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Patient Reported Outcomes Measures (PROMs) in diabetes: Why are they still rarely used in clinical routine?

2012; Elsevier BV; Volume: 97; Issue: 1 Linguagem: Inglês

10.1016/j.diabres.2012.01.025

1872-8227

Fábio Brasil, Roberto Pontarolo, Cassyano Januário Correr,

Diabetes Management and Research

Our scientific staff recently translated and validated for use in Brazil the diabetes mellitus specific instrument Diabetes Quality of Life Measure (DQOL), reporting Cronbach alpha values of 0.94 for type 1 and 0.92 for type 2 diabetes [ [1] Correr C.J. Pontarolo R. Melchiors A.C. Rossignoli P. Fernandez-Llimos F. Radominski R.B. Translation to Portuguese and validation of the Diabetes Quality Of Life Measure (DQOL-Brazil). Arq Bras Endocrinol Metabol. 2008; 52: 515-522 Crossref PubMed Scopus (38) Google Scholar ], with the values for type 1 diabetes being similar to the original DCCT study [ [2] The Diabetes Control and Complications Trial Research Group (DCCT) Reliability and validity of a diabetes quality-of-life measure for the diabetes control and complications trial (DCCT). Diabetes Care. 1988; 11: 725-732 Crossref PubMed Scopus (476) Google Scholar ] (Table 1). Furthermore, a recent study with Brazilian diabetic subjects showed that the perception of quality of life was associated with the severity of depressive symptoms (r = 0.503; p < 0.001), but not with HbA1c levels (r = 0.158; p = 0.117) [ [3] Papelbaum M. Lemos H.M. Duchesne M. Kupfer R. Moreira R.O. Coutinho W.F. The association between quality of life, depressive symptoms and glycemic control in a group of type 2 diabetes patients. Diabetes Res Clin Pract. 2010; 89: 227-230 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar ]. However, we were disappointed with the resistance of physicians who work with diabetes to utilize it in clinical practice, not only the DQOL but also all other diabetes specific PROMs transculturally validated for Brazil: Problem Areas in Diabetes Scale (PAID) [ [4] Gross C.C. Scain S.F. Scheffel R. Gross J.L. Hutz C.S. Brazilian version of the problem areas in diabetes scale (B-PAID): validation and identification of individuals at high risk for emotional distress. Diabetes Res Clin Pract. 2007; 76: 455-459 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar ], Diabetes Quality of Life for Youths (DQOLY) [ [5] Novato T.S. Grossi S.A.A. Kimura M. Cultural adaptation and validation of the "Diabetes Quality of Life for Youths" measure of Ingersoll and Marrero into Brazilian culture. Rev Latinoam Enferm. 2008; 16: 224-230 Crossref PubMed Scopus (23) Google Scholar ] and Diabetes-39 (D-39) [ [6] Queiroz F.A. Pace A.E. Santos C.B. Cross-cultural adaptation and validation of the instrument Diabetes-39 (D-39): Brazilian version for type 2 diabetes mellitus patients – stage 1. Rev Latinoam Enferm. 2009; 17: 708-715 Crossref PubMed Google Scholar ]. Thus, during the DQOL validation process, we looked for factors which lead to this limited use. Table 1Internal consistency of domains DQOL and Brazilian validated version in different groups of patients with diabetes mellitus. Domain DQOL-Brazil a Validation trial of DQOL-Brazil for adults with DM1. DM1 DQOL-Brazil b Validation trial of DQOL-Brazil for adults with DM2. DM2 DQOL-DCCT c Validation trial of original version DQOL for adults with DM1. DM1 Satisfaction 0.89 0.89 0.88 Impact 0.89 0.87 0.77 Worry: social/vocational 0.84 0.83 0.83 Worry: diabetes related 0.75 0.74 0.67 Total 0.94 0.92 0.92 Confiability analyzes using Cronbach's alpha. DQOL = Diabetes Quality of Life Measure; DQOL-Brazil = Brazilian version of DQOL; DCCT = Diabetes Control and Complications Trial; DM1 = type 1 diabetes mellitus; DM2 = type 2 diabetes mellitus. a Validation trial of DQOL-Brazil for adults with DM1. b Validation trial of DQOL-Brazil for adults with DM2. c Validation trial of original version DQOL for adults with DM1. Open table in a new tab Confiability analyzes using Cronbach's alpha. DQOL = Diabetes Quality of Life Measure; DQOL-Brazil = Brazilian version of DQOL; DCCT = Diabetes Control and Complications Trial; DM1 = type 1 diabetes mellitus; DM2 = type 2 diabetes mellitus.