A cross-cultural convergent parallel mixed methods study of what makes a cancer-related symptom or functional health problem clinically important

Abstract

Objective

In this study we investigated what makes a symptom or functional impairment clinically important, that is, relevant for a patient to discuss with a health care professional (HCP). This is the first part of an EORTC Quality of Life Group project focusing on the development of thresholds for clinical importance for the EORTC QLQ-C30 questionnaire and its corresponding computer-adaptive version.

Methods

We conducted interviews with cancer patients and HCPs in six European countries. Participants were asked to name aspects of a symptom or problem that make it clinically important, and to provide importance ratings for a predefined set of aspects (e.g. need for help, limitations of daily functioning).

Results

We conducted interviews with 83 cancer patients (mean age: 60.3y; 50.6% men) and 67 HCPs. Participants related clinical importance to limitations of everyday life (patients: 65.1%, HCPs: 77.6%), the emotional impact of a symptom/problem (patients: 53.0%, HCPs 64.2%), and duration/frequency (patients: 51.8%, HCPs: 49.3%). In the patient sample, importance ratings were highest for worries by partner or family, limitations in everyday life and need for help from the medical staff. HCPs rated limitations in everyday life and need for help from the medical staff to be most important.

Conclusions

Limitations in everyday life, need for (medical) help, and emotional impact on the patient or family/partner were found to be relevant aspects of clinical importance. Based on these findings we will define anchor items for the development of thresholds for clinical importance for the EORTC measures in a Europe-wide field study.

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