title: Patients report improvements in continuity of care when quality of life assessments are used routinely in oncology practice: secondary outcomes of a randomised controlled trial.
abstract: OBJECTIVE
  In a randomised trial investigating the effects of regular use of health-related quality of life (HRQOL) in oncology practice, we previously reported an improvement in communication (objective analysis of recorded encounters) and patient well-being. The secondary aims of the trial were to measure any impact on patient satisfaction and patients' perspectives on continuity and coordination of their care.
  
  
  METHODS
  In a prospective trial involving 28 oncologists, 286 cancer patients were randomised to: (1) intervention arm: regular touch-screen completion of HRQOL with feedback to physicians; (2) attention-control arm: completion of HRQOL without feedback; and (3) control arm: no HRQOL assessment. Secondary outcomes were patients' experience of continuity of care (Medical Care Questionnaire, MCQ) including 'Communication', 'Coordination' and 'Preferences to see usual doctor' subscales, patients' satisfaction, and patients' and physicians' evaluation of the intervention. Analysis employed mixed-effects modelling, multiple regression and descriptive statistics.
  
  
  RESULTS
  Patients in the intervention arm rated their continuity of care as better than the control group for 'Communication' subscale (p=0.03). No significant effects were found for 'Coordination' or 'Preferences to see usual doctor'. Patients' evaluation of the intervention was positive. More patients in the intervention group rated the HRQOL assessment as useful compared to the attention-control group (86% versus 29%), and reported their doctors considered daily activities, emotions and quality of life.
  
  
  CONCLUSIONS
  Regular use of HRQOL measures in oncology practice brought changes to doctor-patient communication of sufficient magnitude and importance to be reported by patients. HRQOL data may improve care through facilitating rapport and building inter-personal relationships.
authors.affiliation: St James's Institute of Oncology, University of Leeds, Cancer Research UK Clinical Centre-Leeds, St James's University Hospital, Leeds, United Kingdom. g.velikova@leeds.ac.uk
authors.forename: Galina
authors.initials: G
authors.lastname: Velikova
authors.forename: Ada
authors.initials: A
authors.lastname: Keding
authors.forename: Clare
authors.initials: C
authors.lastname: Harley
authors.forename: Kim
authors.initials: K
authors.lastname: Cocks
authors.forename: Laura
authors.initials: L
authors.lastname: Booth
authors.forename: Adam B
authors.initials: AB
authors.lastname: Smith
authors.forename: Penny
authors.initials: P
authors.lastname: Wright
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Selby
authors.forename: Julia M
authors.initials: JM
authors.lastname: Brown
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000592:standards*; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D017060:Patient Satisfaction; D011788:Quality of Life; D011795:Surveys and Questionnaires