The relationship between patient-reported experience and patient-reported outcomes in patients with cancer.
Authors: Hassett Michael J. , Cronin Christine Marie , Cronin Angel , Uno Hajime , Paudel Roshan , Osarogiagbon Raymond U. , Wong Sandra L. , Dizon Don S. , Bian Jessica J. , Hazard-Jenkins Hannah W. , Brooks Gabriel A. , Schrag Deb 
Published: September 2024

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Background:
Measures of patient experience (PEX) and patient-reported outcomes (PRO) are used by health systems across the US to improve care delivery and quality of life, respectively. Despite their widespread use, little is known regarding the relationship between these two types of patient-generated data. From 2018 to 2023, we conducted a pragmatic type-II hybrid effectiveness/implementation study of an electronic health record (EHR)-embedded symptom management program (eSyM) across six diverse cancer centers. This project focused on patients who started chemotherapy (CHEMO) or had surgery (SURG) for a suspected or confirmed gastrointestinal, gynecologic, or thoracic malignancy.
Methods:
We conducted a cross-sectional study of adults who were eligible for either the control or intervention arm of the eSyM study to determine if patients who reported having an inferior care-team experience were more likely to report having worse symptoms. Participants completed a one-time survey via REDCap that included elements from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and the Patient-Reported Outcomes Measurement Information System (PROMIS). Analyses determined the extent to which PEX measures were associated with PRO measures by evaluating differences in mean PROMIS scores for those who rated their PEX highly vs. not highly.
Results:
In total, 1419 respondents reported having cancer for which they received care at a participating center: median age 66, 63% female, 5% black, 13% disabled, 66% married/partnered, 23% high school or less education, 22% somewhat-extreme difficulty paying bills. For both CHEMO and SURG patients, 82% rated their overall cancer care-team experience highly (top box score of 9-10). Compared to patients who did not rate their care-team experience highly, those who did reported better scores for depression, fatigue, anxiety, pain interference, physical function, and self-efficacy (Table). PROMIS values differed for other CAHPS measures too.
Conclusions:
Among patients receiving routine cancer care, there was a significant association between PEX and multiple PROs. Further investigation of the nature and strength of the association between PEX and PRO measures is warranted. If confirmed, this association could lead to the development of interventions that impact both patient satisfaction and quality of life.

Clinical trial information:
NCT03850912

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Mean difference in PROMIS scores for patients who rated their care-team experience highly versus not highly (P from two-sample T-test).

CHEMO (N=889)
SURG (N=530)

Mean Diff
95%CI

P
value

Mean Diff
95%CI

P
value

Depression
-2.7
-4.3, -1.1
0.001
-3.3
-5.3, -1.4
<0.001

Anxiety
-3.7
-5.4, -1.9
<0.001
-3.6
-5.7, -1.5
<0.001

Fatigue
-2.3
-4.0, -0.5
0.011
-4.5
-6.8, -2.2
<0.001

Pain interference
-3.6
-5.3, -1.9
<0.001
-4.7
-6.7, -2.7
<0.001

Physical function
1.6
0.1, 3.1
0.042
3.5
1.4, 5.6
0.001

Self-efficacy
3.9
2.6, 5.2
<0.001
6.4
4.6, 8.1
<0.001