework identifies four core constructs for implementation, including Facilitation, Innovation, Context and Recipients.
Methods
A pilot study used the i-PARIHS framework to identify PROM implementation barriers and enablers to inform facilitation support strategies, such as training clinicians and staff, workflow support, technical support and audit and feedback. Pre- and post-implementation surveys were completed by 83 and 72 staff, respectively, (nurses, doctors and allied health), to assess perceived knowledge, enablers, barriers and utility of PROMs; and acceptability of the PROM intervention was also assessed post-implementation.
Results
Important barriers included time constraints and previous experiences with technology. Enablers included good leadership support and a culture of learning. Facilitation strategies were used to overcome barriers identified in the i-PARIHS core domains. Compared to before the intervention, staff surveys showed improvement in perceived usefulness, perceived understanding and interpretation skills for PROMs. Staff perceptions about lack of time to use PROMs during visits remained a major perceived barrier post-implementation.
Conclusion
The i-PARIHS framework was useful for guiding the implementation of PROMs in routine oncology care. The four core i-PARIHS constructs (Facilitation, Innovation, Context and Recipients) identified factors that directly impacted implementation, with Facilitation having a particularly important role to overcome these barriers. Oncology clinics and health systems considering implementing PROMs should consider having a dedicated Facilitator available during PROM implementation.
Background: In SURMOUNT-1, a phase 3, 72-week, randomized, double-blind clinical trial in participants with obesity or overweight with weight-related comorbidities, tirzepatide (TZP), a novel GIP and ...GLP-1 receptor agonist, resulted in significantly greater weight reduction than placebo. This post-hoc analysis assessed whether weight reduction was associated with patient-reported outcomes (PRO) improvements in participants treated with TZP 5,10,15 mg. Methods: SF-36v2, IWQOL-Lite-CT, and EQ-5D-5L are generic and obesity-specific health-related quality of life questionnaires and were collected at baseline and endpoint of the primary treatment period (week 72 or early discontinuation) from patients treated with TZP in the SURMOUNT-1 trial. Higher scores indicate better outcome. Participants with baseline and at least one post-baseline value were included in the analysis. Mean change in PRO scores from baseline to endpoint were summarized by weight reduction targets (>5%, >10%, >15%, >20%, >25%). Results: At endpoint, participants with weight reduction showed improvements from baseline in all domains of SF-36v2 including Physical Functioning (Norm-Based) (>5%, 4.06; >10%, 4.31; >15%, 4.66; >20%, 4.80; >25%, 4.82) and Mental Health (Norm-Based) (>5%, 0.95; >10%, 0.98; >15%, 1.06; >20%, 1.25; >25%, 1.18) domains. Grouped by weight reduction targets, participants who achieved the most weight reduction showed greater improvements from baseline in IWQOL-Lite-CT total score (>5%, 21.16; >10%, 22.38; >15%, 23.93; >20%, 25.86; >25%, 27.54), and both physical and psychosocial composite scores. Participants meeting greater weight reduction targets showed greater improvements from baseline in EQ-5D-5L VAS score (>5%, 8.13; >10%, 8.79; >15%, 9.62; >20%, 9.86; >25%, 10.66). Conclusions: Weight reduction was associated with improvement in all domains of health-related quality of life, including physical function and mental health. Participants who lost the most weight showed the greatest quality of life improvements.
Background: Interventions for managing pediatric obesity can have a positive effect on patient/parent reported outcome measures (PROMs), including health-related quality of life, anxiety, and ...depression. To optimize data presentation and interpretation, the GRADE approach to developing systematic reviews and practice guidelines includes establishing minimal important difference (MID) estimates that represent a small but important difference for PROMs. The purpose of this narrative review was to identify MID estimates for PROMs used in interventions for managing pediatric obesity. Methods: We searched PubMed (1989 to Jan 2023) to identify available MID estimates for the PROMs reported in three systematic reviews on behavioral, pharmacological and surgical interventions to inform the Canadian guidelines for managing pediatric obesity. PROMs included measures of quality of life depression, and anxiety. We searched for both anchor or distribution-based MID estimates using search terms for MID and each of the PROMs reported in our reviews. If no MID estimates were found for PROMs, we calculated the MID using a distribution-based approach (i.e., calculated as onehalf the standard deviation SD from representative or normative sample data). Results: We included 18 PROMs across our three reviews. All MID estimates were distribution-based, using approaches that included standard error of measurement (SEM) and one-half the baseline SD. MIDs were identified for several measures, including the Pediatrics Quality of Life (4.36), Impact of Weight on Quality of Life (4.8), Short Form-36 (11), and State-Trait Anxiety Inventory (10). We also calculated MIDs for other PROMs related to depression (e.g., Children's Depression Inventory: 3.57) and anxiety (e.g., Multidimensional Anxiety Scale for Children: 7.9). Conclusions: MIDs for PROMs will help determine intervention effectiveness for guideline development and improve patients', parents' and clinicians' understanding of PROM data.
Background: Experienced weight stigma (EWS) is common in people with obesity and can impact health outcomes, mental health and quality of life. There is a paucity of published data on the prevalence ...of EWS in metabolic and bariatric surgery (MBS) patients compared to patients who have not completed MBS. Methods: This cross-sectional study analyzed survey data on demographics, MBS status, and social/self-perceptions collected from an academic center's obesity medicine program. The Stigmatizing Situations Inventory (SSI-B, range 0-90; 0 = never, 1-40 = mild-moderate; >40 = severe) categorized EWS. Chi-square tests explored the distribution of EWS by MBS status and logistic regression assessed the association of EWS and MBS status adjusting for key demographics. Results: The analysis included 811 participants with mean age 56.2 (SD 12.5) years, 90.5% female, 52.3% non-Hispanic White, 28.0% non-Hispanic Black, 14.2% Hispanic, 5.5% other race, and 36.3% completed MBS. MBS completers had a higher mean BMI versus NS (nonsurgery) participants (35.9 SD 9.9 33.8 SD 9.4, respectively p = 0.003). NS participants had lower median SSI-B scores vs. MBS completers (5.0 IQR 1.0-15.0 vs. 18 IQR 5.0-34.0, respectively, p < 0.001) and 24.0% of NS vs 15.0% of MBS participants reported no history of EWS (p = 0.002). Mild-moderate EWS was reported by 71.4% of NS versus 66.3% of MBS participants. Severe EWS was reported by 4.64% of NS versus 18.71% of MBS participants (p < 0.001). MBS patients were almost twice (aOR: 1.93; 95% Cl: 1.30-2.86; p = 0.001) as likely to report EWS compared to NS patients, adjusted for BMI, age, sex, and education level. Conclusions: Patients who completed MBS were almost twice as likely to report EWS compared with non-MBS patients. Obesity care programs should consider screening for EWS in patients being evaluated for MBS or those who have completed MBS. This can identify patients who may benefit from additional interventions and support that address EWS and to optimize health outcomes and quality of life.
Participation in regular physical activity improves quality of life and well-being in many, including older adults and adults.
Abstract
Maintaining or improving quality of life (QoL) and well-being ...is a universal goal across the lifespan. Being physically active has been suggested as one way to enhance QoL and well-being. In this systematic review, conducted in part for the 2018 U.S. Health and Human Services Physical Activity Guidelines for Americans Scientific Advisory Committee Report, we examined the relationship between physical activity (PA) and QoL and well-being experienced by the general population across the lifespan and by persons with psychiatric and neurologic conditions. Systematic reviews, meta-analyses, and pooled analyses from 2006 to 2018 were used for the evidence base. Strong evidence (predominantly from randomized controlled trials RCTs) demonstrated that, for adults aged 18–65 years and older adults (primarily 65 years and older), PA improves QoL and well-being when compared with minimal or no-treatment controls. Moderate evidence indicated that PA improves QoL and well-being in individuals with schizophrenia and Parkinson’s disease, and limited evidence indicated that PA improves QoL and well-being for youth and for adults with major clinical depression or bipolar disorder. Insufficient evidence existed for individuals with dementia because of a small number of studies with mixed results. Future high-quality research designs should include RCTs involving longer interventions testing different modes and intensities of PA in diverse populations of healthy people and individuals with cognitive (e.g., dementia) and mental health conditions (e.g., schizophrenia) to precisely characterize the effects of different forms of PA on aspects of QoL and well-being.
To evaluate the quality of life in patients treated for locally advanced laryngeal cancer with surgery, radiation therapy or both
A retrospective study conducted at the radiation therapy department ...of Mohamed 6 University Hospital of Tangier. This study included patients treated for non-metastatic laryngeal cancer between April 2017 and April 2023, who received radiation therapy during their course of treatment. Treatment modalities included either surgery followed by radiotherapy or laryngeal preservation (LP) strategy by concomitant chemoradiotherapy (CRT) or induction chemotherapy (IC) followed by CRT. Clinical data, treatment and follow-up results were gathered using the digitalized hospital network. All patients answered the EORTC QLQ H&N 35 questionnaire for quality of life in its approved Arabic version.
40 patients were included in the study. Mean age was 62 +/- 12 years old. 50% of the patients had a stage IVA disease and 30% had a stage III cancer. Radiation therapy was administered in adjuvant setting for 75% of the patients. Amongst patients treated with surgery + radiotherapy, 50% had a stage IV disease.
Regarding dysphonia, 80% of patients considered they had a poor quality of voice. 45% of the patients found difficulties communicating with others. 66.7% of them described these difficulties as severe. In the LP group, 3 patients reported severe difficulties and they were all treated for a stage IVA disease: the choice of treatment modality was due to patients’ refusal of surgery for 2 of them. Voice restoration surgery was performed for 3 patients.
Pain issues were reported by 3 patients and nearly half of patients (45%) had dysphagia: 13 of them had surgery and 5 were treated following a LP strategy. A feeling of an abnormal rate of mucus secretion was found in 11.5% of the patients. Regarding sensory disorders (taste and odor), there was 1 case of dysgueusia reported: the patient was treated with IC + CRT.
Sexual life was worsened in 12.5% of patients (4 men and a woman), all of whom had a definitive tracheostomy. Issues reported were dyserection, lack of libido and a poorer quality of physical relations.
Quality of life is an important factor to consider in the choice of treatment setting, which has to be done according to the stage and international guidelines. Our study found that quality of voice is the main altered function after treatment according to patients, even when they have recovered their voice. Same results were found in the literature. Despite the mutilating treatment and the toxicity of irradiation, and as shown in the study, a decent quality of life can still be obtained for our patients, thus avoiding a poorer outcome of the cancer. Research in laryngeal cancer these days tends towards the improvement of quality of life without compromising survival results.
Purpose
To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL) and overall health status among Black, Latino, and White youth during adolescence; (2) whether socioeconomic ...status (SES) and family contextual variables influence disparities; and (3) whether disparities are consistent from pre- to early- to mid-adolescence.
Methods
A population sample of 4823 Black (1755), Latino (1812), and White (1256) youth in three US metropolitan areas was prospectively assessed in a longitudinal survey conducted on three occasions, in 5th, 7th, and 10th grades, when youth reported their HRQOL using the PedsQL™ short-form Total, Physical and Psychosocial scales and youth and parents separately reported on youth’s overall health status. Parents reported their education and household income to index SES, family structure, and use of English at home.
Results
Based on analysis conducted separately at each grade, marked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring White and disfavoring Black, and especially Latino youth. More strongly present in 5th and 7th grade, HRQOL disparities decreased by 10th grade. Most disparities between White and Black youth disappeared when adjusting for SES. However, even after adjusting for SES, family structure, and English use, overall health status disparities disfavoring Latino youth remained across all three assessments.
Conclusions
Racial/ethnic disparities in adolescent HRQOL and health are substantial. These disparities appear consistent from pre- to early-adolescence but diminish for HRQOL by mid-adolescence. As disparities appear influenced by SES and other family contextual variables differently in different racial/ethnic groups, efforts to reduce health disparities in youth should address culturally specific conditions impinging on health.
Traditionally seen as a sudden, brutal event with short-term impairment, traumatic brain injury (TBI) may cause persistent, sometimes life-long, consequences. While mortality after TBI has been ...reduced, a high proportion of severe TBI survivors require prolonged rehabilitation and may suffer long-term physical, cognitive, and psychological disorders. Additionally, chronic consequences have been identified not only after severe TBI but also in a proportion of cases previously classified as moderate or mild. This burden affects the daily life of survivors and their families; it also has relevant social and economic costs.Outcome evaluation is difficult for several reasons: co-existing extra-cranial injuries (spinal cord damage, for instance) may affect independence and quality of life outside the pure TBI effects; scales may not capture subtle, but important, changes; co-operation from patients may be impossible in the most severe cases. Several instruments have been developed for capturing specific aspects, from generic health status to specific cognitive functions. Even simple instruments, however, have demonstrated variable inter-rater agreement.The possible links between structural traumatic brain damage and functional impairment have been explored both experimentally and in the clinical setting with advanced neuro-imaging techniques. We briefly report on some fundamental findings, which may also offer potential targets for future therapies.Better understanding of damage mechanisms and new approaches to neuroprotection-restoration may offer better outcomes for the millions of survivors of TBI.
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