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Patient-reported outcome measures in pediatric surgery - A systematic review
Anne-Sophie Besner1, Julia Loyola Ferreira2, Nikki Ow3
1Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Canada; McGill University, Montreal, Canada; Sherbrooke University, Sherbrooke, Canada.
Insights
Patient-reported outcome measures (PROMs) are vital in pediatric surgery quality assessment. This study found a lack of validated, individualized PROMs, highlighting a need for better tools to support family-centered care.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Quality Improvement
Background:
- Measuring surgical care quality is shifting towards patient-reported outcome measures (PROMs).
- PROMs are underutilized in pediatric surgery.
- This study addresses the need to understand current PROM use in this field.
Purpose of the Study:
- To identify existing PROMs used in pediatric surgery.
- To assess the characteristics of these PROMs.
- To identify gaps and areas for improvement in PROM development and application.
Main Methods:
- A systematic literature search was conducted across eight databases up to May 2021.
- PRISMA standards were followed for study screening by two independent reviewers.
- Study quality was assessed using AXIS and Mixed Methods Appraisal Tool.
Main Results:
- 101 articles were included from 8282 screened studies; 99% were cross-sectional.
- 85 PROMs were identified, with 53 disease-specific and the rest generic; PedsQL™ was most common.
- 41% of PROMs lacked validation, and 28% were developed ad hoc; no individualized PROMs were found.
Conclusions:
- PROMs are increasingly adopted in pediatric surgery, with disease-specific tools being prevalent.
- A significant gap exists in validated and individualized PROMs for pediatric surgical patients.
- Future development should focus on robust, individualized PROMs to enhance family-centered care.
Purpose:
With improved long-term survival rates, measuring the quality of surgical care has gradually shifted from clinical morbidity and mortality to patient-reported outcome measures (PROMs). Since the use of PROMs in pediatric surgery is still limited, we undertook a study to identify current PROMs, assess their characteristics, and identify gaps and areas for improvement.
Methods:
A search was conducted in eight databases from their inception until May 2021 to identify PROMs that have been used in pediatric surgical patients. PRISMA standards were followed, and screening was completed by two independent reviewers. The quality of the included studies was appraised using the AXIS and the Mixed Methods Appraisal Tool.
Results:
Of 8282 studies screened, 101 articles met the inclusion criteria. Most of the studies (99%) were cross-sectional. We identified 85 different PROMs among the studies, 53 being disease-specific and the rest generic. The PedsQL™ was the most frequently used tool (42 studies). Almost half of the instruments (41 studies) were not validated, and 28% were developed ad hoc for each specific study. Significantly, all PROMs encountered were standardized (consisting of pre-determined domains), with no individualized tools currently in use. The overall quality of the included studies was good.
Conclusions:
PROMs are increasingly used in pediatric surgery. Disease-specific PROMs predominate the field, yet validated and especially individualized PROMs are notably absent. Future efforts are needed to develop robust tools that reflect individual patient and family needs, preferences, and values, with the aim of furthering family-centered pediatric surgical care.
