Dr Lola Fayanju Shares How Providers Can Leverage PROs to Improve Breast Cancer Care

Utilizing patient-reported outcomes to improve breast cancer care requires detailed consideration to the transportation, financial, and clinical concerns of patients in order to be effective, according to Oluwadamilola "Lola" Fayanju, MD, MA, MPHS, FACS, chief of breast surgery and a Helen O. Dickens presidential associate professor at Penn Medicine.

Transcript

How can patient-reported outcomes be used to improve the quality of clinical care for patients with breast cancer?

Patient-reported outcomes allow for patients to communicate how they're feeling both physically as well as psychologically without interpretation by physicians. By helping them provide information on their baseline function as well as potentially postintervention goals, it allows them to work with physicians in improving shared decision-making with regards to what they want their treatment to be, as well as, ideally, what success looks like for them in their treatment.

What types of patient-reported outcomes should providers make a greater effort to include when treating patients?

Patient-reported outcomes that are important to patients are going to have a range of types of domains—that is, different aspects of their psychosocial, physical, as well as existential well-being.

So, they can include things like how they're feeling in terms of fatigue, pain, or function with regards to a particular part of their body. They can also be related to the social milieu in which they are consuming treatment. So, are they having difficulty with housing or transportation? Or the ability to have childcare when they're going for their appointments? They can also be related to their overall quality of life.

And so, there are many different domains in which patient-reported outcomes can be reported. It's important for doctors to think about all of those things when understanding the whole patient and offering them the type of treatment they need for the cancer they have.

What model is most effective at helping providers take patients’ reports into account? A 5-point Likert scale, an open-ended model, or does it depend?

It depends on the particular validated instrument that's being used to collect the patient-reported outcomes. So, the type of patient-reported outcome measure you use, which is the instrument that's used to translate the subjective responses and subjective data, depends on the population you're working with and the types of questions you want answered. Some of them are open-ended. Some of them have Likert scales. Some have other types of ranges and scales.

What are some initiatives that providers can participate in to increase accessibility of breast cancer therapies and services?

Sure, we actually have a qualitative paper that's about to be published, where we interviewed both patients and providers with regards to what they perceive to be modifiable facilitators as well as barriers to receipt of guideline-concordant care for breast cancer.

Some of the things that patients found were helpful were having different ways for providers to communicate information as well as different opportunities. So, not just in the initial encounter, but also afterwards, making it very clear how patients can get back in touch with their providers. And also, making it clear who is who on the provider team. While it may be obvious to us who the surgeon is, who the medical oncologist is, who the nurse is, who the advanced practice provider is, those roles are not clearly limited to our patients and they're not always sure to whom they should turn for particular types of information. So, making it really clear for our patients who's the right contact person for which part of care for which types of information and what's the best way to get in touch with those individuals.

Other things that patients said were really helpful were being able to bring their family members into conversations, which is always something that was very difficult during the COVID-19 pandemic. But I think, to the extent that it's possible, really encouraging patients to bring their support system into the conversations that we have.

Another important thing that was brought up and raised by patients as they felt there was inadequate discussion about the role that finances played in their receipt of care. Many of them felt that their physicians did not adequately address or bring up or seem comfortable talking about financial toxicity. And that when they did raise it, as when the patients raised it, the providers would simply refer them to the financial counselors at the hospital, but that it wasn't something that they seemed very comfortable talking about.

In contrast, our providers seem to think that they did not want to bring it up because they didn't want their patients to misperceive them as thinking that their financial situation would influence the kind of care they would deliver.

And so, it was a disconnect we noticed between patients and providers where money was very much the elephant in the room. Everyone was thinking about it, but physicians didn't want to bring it up because they didn't want patients to misperceive them as judging them or treating them differently as a result of their finances, while patients actually really wished that providers would bring it up more often.

Other major barriers were frankly, parking was something that patients brought up as a real problem and something that would ideally be dealt with. And actually, providers mentioned it as well.

So, things that we can do to help our patients, one, make sure that they know how to get in touch with us and how to give them information in ways that they can understand. Making sure we include their families in the process. Doing whatever we can to work with our health systems to make it easy for us to get them to appointments with transportation and easy parking. And then, really listening to them and acknowledging their financial concerns and hopefully, developing a better understanding ourselves of the financial implications of the treatments that we recommend.