進行癌ケアにおける予後の理解

タイトル: Outcomes of prognostication in people living with advanced cancer: a qualitative study to inform a Core Outcome Set

概要: ObjectiveStudies of prognostication in advanced cancer use a wide range of outcomes and outcome measures, making it difficult to compare these studies and their findings. Core Outcome Sets facilitate comparability and standardisation between studies and would benefit future prognostic research. This qualitative study is the second step in developing such a Core Outcome Set, with the aim to explore the perceptions and experiences of patients with advanced cancer, informal caregivers, and clinicians regarding the potential outcomes of prognostication. MethodsA qualitative study using semi-structured interviews and framework analysis, informed by the Core Outcome Measures for Effectiveness Trials (COMET) taxonomy. We conducted semi-structured interviews with patients living with advanced cancer (n=8), informal caregivers (n=10), and clinicians (n=10) recruited from palliative care services across three sites in London, United Kingdom. Interviews were conducted in-person, via telephone, or video conferencing. ResultsWe identified 33 outcomes, 16 of which were not previously reported in the literature. We grouped outcomes into 10 domains, using a modified COMET taxonomy: 1) mortality/survival; 2) general physiological/clinical outcomes; 3) psychiatric outcomes; 4) spiritual/religious/existential functioning/wellbeing; 5) emotional functioning/wellbeing; 6) social functioning; 7) delivery of care; 8) perceived health status; 9) personal circumstances; 10) societal/carer burden. ConclusionsThis study offers valuable insights into outcomes significant to key stakeholders, underscoring the need for a patient-centred approach in research and clinical practice in prognostication in advanced cancer. These outcomes will play a key role in the development of a Core Outcome Set to assess the impact of prognostication in advanced cancer. What is already known on this topic?O_LIPrevious studies have developed and validated prognostic models in palliative care, but there has been a lack of research evaluating the impact of such models on clinically relevant outcomes. C_LIO_LIThe perspectives of patients, informal caregivers, and clinicians on prognostication in advanced cancer are under-explored. C_LIO_LIThe growing field of patient-reported outcome measurement indicates that the lived experiences of patients and informal caregivers provide valuable insights into care preferences, and how these align with or differ from current clinical practices. C_LI What this study addsO_LIThis study identified 33 outcomes of prognostication, of which 16 (48%) had not previously been included in existing literature. C_LIO_LIThe qualitative data presented are a valuable resource for a Core Outcome Set for assessing the impact of prognostication in advanced cancer. C_LI How this study might affect research, practice, or policyO_LIThe final Core Outcome Set will enable increased consistency between future studies evaluating the effects of different methods of prognostication on clinically relevant outcomes. C_LIO_LIFindings from future, more consistent and comparable, research studies will assist clinicians in deciding which methods of prognostication are preferable. C_LI