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Multilevel Factors Associated with Nonresponse to Patient-Reported Outcome Measures in Routine Radiation Oncology
Medrxiv : the Preprint Server for Health Sciences
|July 30, 2026
Summary
Patient-reported outcome measure nonresponse in radiation oncology is linked to clinic factors, not just patient traits. Improving data representativeness requires focusing on collection methods over volume.
Area of Science:
- Oncology
- Health Services Research
- Patient-Reported Outcomes
Background:
- Nonresponse to patient-reported outcome measures (PROMs) compromises the representativeness of aggregated clinical data.
- Understanding factors influencing PROM nonresponse is crucial for accurate data interpretation in routine care.
Purpose of the Study:
- To identify patient-, provider-, and clinic-level factors associated with nonresponse to the PROMIS Global-10 measure in radiation oncology settings.
- To characterize the multilevel drivers of PROM nonresponse to inform strategies for improving data representativeness.
Main Methods:
- Retrospective cohort study of adult patients across five radiation oncology clinics.
- Analysis of patient-level nonresponse (defined as never completing the Global-10) using iterative mixed-effects logistic regression.
- Inclusion of patient demographics, clinical factors, provider data, and clinic-level characteristics.
Main Results:
- Overall patient-level response rate was 35.4%, with significant variation across clinics (12.8% to 66.2%).
- Initially, patient factors like male sex, lower education, unemployment, and recent surgery were associated with nonresponse. After accounting for provider and clinic factors, only recent surgery and time since diagnosis remained significant.
- Clinic-level factors, including program launch timing and historical collection rates, were strongly associated with lower nonresponse, while provider collection rates showed a protective effect that was attenuated at the clinic level.
Conclusions:
- Nonresponse to routinely collected PROMs is a complex, multilevel issue significantly influenced by clinic-level implementation factors.
- Patient characteristics alone do not fully explain PROM nonresponse.
- PROM programs and performance measures should prioritize maximizing representative data collection rather than solely focusing on response volume.
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