Abstract:Background
In the last decades, the number of cancer survivors has increased significantly due to improved treatment and better detection of recurrence. This increased survival redirects the scope from survival towards optimising functional outcomes and improving health-related quality of life (HRQol). Functional and HRQoL outcomes can be assessed with patient-reported outcome measures (PROMs). However, the use of PROMs in daily oncological care is not common. This qualitative study investigates … Show more
“…The online survey was designed based on review of the existing literature on implementation sciences regarding the use of PRO in cancer care (e.g., identifying common barriers and facilitators). [ 1 , 3 – 5 , 14 , 16 – 18 , 20 , 21 ] The survey was comprised of three sections (total 40 items) and included a short introduction describing the overall objective of the study. The first section collected demographic and work-related information.…”
Section: Methodsmentioning
confidence: 99%
“…The last section included a list of 18, practitioner-, patient-, and system-related implementation barriers to the routine collection of PROs. [ 1 , 3 – 5 , 14 , 16 – 18 , 20 , 21 ] Respondents rated the salience of these potential barriers on a 5-point Likert scale ranging from “totally agree” to “totally disagree.” Respondents also had the option to provide additional barriers to PRO collection. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…PROs are broadly defined as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else". [1,2] There is emerging evidence that PROs are useful as communication tools to improve symptom control and treatment response monitoring in the oncology setting [1,3,4], as well as to enhance physician-patient communication. [4,5] Other than adding value to patient care at the clinician level, recent studies have also reported the impact of PRO monitoring on greater benefits, including longer overall survival and reduced emergency department use.…”
Section: Introductionmentioning
confidence: 99%
“…On a macro level, technical and administrative challenges in establishing a user-friendly platform for electronic data capture, linkage with relevant clinical characteristics, and concerns about data security also hinder the successful implementation PRO monitoring in care delivery settings. [3,[15][16][17][18] Other system-level challenges include difficulties assimilating the use of PRO information into clinical workflows [3,4,19] and deficiencies in the expertise needed to interpret PRO data and apply the information to clinical decision-making. [17,20,21].…”
Background
There exists scant evidence on the optimal approaches to integrating patient-reported outcomes (PROs) in clinical practice. This study gathered oncology practitioners’ experiences with implementing PROs in cancer care.
Methods
Between December 2019 and June 2020, we surveyed practitioners who reported spending > 5% of their time providing clinical care to cancer patients. Respondents completed an online survey describing their experiences with and barriers to using PROs in clinical settings.
Results
In total, 362 practitioners (physicians 38.7%, nurses 46.7%, allied health professionals 14.6%) completed the survey, representing 41 countries (Asia–Pacific 42.5%, North America 30.1%, Europe 24.0%, others 3.3%). One quarter (25.4%) identified themselves as “high frequency users” who conducted PRO assessments on > 80% of their patients. Practitioners commonly used PROs to facilitate communication (60.2%) and monitor treatment responses (52.6%). The most commonly reported implementation barriers were a lack of technological support (70.4%) and absence of a robust workflow to integrate PROs in clinical care (61.5%). Compared to practitioners from high-income countries, more practitioners in low-middle income countries reported not having access to a local PRO expert (
P
< .0001) and difficulty in identifying the appropriate PRO domains (
P
= .006). Compared with nurses and allied health professionals, physicians were more likely to perceive disruptions in clinical care during PRO collection (
P
= .001) as an implementation barrier.
Conclusions
Only a quarter of the surveyed practitioners reported capturing PROs in routine clinical practice. The implementation barriers to PRO use varied across respondents in different professions and levels of socioeconomic resources. Our findings can be applied to guide planning and implementation of PRO collection in cancer care.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00520-021-06545-7.
“…The online survey was designed based on review of the existing literature on implementation sciences regarding the use of PRO in cancer care (e.g., identifying common barriers and facilitators). [ 1 , 3 – 5 , 14 , 16 – 18 , 20 , 21 ] The survey was comprised of three sections (total 40 items) and included a short introduction describing the overall objective of the study. The first section collected demographic and work-related information.…”
Section: Methodsmentioning
confidence: 99%
“…The last section included a list of 18, practitioner-, patient-, and system-related implementation barriers to the routine collection of PROs. [ 1 , 3 – 5 , 14 , 16 – 18 , 20 , 21 ] Respondents rated the salience of these potential barriers on a 5-point Likert scale ranging from “totally agree” to “totally disagree.” Respondents also had the option to provide additional barriers to PRO collection. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…PROs are broadly defined as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else". [1,2] There is emerging evidence that PROs are useful as communication tools to improve symptom control and treatment response monitoring in the oncology setting [1,3,4], as well as to enhance physician-patient communication. [4,5] Other than adding value to patient care at the clinician level, recent studies have also reported the impact of PRO monitoring on greater benefits, including longer overall survival and reduced emergency department use.…”
Section: Introductionmentioning
confidence: 99%
“…On a macro level, technical and administrative challenges in establishing a user-friendly platform for electronic data capture, linkage with relevant clinical characteristics, and concerns about data security also hinder the successful implementation PRO monitoring in care delivery settings. [3,[15][16][17][18] Other system-level challenges include difficulties assimilating the use of PRO information into clinical workflows [3,4,19] and deficiencies in the expertise needed to interpret PRO data and apply the information to clinical decision-making. [17,20,21].…”
Background
There exists scant evidence on the optimal approaches to integrating patient-reported outcomes (PROs) in clinical practice. This study gathered oncology practitioners’ experiences with implementing PROs in cancer care.
Methods
Between December 2019 and June 2020, we surveyed practitioners who reported spending > 5% of their time providing clinical care to cancer patients. Respondents completed an online survey describing their experiences with and barriers to using PROs in clinical settings.
Results
In total, 362 practitioners (physicians 38.7%, nurses 46.7%, allied health professionals 14.6%) completed the survey, representing 41 countries (Asia–Pacific 42.5%, North America 30.1%, Europe 24.0%, others 3.3%). One quarter (25.4%) identified themselves as “high frequency users” who conducted PRO assessments on > 80% of their patients. Practitioners commonly used PROs to facilitate communication (60.2%) and monitor treatment responses (52.6%). The most commonly reported implementation barriers were a lack of technological support (70.4%) and absence of a robust workflow to integrate PROs in clinical care (61.5%). Compared to practitioners from high-income countries, more practitioners in low-middle income countries reported not having access to a local PRO expert (
P
< .0001) and difficulty in identifying the appropriate PRO domains (
P
= .006). Compared with nurses and allied health professionals, physicians were more likely to perceive disruptions in clinical care during PRO collection (
P
= .001) as an implementation barrier.
Conclusions
Only a quarter of the surveyed practitioners reported capturing PROs in routine clinical practice. The implementation barriers to PRO use varied across respondents in different professions and levels of socioeconomic resources. Our findings can be applied to guide planning and implementation of PRO collection in cancer care.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00520-021-06545-7.
“…Exploring the disease burden and treatment expectations of patients with help of a PROM improves patient satisfaction with care ( 36 ). Additionally, in our experience as clinicians, the conversation with the patient is facilitated when a PROM has been completed before the consultation since it can quickly identify issues of concern to the patient ( 37 ).…”
Section: Future Directions In Haemorrhoidal Disease Promsmentioning
Haemorrhoidal disease (HD) affects millions of people around the world and for most it is a recurring problem. Increasingly, clinicians broaden their focus on the patient's experiences with haemorrhoidal symptoms, including their impact on daily life. The patient's experience can be assessed using a patient-reported outcome measure (PROM). A PROM facilitates a deeper understanding of the disease-burden and allows a clinician to obtain information directly from the patients about their experiences with the ailment. Over the last years, PROMs have shown their additional role to traditional outcomes for several diseases and have earned their place in the daily consultation room. In order to improve and personalize the treatment of HD, we endorse the use of validated PROMs in clinical care.
Purpose
Symptoms can negatively impact quality of life for patients with a history of cancer. Digital, electronic health record (EHR)-integrated approaches to routine symptom monitoring accompanied by evidence-based interventions for symptom management have been explored as a scalable way to improve symptom management, particularly between clinic visits. However, little research has evaluated barriers and facilitators to implementing these approaches in real-world settings, particularly during the pre-implementation phase. Pre-implementation assessment is critical for informing the selection and sequencing of implementation strategies and intervention adaptation. Thus, this study sought to understand pre-implementation perceptions of a remote cancer symptom monitoring and management intervention that uses electronic patient-reported outcome measures for symptom assessment.
Methods
We interviewed 20 clinical and administrative stakeholders from 4 geographic regions within an academic medical center and its affiliated health system during the months prior to initiation of a stepped-wedge, cluster randomized pragmatic trial. Transcripts were coded using the Consolidated Framework for Implementation Research [CFIR] 2.0. Two study team members reviewed coded transcripts to understand how determinants were relevant in the pre-implementation phase of the trial and prepared analytic memos to identify themes.
Results
Findings are summarized in four themes: (1) ability of the intervention to meet patient needs [recipient characteristics], (2) designing with care team needs in mind [innovation design and adaptability], (3) fit of the intervention with existing practice workflows [compatibility], and (4) engaging care teams early [engaging deliverers].
Conclusion
Attention to these aspects when planning intervention protocols can promote intervention compatibility with patients, providers, and practices thereby increasing implementation success.
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