The correlation between patient report outcomes and clinician reported outcomes

Abstract

OBJECTIVES: To explore evidence of the degree of correlation between patient reported outcomes (PROs) and clinician reported outcomes (ClinROs), and how this varies by therapeutic area, measure and language. METHODS: A review of the literature and analysis of existing patient registry data was conducted to qualitatively assess degree of correlation between PROs and ClinROs - at points in time, change over time, and how the relationship between these assessments varies by disease area and measure. A review of translation and linguistic validation projects involving PRO and ClinROs was also conducted to examine language-related differences and correlations between the scales. Specific examples of PRO-ClinRO pairs are given for multiple sclerosis, rheumatoid arthritis, and atopic eczema, among others. RESULTS: For multiple sclerosis and rheumatoid arthritis, moderate correlation (0.5-0.7) was found between patient assessments of disease severity and physician assessment, with patient assessments influenced by concomitant feelings (e.g., depression, anxiety). The correlation between patient and clinician assessment of change/responsiveness depends on whether an improvement or deterioration is experienced, where deterioration has a perceived stronger impact, patient-wise, than an improvement. Differences in language complexity and terminology between PROs and ClinROs were essential for the appropriate comprehension by the target population. Clinically appropriate and current terminology used for ClinROs was key to clinicians accepting the scale as relevant. Simple, clear phrasing and wording with language with lower education level was important for PROs. CONCLUSIONS: For reviewing PROs and ClinROs, specific differences in language and terminology must be taken into account, both in the development of instruments and linguistic validation into various target languages. In some disease areas, a significant and strong correlation of patient's assessment with objective clinical measures may support its use as a valid proxy measure of clinical status, thus opening up multiple research design opportunities where the perspective of the patient is paramount.