Core Patient-Reported Outcomes (PROs) and PRO Measures (PROMs) for Polypharmacy Medicines Reviews: A Sequential Mixed-Methods Study

Figures & data

Figure 1 PRISMA flow diagram of article screening and selection procedures (adapted from Moher et al, 2009¹⁷).

Table 1 Content Domains of the 12 PROMs

Content Domains	BMQ	LMQ-2	LMQ3	MedUseQ	MRB-QoL	PATD	PETS	PPDQ	rPATD	TSQM v1	TSQM v2	LMQ	Total
1. Perceived effectiveness of prescribed medicines		●	●	●					●	●	●	●	7
2. Convenience, practicalities and/or managing medicines (including support)		●	●	●	●		●		●	●	●	●	9
3. Patient knowledge about and/or understanding of medicines; need for information		●	●	●	●				●			●	6
4. Medicine side-effects (specific symptoms);		●	●	●	●				●			●	6
5. Relationships and/or communication with healthcare professionals about medicines (including decision-making)		●	●					●	●			●	5
6. Impact on daily living due to medicine use (including medicine burden)		●	●	●	●		●	●	●	●	●	●	10
7. General satisfaction with prescribed medicines			●						●	●	●		4
8. Views, attitudes, beliefs and/or perceptions about medicines	●	●	●	●	●	●		●				●	8
9. Concerns about medicines overall and/or about prescribed medicines (including number of medicines taken; appropriateness)	●		●	●	●			●	●				6
10. Medical follow-up, monitoring or adherence issues, risk of misuse/abuse				●	●	●							3
11. Sense of control/autonomy and/or self-confidence		●	●	●				●				●	5
12. Availability and accessibility of therapy/medicines				●									1
13. Interest/willingness/need/attempt to de-prescribe/discontinue medicines						●		●	●				3
14. Patient-perceived healthcare professional knowledge about medicines or attention to medicines								●	●				2
Total	2	8	10	10	7	3	2	7	10	4	4	8

Abbreviations: PROMs, patient-reported outcome measures; LMQ, Living with Medicines Questionnaire; TSQM, Treatment Satisfaction Questionnaire for Medication; PATD, Patients’ Attitudes Towards Deprescribing; rPATD, revised Patients’ Attitudes Towards Deprescribing; BMQ, Beliefs about Medicines Questionnaire; MedUseQ, Medication Use Questionnaire; MRB-QoL, Medication-Related Burden Quality of Life; PETS, Patient Experience with Treatment and Self-Management; PPDQ, Patient Perceptions of Deprescribing Questionnaire.

Table 3 Breakdown of Characteristics of Members of the Public

Study ID	Gender	Age (Years)	Family Status	Work Status	Conditions (n)	Prescribed Meds (n)	Interview Duration (Minutes)
MP-01	Female	24	Single	Student	5	5	27
MP-03	Male	22	Single	Employed (p/t)	2	3	22
MP-04	Female	29	Partnered	Employed (f/t)	3	8	51
MP-06	Female	56	Widowed	Retired	5	7	50
MP-08	Male	32	Single	Employed (f/t)	3	5	36
MP-10	Male	36	Married	Employed (p/t)	6	16	58
MP-12	Female	78	Widowed	Retired	4	10	53

Abbreviations: MP, member of the public; p/t, part-time; f/t, full-time.

Table 2 Background Characteristics of the Study Participants

Participant Group	Variable	Attribute	Value
Members of the public	Gender	Male:female	3:4
	Role	Patient:carer	6:1
	Age (years)	Mean±SD	39.5±20.3
		Median	32
		Min-Max	22–78
	Family status	Married/partnered	2
		Single	3
		Widowed	2
	Employment status	Employed (full-time)	3
		Employed (part-time)	2
		Retired	2
		Student	1
	Chronic conditions	Median	4
	Min-Max	2–6
	Prescribed medicines	Median	7
	Min-Max	3–16
Healthcare professionals	Gender	Male:female	6:2
	Clinical role	General practitioner	3
		Consultant	1
		Pharmacist	2
		Pharmacy technician	1
		Advanced nurse practitioner	1
	Clinical experience (years)	Mean±SD	22.6±8.1
		Median	25
		Min-Max	10–30
	Area of practice	Urban:rural	5:3

Abbreviation: SD, standard deviation.

Table 4 Breakdown of Characteristics of Healthcare Professionals

Study ID	Gender	Clinical Role	Clinical Experience (Years)	Area of Practice	Interview Duration (Minutes)
HCP-01	Male	GP	20	Semi-rural	19
HCP-02	Male	GP	30	Urban	24
HCP-03	Male	GP	12	Semi-rural	48
HCP-05	Male	Consultant geriatrician	28	Urban	28
HCP-06	Female	Pharmacist	30	Urban	35
HCP-07	Male	Pharmacy technician	10	Rural	20
HCP-08	Female	Pharmacist	29	Urban	47
HCP-11	Male	ANP	22	Urban	19

Abbreviations: HCP, healthcare professional; GP, general practitioner; ANP, advanced nurse practitioner.

Figure 2 Thematic core categories of most meaningful/important PROs for assessment during polypharmacy medicines reviews.

Table 5 Five-Step Process for the Use of a Bespoke PROM for Realistic Integration in Polypharmacy Medicines Reviews

Steps	Description
Step 1 (clinical relevance)	Consider existing PROMs that have been fully validated in terms of their content validity (extensive literature review and direct user involvement), including user involvement at the generation and clarification stage (ie, MedUseQ,^Citation30 rPATD^Citation28 and PPDQ^Citation33).
Step 2 (usability)	Consider how appropriate the length of the measures identified in Step 1 is.
Step 3 (breadth)	Consider the content domains that each of the measures addresses, identifying overlapping domains and domains that the measures make a unique contribution to, so that all four core PROs (and ideally all 14 content domains) can be assessed by the bespoke PROM.
Step 4 (degree of established validity)	Consider the extent of construct and criterion validity undertaken for the measures identified in Step 1. Identify valid stand-alone content domains of individual PROMs.
Step 5 (content validity)	Develop draft bespoke PROM and initiate consultation with stakeholders to establish content validity in the first instance.

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