Yearly depression, physical function screening recommended for all patients with lupus
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Key takeaways:
- Depression and physical function are patient-reported outcome measures that should be assessed at least annually.
- Fatigue and cognitive function are important, but optional measures.
Depression and physical function should be assessed at least once per year in all patients with systemic lupus erythematosus, according to recommended quality measures devised by an American College of Rheumatology workgroup.
“Despite significant progress in the pharmacological management of SLE, there remains a need to understand and address the patient experience of illness more fully, particularly as there is often discordance between physician and patient assessments of disease,” Patricia P. Katz, PhD, of the University of California, San Francisco, Claire E.H. Barber, MD, PhD, FRCPC, of the University of Calgary, and colleagues wrote in Arthritis Care & Research. “One important strategy for gaining this understanding is using standardized patient-reported outcomes.”
However, “no updated or specific recommendations exist” for clinical use of patient-reported outcomes in the management of SLE, they added. To fill that gap, Katz, Barber and colleagues assembled a workgroup with experts and patient partners to draft quality measures for patient-reported outcome measure (PROM) use in SLE clinical care, as part of a collaboration with the CDC and American College of Rheumatology. Altogether, the group included 10 physicians and researchers with SLE experience, as well as an advisory panel of 11 patient partners identified via clinics and advocacy organizations.
Members performed literature reviews to identify domains and patient-reported outcomes that mattered most, then psychometric reviews and a series of delphi exercises to rate the usefulness, importance and feasibility of each measure. Throughout, there was “extensive engagement” with the patient partners, Katz, Barber and colleagues wrote.
The experts and patient advisers unanimously agreed that patients with SLE should be assessed or screened at least once per year for both physical function and depression symptoms, using ACR-preferred assessment tools. The rationales were that, in patients with SLE, physical activity can control fatigue, depression and cardiovascular health, while depression and anxiety were associated with more pain, fatigue, worse symptoms and lower medication adherence.
Fatigue and cognitive function, meanwhile, were both accepted as optional patient-reported outcome measures “after debate,” the co-authors wrote. Both were considered important for patient quality of life, but “slightly less feasible” to measure in clinical practice, with “less-established” therapeutic interventions available to address them, they added.
“While clinicians are often focused on organ disease activity and damage, outcomes that are highly relevant and important to patients can be missed, leading to poor overall quality of life,” Katz, Barber and colleagues wrote. “Depression and physical function are two priority domains in SLE that correlate with outcomes, with well-established PRO metrics selected for quality measure development and implementation by the ACR.”
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