Patient-reported outcomes and patient-reported outcome measures in interstitial lung disease: where to go from here?

Abstract

Patient-reported outcome measures (PROMs), tools to assess patient self-report of health status, are now increasingly used in research, care and policymaking. While there are two well-developed disease-specific PROMs for interstitial lung diseases (ILD) and idiopathic pulmonary fibrosis (IPF), many unmet and urgent needs remain. In December 2019, 64 international ILD experts convened in Erice, Italy to deliberate on many topics, including PROMs in ILD. This review summarises the history of PROMs in ILD, shortcomings of the existing tools, challenges of development, validation and implementation of their use in clinical trials, and the discussion held during the meeting. Development of disease-specific PROMs for ILD including IPF with robust methodology and validation in concordance with guidance from regulatory authorities have increased user confidence in PROMs. Minimal clinically important difference for bidirectional changes may need to be developed. Cross-cultural validation and linguistic adaptations are necessary in addition to robust psychometric properties for effective PROM use in multinational clinical trials. PROM burden of use should be reduced through appropriate use of digital technologies and computerised adaptive testing. Active patient engagement in all stages from development, testing, choosing and implementation of PROMs can help improve probability of success and further growth.

FIGURE 1:

Comprehensive outcomes assessment in interstitial lung disease (ILD)/idiopathic pulmonary fibrosis/progressive fibrotic ILD. HRQoL: health-related quality of life; PESaM: patient experience and satisfaction with medication.

FIGURE 2:

Development of patient-reported outcome measures (PROMs). MCID: minimal clinically important difference. Adapted from US Food and Drink Administration guidance on the development of a PROM instrument for drug development to support labelling claims [80].