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How do clinicians rate patient’s performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology

BACKGROUND: Medical decisions made by oncology clinicians have serious implications, even when made collaboratively with the patient. Clinicians often use the Eastern Clinical Oncology Group (ECOG) performance status (PS) scores to help them make treatment-related decisions. METHODS: The current stu...

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Autores principales: Datta, Soumitra S, Ghosal, Niladri, Daruvala, Rhea, Chakraborty, Santam, Shrimali, Raj Kumar, van Zanten, Chantalle, Parry, Joe, Agrawal, Sanjit, Atreya, Shrikant, Sinha, Subir, Chatterjee, Sanjoy, Gollins, Simon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cancer Intelligence 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467460/
https://www.ncbi.nlm.nih.gov/pubmed/31123496
http://dx.doi.org/10.3332/ecancer.2019.913
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author Datta, Soumitra S
Ghosal, Niladri
Daruvala, Rhea
Chakraborty, Santam
Shrimali, Raj Kumar
van Zanten, Chantalle
Parry, Joe
Agrawal, Sanjit
Atreya, Shrikant
Sinha, Subir
Chatterjee, Sanjoy
Gollins, Simon
author_facet Datta, Soumitra S
Ghosal, Niladri
Daruvala, Rhea
Chakraborty, Santam
Shrimali, Raj Kumar
van Zanten, Chantalle
Parry, Joe
Agrawal, Sanjit
Atreya, Shrikant
Sinha, Subir
Chatterjee, Sanjoy
Gollins, Simon
author_sort Datta, Soumitra S
collection PubMed
description BACKGROUND: Medical decisions made by oncology clinicians have serious implications, even when made collaboratively with the patient. Clinicians often use the Eastern Clinical Oncology Group (ECOG) performance status (PS) scores to help them make treatment-related decisions. METHODS: The current study explores the variability of the ECOG score when applied to 12 predetermined specially designed clinical case vignettes presented to a group of oncology clinicians (n = 72). The quantitative analysis included evaluation of variability of ECOG PS scores and exploration of rater and patient-related factors which may influence the final ECOG rating. In-depth interviews were conducted with oncology clinicians to ascertain factors that they felt were important while making treatment-related decisions. Basic and global themes were generated following qualitative data analysis. RESULTS: Quantitative results showed that there was poor agreement in ECOG rating between raters. Overall concordance with the gold standard rating ranged between 19.4% and 56.9% for the vignettes. Moreover, patients deemed to have socially desirable qualities (p < 0.004) were rated to have better PS and women patients (p < 0.004) to have worse PS. Clinicians having international work experience had increased concordance with ECOG PS rating. Qualitative results showed that ‘perceived socio-economic background of the patient’, ‘age of the patient’, ‘patient’s and family’s preferences’ and ‘past treatment response’ were the major themes highlighted by respondents that influenced the treatment-related decisions made by clinicians. CONCLUSION: There is considerable variability in ECOG PS determined by clinicians. Decision-making in oncology is complex, multifactorial and is influenced by rater and patient-related factors.
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spelling pubmed-64674602019-05-23 How do clinicians rate patient’s performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology Datta, Soumitra S Ghosal, Niladri Daruvala, Rhea Chakraborty, Santam Shrimali, Raj Kumar van Zanten, Chantalle Parry, Joe Agrawal, Sanjit Atreya, Shrikant Sinha, Subir Chatterjee, Sanjoy Gollins, Simon Ecancermedicalscience Research BACKGROUND: Medical decisions made by oncology clinicians have serious implications, even when made collaboratively with the patient. Clinicians often use the Eastern Clinical Oncology Group (ECOG) performance status (PS) scores to help them make treatment-related decisions. METHODS: The current study explores the variability of the ECOG score when applied to 12 predetermined specially designed clinical case vignettes presented to a group of oncology clinicians (n = 72). The quantitative analysis included evaluation of variability of ECOG PS scores and exploration of rater and patient-related factors which may influence the final ECOG rating. In-depth interviews were conducted with oncology clinicians to ascertain factors that they felt were important while making treatment-related decisions. Basic and global themes were generated following qualitative data analysis. RESULTS: Quantitative results showed that there was poor agreement in ECOG rating between raters. Overall concordance with the gold standard rating ranged between 19.4% and 56.9% for the vignettes. Moreover, patients deemed to have socially desirable qualities (p < 0.004) were rated to have better PS and women patients (p < 0.004) to have worse PS. Clinicians having international work experience had increased concordance with ECOG PS rating. Qualitative results showed that ‘perceived socio-economic background of the patient’, ‘age of the patient’, ‘patient’s and family’s preferences’ and ‘past treatment response’ were the major themes highlighted by respondents that influenced the treatment-related decisions made by clinicians. CONCLUSION: There is considerable variability in ECOG PS determined by clinicians. Decision-making in oncology is complex, multifactorial and is influenced by rater and patient-related factors. Cancer Intelligence 2019-03-28 /pmc/articles/PMC6467460/ /pubmed/31123496 http://dx.doi.org/10.3332/ecancer.2019.913 Text en © the authors; licensee ecancermedicalscience. http://creativecommons.org/licenses/by/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Datta, Soumitra S
Ghosal, Niladri
Daruvala, Rhea
Chakraborty, Santam
Shrimali, Raj Kumar
van Zanten, Chantalle
Parry, Joe
Agrawal, Sanjit
Atreya, Shrikant
Sinha, Subir
Chatterjee, Sanjoy
Gollins, Simon
How do clinicians rate patient’s performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology
title How do clinicians rate patient’s performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology
title_full How do clinicians rate patient’s performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology
title_fullStr How do clinicians rate patient’s performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology
title_full_unstemmed How do clinicians rate patient’s performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology
title_short How do clinicians rate patient’s performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology
title_sort how do clinicians rate patient’s performance status using the ecog performance scale? a mixed-methods exploration of variability in decision-making in oncology
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467460/
https://www.ncbi.nlm.nih.gov/pubmed/31123496
http://dx.doi.org/10.3332/ecancer.2019.913
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