Patient Reported Outcome Measures for Mental Health: Development and Pragmatic Evaluation in the NHS

Background: Patient-reported outcome measures (PROMs) are standardised questionnaires or interviews that elicit subjective reports of health. They have growing potential for improving patient-centred care and decision making. The National Institute for Health and Care Excellence (NICE) recommends considering their use at regular points in the treatment pathway for common mental health conditions and physical problems such as cancer.Aims: To assess the feasibility, acceptability and usefulness of implementing four established PROMS: the Patient Health Questionnaire-9 (PHQ-9) for depression, Generalised Anxiety Disorder-7 scale (GAD-7), Short Warwick & Edinburgh Mental Wellbeing Scale (SWEMWBS) and Distress Thermometer (DT), and to pilot two novel ‘developed for purpose’ satisfaction tools: Carers’ & Users’ Expectations of Service (CUES) and Recovering Quality of Life (ReQoL).Setting: Mental health multidisciplinary teams within the UK National Health Service.Methods: Outcomes evaluated were mental/physical symptoms, emotional distress, life/service satisfaction and global quality of life. Designs were pragmatic, including quantitative and mixed methods, cross sectional and prospective before and after studies.Results: The thesis comprises five original research publications and three academic linked papers. Where assessed, PROM acceptability and completion rates were high (76-98%), leading to changes in care in 49% cases. Following therapeutic interventions, a large clinical effect size was observed: within community mental health teams PHQ-9, GAD-7 scores and functioning all improved (Cohen’s d = 0.52-0.77). In cancer psychology services, median distress (DT) scores decreased significantly (Wilcoxon’s z = -4.83, p<0.001, Cohen’s d =1.22). Sensitivity to change was greater for ReQoL, PHQ-9, GAD-7 and DT than for SWEMWBS.Conclusions: This body of research provides cumulative evidence that validated mental health PROMS can reliably assess meaningful changes at key stages in a patient’s journey, with apparent absence of significant harms. PROMS should be more widely integrated into frontline care, to inform individual treatment planning and contribute to service improvements.