Project Summary
Background: Symptoms account for half of all outpatient encounters in the United States, or more than 400 million clinic visits annually. In contrast to specific diseases, however, symptoms have received far less attention in research, training, and, consequently, patient care. Five symptoms that warrant special attention are the SPADE pentad (sleep problems, pain, anxiety, depression, and energy/fatigue). These symptoms are among the most prevalent, chronic, disabling, and undertreated symptoms in clinical practice, and they occur frequently in most medical and mental disorders. The SPADE pentad accounts for five of the seven areas assessed in the Patient-Reported Outcomes Measurement Information System (PROMIS) profile scales.
Objectives: The study’s objectives are to:
- Find out if providing PROMIS symptom scores to physicians improves the treatment of patients’ symptoms, and if so, the degree to which symptoms improve
- Find out from both patients and physicians the best way to use PROMIS symptom scores in improving care
- Compare PROMIS symptom scores to other scales used for measuring patient symptoms
Methods: The study design will be a clinical trial involving 300 primary care patients who suffer from one or more of the five symptoms in the SPADE pentad. Participants will complete, prior to seeing their physician, the PROMIS-29 profile. Patients will then be randomly assigned to an intervention or control group. For patients in the intervention group, their physician will be given the PROMIS scores for the five symptoms. Control patients will complete the same pre-visit questionnaires but their physicians will not receive the PROMIS scores. All patients will be assessed three months later by a telephone interviewer who will re-administer the PROMIS-29 profile as well as ask questions about symptom-specific residual concerns and satisfaction. Also, 30–45 patients and 10–15 physicians will have more detailed interviews to find out the best way to use PROMIS scores to improve care for symptoms.
Anticipated Impact: We will learn, from both the patient and physician viewpoints, the usefulness of assessing symptoms with PROMIS measures and how to optimize the value of these symptom assessments. We will also determine whether a numerical or visual display of scores is optimal. Because the symptoms being evaluated in the PROMIS profile are common in most diseases, the study findings can improve care for patients seeing specialists as well primary care clinicians.
Project Details
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