Patient-reported outcome measures in oncology: a qualitative study of the healthcare professional's perspective.

BACKGROUND: In the last decades, the number of cancer survivors has increased significantly due to improved treatment and better detection of recurrence. This increased survival redirects the scope from survival towards optimising functional outcomes and improving health-related quality of life (HRQol). Functional and HRQoL outcomes can be assessed with patient-reported outcome measures (PROMs). However, the use of PROMs in daily oncological care is not common. This qualitative study investigates the barriers and facilitators of PROM use in an oncological setting, from the perspective of the healthcare professionals (HCPs). METHODS: Individual semi-structured interviews were conducted among Dutch oncological HCPs. Barriers and facilitators of PROM implementation were identified on various levels of the healthcare system (i.e. level of the patient, individual professional, medical team, and healthcare organisation). Interviews were audio recorded and transcribed verbatim. Transcripts were manually analysed by two independent reviewers using a thematic approach. Identified barriers and facilitators were categorised into Grol and Wensing's framework for changing healthcare practice. RESULTS: Nineteen oncological HCPs working in academic and non-academic hospitals were interviewed. Barriers for PROM implementation were lack of good IT support, lack of knowledge on how to use PROMs, lack of time to complete and interpret PROMs, and a high administrative burden. PROM implementation can be facilitated by providing clear guidance regarding PROM interpretation, evidence that PROMs can save time, and stimulating multidisciplinary teamwork. CONCLUSION: From a HCP point of view, adequately functioning IT technology, sufficient knowledge on PROMs, and dedicated time during the consultation are essential for successful implementation of PROMs in oncological care. Additional local context-specific factors need to be thoroughly addressed.

[Bluish-gray discoloration of skin and conjunctiva]. / Blaugraue Verfärbung von Haut und Bindehaut.

Colloidal silver used as a suspension for (alternative) therapeutic purposes or silver exposure due to environmental or working conditions can lead to irreversible deposits of silver granules in the skin (bluish-gray hue of the skin), mucosa, cornea, retina and internal organs. Silver-induced discoloration of the conjunctiva should therefore be taken into account when a bluish-gray discoloration raises the suspicion of conjunctival melanoma.

Evaluation of contrast acuity and defocus curve in bifocal and monofocal intraocular lenses.

We compared visual quality of the following intraocular lenses in a prospective study: monofocal, True Vista bifocal, 3M diffractive bifocal, and Nordan aspheric VariFocal silicone. Four to six months postoperatively we measured distance acuity, Snellen near acuity (Lighthouse chart), reading acuity (Nieden chart), and contrast acuity at far and near focus (Regan charts: 96%, 50%, 25%, 11% contrast) with different pupil sizes. A defocus curve was obtained by spectacle defocus (+1 diopter [D] to -5 D). Eleven patients had True Vista in one eye and monofocal in the fellow. Contrast acuity at far focus decreased with decreasing contrast and increasing pupil size. This decrease was more pronounced with the True Vista than with the monofocal lenses. These differences were significant, with a 4.5 mm pupil at lower contrast (25%, P = .02; 11%, P = .01). Depth of focus was 4.5 D (+1.0 D to -2.0 D) with True Vista lenses and 2.5 D (+1.0 D to -1.5 D) with monofocal lenses. Corrected distance acuity was 20/22 with True Vista, 20/25 with 3M, and 20/20 with VariFocal. Distance corrected Snellen near acuity was 20/39 with True Vista, 20/34 with 3M, and 20/57 with VariFocal. Distance corrected reading acuity was 20/29 with True Vista, 20/23 with 3M, and 20/44 with VariFocal (P = .005). Contrast acuity at far focus was best with the VariFocal IOL, followed by True Vista and 3M. At near focus it was best with 3M, followed by True Vista and VariFocal. Contrast acuity at near focus was lower than at far focus. Average acuity differences were as follows: VariFocal 0.43, P = .01; True Vista 0.19, P = .05; 3M 0.04, P = .3. Depth of focus was 4.5 D (+1.0 D to -3.5 D) with True Vista and 3M and was 3 D (+1.0 D to -2.0 D) with VariFocal. Each design offers unique features. VariFocal is best at distance, but near vision is not sufficient. The 3M lens is best at near vision but distance contrast acuity is somewhat reduced. The True Vista lens provides a good compromise as distance contrast acuity is good and near vision is sufficient.

[Contrast sensitivity and defocus curve with various bifocal-IOL]. / Kontrastsehschärfe und Defokussierkurve mit verschiedenen Bifokal-IOLs.

Simultaneous vision, the basic principle of all bifocal intraocular lenses (IOLs), provides increased depth of focus but also causes a loss in contrast. We therefore measured contrast acuity (CA) (Regan Charts) and the defocus curve at different pupil sizes in 14 patients with a TRUE VISTA bifocal IOL (TV) (Storz Co.), 10 patients with a 3M diffractive bifocal IOL (3M) (3M Co.) and 9 patients with a Nordan Aspheric Varifocal Silicone IOL (VF) (Wright Medical Inc.). CA at distance focus was best with VF; next was TV, and 3M showed the lowest values. At near focus, CA was best with 3M; next was TV, and VF showed the lowest values. Differences between VF and 3M were significant (P = 0.05; t-test). CA at near focus was significantly lower than at distance focus with TV and VF (TV: P = 0.0001; VF: P = 0.005). Pseudoaccommodation was 4.5 D with TV and 3M and 3D with VF. In conclusion, distance CA was best with VF but pseudoaccommodation was not sufficient for reading. Near CA was best with 3M while distance CA was somewhat reduced. TV showed good distance CA while near CA was still sufficient. TV therefore seems to provide a good compromise.