Using patient‐reported outcomes (PROs) and patient‐reported outcome measures (PROMs) in routine head and neck cancer care: What do health professionals perceive as barriers and facilitators?

Abstract

Introduction: Patient-reported outcomes (PROs) are direct reports from patients about their health status. Patient-reported outcome measures (PROMs) are validated tools assessing PROs and completed by patients. Though commonly used in research, implementing PROMs into routine clinical care has been challenging. We aimed to examine health professionals' (HPs') perceptions of barriers and facilitators to PRO and PROM use in the routine care of head and neck cancer (HNC) patients. Methods: A custom survey was created, pilot-tested and disseminated to all HPs involved in the care of HNC patients in Western Sydney Local Health District, Australia. Participants were asked to rate the degree to which they believed the survey items were barriers or facilitators to routine PRO use by answering 'not at all', 'very little', 'quite a bit' and 'very much'. Results: Of 129 HPs, 86% had never routinely used PROs. Key barriers perceived were low workplace awareness of PROs (73%), HPs' lack of knowledge on PRO use (63%) and lack of PROMs in patient preferred languages (63%). Insufficient time, staff and infrastructure to support routine PRO collection and non-integrated PROMs in patient electronic medical records were also highlighted. Top facilitators were time for PRO administration and interpretation (86%), clear definition of staff roles (84%) and automatic scoring and interpretation of PROMs (81%). Conclusions: This study highlighted key barriers and facilitators to PRO use in routine HNC patient care as perceived by HPs. The findings will be useful in guiding the successful and sustainable implementation of routine PRO collection in clinical settings.

Knowledge, use and attitudes of healthcare professionals towards patient-reported outcome measures (PROMs) at a comprehensive cancer center

“…Consistent with findings in the literature [10,13,19,27], the perceived weaknesses of PROMs mainly concern the lack of resources and the additional workload for their administration, while concerns about their utility are less strong. Conversely, there is published evidence that routine PROM assessment allows more effective use of time and resources [11,31].…”

“…The results of this survey indicate that HCPs in a comprehensive cancer center, especially physicians, were familiar with a fair number of PROMs and expressed a generally positive attitude towards them. As reported in previous studies [10,11,16], the strengths of PROMs were considered to outweigh their weaknesses; however, frequent use was not common, which is also consistent with available evidence [10,17,27]. In particular, all tools but pain scales were reported to be used frequently only by a small percentage of respondents.…”

Patient-reported outcome measures in oncology: a qualitative study of the healthcare professional’s perspective

“…Barriers to implementation can include individual, structural, and organisational factors. Reported reasons for clinicians not engaging in routine PROM use are a low familiarity with the concept of patient-reported outcomes, the lack of available validated questionnaires, and a potential loss of human touch between caregiver and patient [13,14]. Furthermore, HCPs might be concerned that incorporating PROMs disturbs their workflow and augment their already existing administrative burden.…”

Validating an Instrument for Direct Patient Reporting of Distress and Chemotherapy-Related Toxicity among South African Cancer Patients

“…Following validation, it will be necessary to pilot and study implementation of general use of the PRA-SA at our clinic and similar settings. In high-income environments, provider-level barriers to PROM implementation have included skepticism regarding their value or necessity, underdeveloped strategies for interpreting or reacting to symptoms and distress, insufficient time or staffing to review reports, underuse of information technology solutions for presenting and tracking response over time and fear that PROMs depersonalize doctor–patient interactions [ 45 , 46 , 47 , 48 ]. Resource-constrained settings are potentially vulnerable to all these issues.…”