QOL in Head & Neck Cancer – 5 th International Workshop Maritime Museum, Liverpool

1. A Survey of Consultants and Specialists in Restorative Dentistry on their use of HRQOL Questionnaires. QOL in Head & Neck Cancer – 5th International Workshop Maritime Museum, Liverpool 2nd & 3rd November 2006 Adrian Pace-Balzan SpR in Restorative Dentistry Edinburgh Dental Institute

2. Aims • Background • Aims & Objectives • Methods • Results • Conclusions

3. Background • Aims & Objectives • Methods • Results • Conclusions

4. Background The transfer of information between healthcare professionals and their patients is a critically important element in diagnosis, management and patient support-Velikova et al., 2002 • HRQOL - essential component to best patient care • Data set components - BAOMS & BAO-HNS

5. Background • Resistance to the routine use of HRQOL questionnaires within everyday clinical practice • Kanatas & Rogers (2004) • UK consultant clinicians (BAOMS) • 29% used HRQOL questionnaires • Lack of resources and proven value • Mehanna & Morton (2006) • H&N clinicians (ANZHNS) • 34% used a QOLQ & only13% currently using one • Time-consuming / no proven benefit

6. Background • Aims & Objectives • Methods • Results • Conclusions

7. Aims of Study • To assess the prevalence of use of HRQOL questionnaires by Consultants and Specialists in Restorative Dentistry undertaking Oral Rehabilitation following treatment for HNC • Identify acceptance and barriers for the use of HRQOL outcome measures within the speciality

8. Aims of Study The Liverpool Oral Rehabilitation Questionnaire (LORQ) • 40 – item questionnaire • specific to patients undergoing oral rehabilitation following HNC Pace-Balzan et al., (2004), (2005) & MPhil thesis (University of Liverpool - 2006)

9. Background • Aims & Objectives • Methods • Results • Conclusions

10. Methods – The Survey Questionnaire Section 1 - All clinicians • Oral rehabilitation (HNC)? • MDT? • Previous/current used • Intention to use • Perceived barriers

11. Methods – The Survey Questionnaire Section 1 - All clinicians • Oral rehabilitation (HNC)? • MDT? • Previous/current used • Intention to use • Perceived barriers Section 2 - Clinicians with HRQOL experience • Used/current use • Questionnaires used • Patient groups • Who distributes Qs • How Qs distribute

12. Methods – The Survey Questionnaire Section 1 - All Clinicians • Oral rehabilitation (HNC)? • MDT? • Previous/current used • Intention to use • Perceived barriers Section 2 - Clinicians with HRQOL experience • Used/current use • Questionnaires used • Patient groups • Who distributes Qs • How Qs distribute Section3 Clinicians undertaking oral rehab in HNC patients and using HRQOL outcome measures • Questionnaires used • Timing of questionnaire • Patient recruitment • Need another questionnaire • Ideal attributes

13. Methods – The Survey Questionnaire Section 1 - All clinicians • Oral rehabilitation (HNC)? • MDT? • Previous/current used • Intention to use • Perceived barriers Section 2 - Clinicians with HRQOL experience • Used/current use • Questionnaires used • Patient groups • Who distributes Qs • How Qs distribute Section3 Clinicians undertaking oral rehab in HNC patients and using HRQOL outcome measures • Questionnaires used • Timing of questionnaire • Patient recruitment • Need another questionnaire • Ideal attributes Comments about the use of HRQOL questionnaires

14. Methods • Members of the Association of Consultants and Specialists in Restorative Dentistry (ACSRD) • 2 wave mailing procedure(July/Sept 2005) • Other data collected • No. yrs post qualification • Work setting • UK region

15. Statistical Analysis • SPSS V11.0 • Chi-squared test • Fischer’s Exact Test (Yes/No) • P<0.05

16. Background • Aims & Objectives • Methods • Results • Conclusions

17. Results • All Respondents • Clinicians with experience of HRQOLQs • Clinicians providing Oncology Oral Rehab. • Free Text

18. Results • All Respondents • Clinicians with experience of HRQOLQs • Clinicians providing Oncology Oral Rehab. • Free Text

19. Results - Response • 197 ACSRD members on mailing list • 15 retired/no clinical contact • 3 no contact address • 1 overseas • Response rate – 74%(132/178) • Better response rate from clinicians • Working outside England (P=0.013) • More recently qualified (trend) • Hospital setting (P=0.047)

20. Results • 42% provided oral rehab following HNC • 25% formed part of HNC MDT • 19% ever used HRQOLQs • No difference whether formed part of MDT • Increased use in those • Providing oral rehab • NE/NW England

21. Results – Future use

22. Results – Future use • Clinicians • Providing oral rehab • Part of HNC MDT • Based in England • Recently qualified

23. Results -Barriers to HRQOL use

24. Results • All Respondents • Clinicians with experience of HRQOLQs • Clinicians providing Oncology Oral Rehab. • Free Text

25. Results – Clinicians used/using HRQOLQs N=25 * Implant supported prosthesis (4), periodontal treatment (3) Cleft (2) edentulism (2) caries(1) tooth wear (1) TMJ (1) & ageing/nutrition/DM (1)

26. Results – Which Questionnaires? * Ad hoc (5), GOHAI, OIDP, GHQ (1)

27. Results – Distribution of Questionnaires (Who?)

28. Results – Distribution of Questionnaires (How?)

29. Results • All Respondents • Clinicians with experience of HRQOLQs • Clinicians providing Oncology Oral Rehab. • Free Text

30. Clinicians undertaking oral rehabilitation and using/used HRQOLQs N = 15

31. Results – Which Questionnaires? Oral Oncology Rehabilitation * Ad hoc

32. Results – Administration of Questionnaires • When were the questionnaires administered? • 7 Baseline • 9 Post treatment • Which patient groups were targeted? • 7 all patients • 2 some patients (selection criteria unstated)

33. Most Important Attributes of an Oral Rehabilitation Questionnaire

34. Results • All Respondents • Clinicians with experience of HRQOLQs • Clinicians providing Oncology Oral Rehab. • Free Text

35. Free Text • 25% (33/132) expressed their views • “ A vital part of our understanding of patient care – outcome - Much under-rated.” • “ An excellent idea.” • “ Extremely important as a measuring tool especially when trying to commission services. “

36. Free Text • “Poor patients - so many questionnaires at such a difficult time.” • “ It may open up problems that we as an institution have no resources to treat.” • “Why don't we just apply previous findings and make it part of "good practice"? Why keep repeating what has been done?”

37. Background • Aims & Objectives • Methods • Results • Conclusions

38. Conclusions • Low rate of HRQOLQ usage (19%) • Research tool • Expected substantial impact on HRQOL • Clinicians providing oral rehabilitation following HNC more likely to use/used HRQOLS • Few thought that these were not clinically relevant or that no suitable questionnaires existed

39. Conclusions • Barriers • lack of experience & resources (time /staff) If the role of questionnaires in clinical practice is to be realized then these barriers and attitudes need to be addressed • Educational methods e.g Formal teaching at UG level • Computer-based methods e.g TST

40. Conclusions • The questionnaire is not dictating or influencing whether clinicians use patient-derived outcome measures, but it is the clinical setting and a lack of training and appreciation of the concept of HRQOL. • The introduction of the LORQ in the clinical setting is not making the clinical process any simpler and rather may be perceived as introducing an increased level of complexity in patient management.

41. Acknowledgements • Simon N Rogers • Luke J Dawson • Chris J Butterworth • Derek Lowe • Robert A Howell • John I Cawood

42. Thank You Any Questions ?