Priority recommendations for the implementation of patient-reported outcomes in clinical cancer care: a Delphi study

Abstract

Purpose The aim of this study was to develop priority recommendations for the service level implementation of patient-reported outcomes (PROs) into clinical cancer care. Methods Development of draft guidance statements was informed by a literature review, the Knowledge to Action (KTA) implementation framework, and discussion with PRO experts and cancer survivors. A two-round modified Delphi survey with key stakeholders including cancer survivors, clinical and research experts, and Information Technology specialists was undertaken. Round 1 rated the importance of the statements and round 2 ranked statements in order of priority. Results Round 1 was completed by 70 participants with round 2 completed by 45 participants. Forty-seven statements were rated in round 2. In round 1, the highest agreement items (>90% agreement) included those that focused on the formation of strong stakeholder partnerships, ensuring ongoing communication within these partnerships, and the use of PROs for improvement and guidance in clinical care. Items ranked as the highest priorities in round 2 included assessment of current staff capabilities and service requirements, mapping of workflows and processes to enable collection, and using collected PROs to guide improved health outcomes. Conclusions This stakeholder consultation process has identified key priorities in PRO implementation into clinical cancer care that include clinical relevance, stakeholder engagement, communication, and integration within the existing processes and capabilities. Implication for Cancer Survivors Routine adoption of PRO collection by clinical cancer services requires multiple implementation steps; of highest priority is strong engagement and communication with key stakeholders including cancer survivors.

Patient and public involvement in cancer research: A scoping review

“…Out of the 66 PPI articles, 16 originated in the United Kingdom, 31–46 14 in the United States, 47–60 12 in Australia, 61–72 7 in Canada, 73–79 2 in China, 80,81 and 1 in Japan 82 . European countries included: Switzerland ( n = 2), 83,84 The Netherlands ( n = 2), 85,86 and Spain ( n = 1), 87 as well as two studies comprising several countries ( n = 2) 88,89 .…”

Using Implementation Science Frameworks to Guide the Use of Electronic Patient-Reported Outcome Symptom Monitoring in Routine Cancer Care

“…25 Theory-informed implementation strategies can bridge the gap between ePRO research and implementation. 27,29,39,49,50 Certain strategies were relevant to multiple CFIR domains, enabling prioritization of strategies likely to have the greatest impact on implementation. While there was some alignment with the implementation strategies previously reported, 34,39,56,64 some of the strategies proposed may be more specific to our local setting, patient population, and stage of implementation of ePROs.…”

“…Australia, implementation of ePROs in routine cancer care remains confined to single centers [34][35][36] or the research context. 17,37,38 Priority recommendations for implementing ePRO symptom monitoring have been defined, 39,40 and national implementation in specific groups (eg, hematologic cancers 41 ) has been recommended although this is yet to be implemented. Furthermore, there is significant variation in how ePROs are implemented, 42,43 including their purpose, timing of review, PRO measures used, mode of administration, and degree of electronic medical record (EMR) integration, as well as the impact on care processes and outcomes.…”

Implementing a web-based system of screening for symptoms and needs using patient-reported outcomes in people with cancer

“…The findings of the present study are consistent with these theoretical considerations and highlight the complexity of the implementation process with nurses offering suggestions for improvement that related to the intervention itself (such as automation of registration), the team roles (using clinic administration staff to register patients) and the implementation process (using the link to the hospital electronic medical record as a trigger for screening). A recent Delphi study of strategies for implementation conducted with input from patients, clinicians, researchers and technology developers offers an example of steps required to implement patient-reported outcomes in clinical cancer care [ 23 ]. In line with these steps, further adoption of the iSCREEN system needs to focus on assessment, and boosting, of readiness for implementation of PRO screening; identification and addressing of barriers to use for patients and health care providers; embedding the screening into the routine workflow; and ongoing monitoring of performance to further refine and adapt.…”