How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis

Background: In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care. We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians’ awareness of patients’ problems and prompts discussion and action. We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes. Results: PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians. However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication. In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships. Individualised PROMs supported dialogue by enabling the patient to tell their story. In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL). Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit. Conclusions: This paper makes two important contributions to the literature. First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition. Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries. Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making

The role of ceramic and glass science research in meeting societal challenges: Report from an NSF-sponsored workshop

Under the sponsorship of the U.S. National Science Foundation, a workshop on emerging research opportunities in ceramic and glass science was held in September 2016. Reported here are proceedings of the workshop. The report details eight challenges identified through workshop discussions: Ceramic processing: Programmable design and assembly; The defect genome: Understanding, characterizing, and predicting defects across time and length scales; Functionalizing defects for unprecedented properties; Ceramic flatlands: Defining structure-property relations in free-standing, supported, and confined two-dimensional ceramics; Ceramics in the extreme: Discovery and design strategies; Ceramics in the extreme: Behavior of multimaterial systems; Understanding and exploiting glasses and melts under extreme conditions; and Rational design of functional glasses guided by predictive modeling. It is anticipated that these challenges, once met, will promote basic understanding and ultimately enable advancements within multiple sectors, including energy, environment, manufacturing, security, and health care.National Science Foundation (U.S.) (Award DMR-1619666