Preliminary Normative Standards of the Mayo Clinic Esophagectomy CONDUIT Tool

Nandita N Mahajan, Minji K Lee, Kathleen J Yost, Karlyn E Pierson, Jason K Viehman, Mark S Allen, Stephen D Cassivi, Francis C Nichols, Janani S Reisenauer, K Robert Shen, Dennis A Wigle, Shanda H Blackmon, Nandita N Mahajan, Minji K Lee, Kathleen J Yost, Karlyn E Pierson, Jason K Viehman, Mark S Allen, Stephen D Cassivi, Francis C Nichols, Janani S Reisenauer, K Robert Shen, Dennis A Wigle, Shanda H Blackmon

Abstract

Objective: To collect patient-reported outcomes after esophagectomy to establish a set of preliminary normative standards to aid in symptom-score interpretation.

Patients and methods: Patients undergoing esophagectomy often have little understanding about postoperative symptom management. The Mayo Clinic esophageal CONDUIT tool is a validated questionnaire comprising 5 multi-item symptom-assessment domains and 2 health-assessment domains. A prospective nonrandomized cohort study was conducted on adult patients who have had esophagectomies using the CONDUIT tool from August 17, 2015, to July 30, 2018 (NCT02530983). The Statistical Analysis System v9.4 (SAS Institute Inc., Cary, NC) was used to calculate and analyze the scores.

Results: Over the study period, 569 patients were assessed for eligibility, and 241 patients consented and were offered the tool. Of these, 188 patients (median age: 65 years; range: 24 to 87 years; 80% male patients) had calculable scores. Of the 188 patients, 50 (26.6%) patients were identified as potential beneficiaries for educational intervention to improve symptoms (received moderate scores for a domain), and 131 (69.7%) patients were identified as needing further testing or provider intervention (received poor scores for a domain) based on the tool.

Conclusion: The CONDUIT tool scores, when compared with standardized scales with established preliminary normative scores, could be used to identify and triage patients who need targeted education, further testing, or provider interventions. These score ranges will serve as the first set of normative standards to aid in the interpretation of conduit performance among providers and patients.

Keywords: CONDUIT, Conduit Outcomes Noting Dysphagia/Dumping and Unknown outcomes with Intermittent symptoms over Time after esophageal reconstruction; EORTC, European Organization for Research and Treatment of Cancer; FACT-E, Functional Assessment of Cancer Therapy-Esophageal cancer; PROMIS, Patient-Reported Outcomes Measurement Information System; PROMs, Patient-Reported Outcomes Measures.

© 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.

Figures

Figure 1
Figure 1
Scoring algorithm. Prorating for missing item data, provided that at least 50% of the total number of items in a scale were nonmissing (eg, 2 of 3 items, 3 of 5 items) and has been used with other patient-reported measures.
Figure 2
Figure 2
Mayo Clinic CONDUIT Patient Report Card. Score Interpretation: Green = Good (no intervention needed), Yellow = Moderate (candidates for targeted education), Red = Poor (candidates for further testing and/ possible provider intervention). GI = gastrointestinal; ◊ = mean; N = number of scored questionnaires.
Figure 3
Figure 3
Demonstrating how the CONDUIT tool with preliminary normative standards could be used in the clinical setting of a patient with a twisted conduit. GI = gastrointestinal.

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