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Development and Testing of the Patient-Reported Chemotherapy Indicators of Symptoms and Experience: Patient-Reported Outcome and Process Indicators Sensitive to the Quality of Nursing Care in Ambulatory Chemotherapy Settings

Armes, Jo PhD; Wagland, Richard PhD; Finnegan-John, Jennifer MSc; Richardson, Alison PhD; Corner, Jessica PhD; Griffiths, Peter PhD

doi: 10.1097/NCC.0b013e3182980420
Articles: Online Only

Background: Outcome indicators are increasingly advocated to demonstrate the impact of high-quality care; however, generic measures do not encompass outcomes relevant to specialist areas.

Objective: The aim of this study was to develop an outcome measure (Patient-Reported Chemotherapy Indicators of Symptoms and Experience [PR-CISE]) for use in ambulatory chemotherapy settings and assess its feasibility, acceptability, and preliminary efficacy in clinical practice.

Methods: Three areas were covered by PR-CISE—symptom management, safe medication administration, and experience of supportive care. Outcome selection was guided by review of evidence and reference groups of users, clinicians, and experts. Over 12 weeks, PR-CISE was distributed to patients receiving ambulatory chemotherapy at 10 cancer centers. Data were analyzed descriptively and with case mix adjustment using regression-based models.

Results: There were 2466 responses. There was variability across centers in terms of symptom experience and support provided. Across the whole sample, 25% reported moderate or severe nausea; however, rates varied between centers (25%–75%). Similar results emerged for other symptoms. When asked about support for symptom management, 80% reported that chemotherapy nurses asked about and were aware of symptom severity and provided useful information/advice. Once again, there was substantial variability between centers. Unexplained variation remained after case mix adjustment, suggesting that differences may be “real” rather than caused by population differences. Stakeholders planned to make changes to care delivery based on data on their performance.

Conclusions: We successfully developed and tested indicators assessing the quality of care provided in ambulatory chemotherapy services.

Implications: Results show that monitoring outcomes demonstrate potential differences in care quality and provide a stimulus to improve the experience and health of patients.

Author Affiliations: Florence Nightingale School of Nursing and Midwifery, King’s College London, London (Dr Armes and Ms Finnegan-John); Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton (Drs Wagland, Richardson, Corner, and Griffiths); and University Hospital Southampton NHS Foundation Trust, Southampton, UK (Dr Richardson).

The study was funded by The National Cancer Action Team, UK.

The views expressed here are those of the authors and do not necessarily reflect the views of the reference groups members or our funders.

The authors have no conflicts of interest to disclose.

Correspondence: Jo Armes, PhD, King’s College London, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK (

Accepted for publication April 16, 2013.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins