The Wolverhampton Assessment Tool, a Step Towards Remote Monitoring of Patient-reported Wellbeing in the Context of Prostate Cancer

It is widely recognised that patient-reported outcomes give a measure of overall effect of clinicians' actions on patients and that they can be used to guide the management of the patient's condition. They can also have an empowering effect as the patient may feel that they are agents, and not just subjects, in their treatment pathway. In the case of advanced and metastatic prostate cancer (i.e. cancer which has spread from the prostate to distant sites), the clinical means of assessing how the patient's disease is responding to treatment (radiological/magnetic scans) are somewhat imperfect as they do not take into account the impact on the patient's life and his response and reaction. Patient-reported outcomes, such as WATapp, allow a way to measure the impact of clinicians' actions on patients' lives. They offer an assessment of how well treatments are working and this is critical in the management of patients with advanced or metastatic prostate cancer. Failure to recognise how the patient responds to treatment can lead to effective treatment being stopped inappropriately; progression of the disease may not always be recognised; and the patient may have unnecessary side effects that go unchecked. Ignoring the patient-reported outcomes, such as WATapp, can reduce the opportunity to use alternative treatments. WATapp has been developed as an objective and reproducible clinical assessment tool by using questions from these validated clinical study tools:

The Functional Assessment of Cancer Therapy - Prostate; The Brief Pain Inventory; The Karnofsky Performance Scale

WATapp was refined with patient and clinician input to produced the present 5-item questionnaire.

This is a mixed-method study, incorporating both quantitative and qualitative elements. As such, it is both objective and subjective:

1. It is subjective in that, in using the WATapp, the patient selects his response to each question on the basis of how he feels normally
2. It is objective in that the tools to be used in the analysis of the quantitative data [i.e. statistical tests such as Mann Whitney-U, Spearman Rank Correlation etc.] are independent of the person using them
3. Determining clinically the patient's disease status employs objective measures such as PSA, size, distribution and type of metastasis, frequency of night-time urination etc. as well as the clinician's professional judgment which contains both objective and subjective elements
4. The researchers are not mirrors but rather prisms and hence the entire study from conception to analysis and report is a refraction of their experiences