Implementation analysis of patient reported outcomes (PROs) in oncological routine care: an observational study protocol

Abstract Background The successful implementation of patient-reported outcomes (PROs) in clinical routine faces many challenges, first and foremost the lack of consideration thereof in the patient care process. The aim of this study will be to first identify relevant barriers and facilitators and then design suitable implementation strategies which will be evaluated to improve the effectiveness of a PRO measure assessment in inpatient and outpatient cancer routine care. Methods During the preparation phase, interviews with oncological patients (N = 28) and medical staff (N = 4) as well as focus groups with medical staff (N = 18) across five different departments caring for cancer patients were conducted. On the basis of these, qualitative content analysis revealed relevant barriers and facilitators for implementation of PROs in cancer care. Subsequently, implementation strategies and a model of implementation were developed. In the study phase, implementation strategies will be evaluated based on nine different implementation outcomes in five different oncological clinics. Evaluation of the implementation process will take place during three months in each clinic and data will be conducted pre, while and post implementation of the PRO measure. Therefore a sample size of 60 participants of whom 30 staff members and 30 participants will be questioned using existing and newly developed implementation outcome evaluation instruments. Discussion Key to improving the effectiveness of PRO assessment in the time-critical clinical environment is the utilization of easy-to-use, electronic PRO questionnaires directly linked to patients’ records thereby improving consideration of PROs in patient care. In order to validate the effectiveness of this implementation process further, an evaluation parallel to implementation following an observational study design with a mixed-methods approach will be conducted. This study could contribute to the development of adequate evaluation processes of implementation of PROs to foster sustainable integration of PRO measures into routine cancer care. Trial registration This study was registered at Open Science Framework (https://osf.io/y7xce/).

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Clinicians’ knowledge and attitudes towards patient reported outcomes in colorectal cancer care – insights from qualitative interviews

BMC Health Services Research ◽

10.1186/s12913-021-06361-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nora Tabea Sibert ◽

Christoph Kowalski ◽

Holger Pfaff ◽

Simone Wesselmann ◽

Clara Breidenbach

Keyword(s):

Colorectal Cancer ◽

Cancer Care ◽

Patient Reported Outcomes ◽

Qualitative Content Analysis ◽

Qualitative Interviews ◽

Implementation Strategies ◽

Clinical Staff ◽

Successful Implementation ◽

Patient Reported ◽

Clinical Benefits

Abstract Introduction Patient-reported outcomes (PROs) can be used in cancer care to monitor patients’ disease-related symptoms and functional status. However, successful implementation of such instruments is only possible if clinical staff are convinced of the clinical benefits. It is therefore crucial to investigate the attitudes of clinical staff to PROs in routine cancer care. Methods Semi-structured, guideline-based interviews were held with 12 clinicians working in certified colorectal cancer centers in Germany who are taking part in an observational study on PROs (five surgeons, two oncologists, one psycho-oncologist, two oncological care nurses, one stoma therapist, and one physician assistant) in order to investigate firstly, how clinicians describe PRO instruments (“wording”); and secondly, the clinicians’ general attitude toward PROs. A qualitative content analysis according to Kuckartz was performed. Results The wording used to describe PROs was not consistent. Statements on attitudes toward PROs were very heterogeneous and were therefore categorized into “(rather) positive” and “(rather) negative.” The principal advantages of PROs mentioned by participants included broader, structured knowledge about patients and treatment, as well as relevance for patients. Subcategories for (rather) negative attitudes included statements expressing doubts about the questionnaires and “no need for PROs.” Discussion The clinicians participating mainly expressed fairly positive attitudes toward PROs. However, they had little knowledge about PROs in general and the interviews therefore mainly reflect their expectations and assumptions about them. These initial impressions may be regarded as providing a basis for future implementation strategies and for training of clinicians on how to use PROs in routine cancer care.

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Implementation of Electronic Patient-Reported Outcomes in Routine Cancer Care at an Academic Center: Identifying Opportunities and Challenges

JCO Oncology Practice ◽

10.1200/op.20.00357 ◽

2020 ◽

Vol 16 (11) ◽

pp. e1255-e1263

Author(s):

Sahil Sandhu ◽

Zoe King ◽

Michelle Wong ◽

Sean Bissell ◽

Jessica Sperling ◽

...

Keyword(s):

Cancer Care ◽

Patient Reported Outcomes ◽

Medical Center ◽

Clinical Care ◽

Qualitative Interviews ◽

Academic Medical Center ◽

Implementation Strategies ◽

Ease Of Use ◽

Validity And Reliability ◽

Patient Reported

PURPOSE: Electronic patient-reported outcomes (ePROs) can help clinicians proactively assess and manage their patients’ symptoms. Despite known benefits, there is limited adoption of ePROs into routine clinical care as a result of workflow and technologic challenges. This study identifies oncologists’ perspectives on factors that affect integration of ePROs into clinical workflows. METHODS: We conducted semistructured qualitative interviews with 16 oncologists from a large academic medical center, across diverse subspecialties and cancer types. Oncologists were asked how they currently use or could imagine using ePROs before, during, and after a patient visit. We used an inductive approach to thematically analyze these qualitative data. RESULTS: Results were categorized into the following three main themes: (1) selection and development of ePRO tool, (2) contextual drivers of adoption, and (3) patient-facing concerns. Respondents preferred diagnosis-based ePRO tools over more general symptom screeners. Although they noted information overload as a potential barrier, respondents described strong data visualization and ease of use as facilitators. Contextual drivers of oncologist adoption include identifying target early adopters, incentivizing uptake through use of ePRO data to support billing and documentation, and emphasizing benefits for patient care and efficiency. Respondents also indicated the need to focus on patient-facing issues, such as patient response rate, timing of survey distribution, and validity and reliability of responses. DISCUSSION: Respondents identified several barriers and facilitators to successful uptake of ePROs. Understanding oncologists’ perspectives is essential to inform both practice-level implementation strategies and policy-level decisions to include ePROs in alternative payment models for cancer care.

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Impact of Surgical Approach on Patient-Reported Outcomes after Radical Prostatectomy: A Propensity Score-Weighted Analysis from a Multicenter, Prospective, Observational Study (The Pros-IT CNR Study)

Urologia Internationalis ◽

10.1159/000496980 ◽

2019 ◽

Vol 103 (1) ◽

pp. 8-18 ◽

Cited By ~ 5

Author(s):

Alessandro Antonelli ◽

Carlotta Palumbo ◽

Marianna Noale ◽

Angelo Porreca ◽

Stefania Maggi ◽

...

Keyword(s):

Radical Prostatectomy ◽

Propensity Score ◽

Observational Study ◽

Surgical Approach ◽

Patient Reported Outcomes ◽

Prospective Observational Study ◽

Weighted Analysis ◽

Patient Reported ◽

Multicenter Prospective Observational Study

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Patient‐reported outcomes and personalised cancer care

The Medical Journal of Australia ◽

10.5694/mja2.50893 ◽

2020 ◽

Author(s):

◽

Bogda Koczwara ◽

James Bonnamy ◽

Peggy Briggs ◽

Bena Brown ◽

...

Keyword(s):

Cancer Care ◽

Patient Reported Outcomes ◽

Patient Reported

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A PRO-cision Medicine Methods Toolkit to Address the Challenges of Personalizing Cancer Care Using Patient-Reported Outcomes

Medical Care ◽

10.1097/mlr.0000000000001089 ◽

2019 ◽

Vol 57 ◽

pp. S1-S7 ◽

Cited By ~ 5

Author(s):

Claire Snyder ◽

Michael Brundage ◽

Yonaira M. Rivera ◽

Albert W. Wu

Keyword(s):

Cancer Care ◽

Patient Reported Outcomes ◽

Patient Reported

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Systematic collection of patient-reported outcomes in atrial fibrillation: feasibility and initial results of the Utah mEVAL AF programme

EP Europace ◽

10.1093/europace/euz293 ◽

2019 ◽

Vol 22 (3) ◽

pp. 368-374 ◽

Cited By ~ 5

Author(s):

Benjamin A Steinberg ◽

Jeffrey Turner ◽

Ann Lyons ◽

Joshua Biber ◽

Mihail G Chelu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Symptom Score ◽

Patient Reported Outcomes ◽

Full Range ◽

Heart Rhythm ◽

Routine Care ◽

Time Investment ◽

Generic Hrqol ◽

Patient Reported ◽

Related Quality

Abstract Aims Incorporating patient-reported outcomes (PROs) into routine care of atrial fibrillation (AF) enables direct integration of symptoms, function, and health-related quality of life (HRQoL) into practice. We report our initial experience with a system-wide PRO initiative among AF patients. Methods and results All patients with AF in our practice undergo PRO assessment with the Toronto AF Severity Scale (AFSS), and generic PROs, prior to electrophysiology clinic visits. We describe the implementation, feasibility, and results of clinic-based, electronic AF PRO collection, and compare AF-specific and generic HRQoL assessments. From October 2016 to February 2019, 1586 unique AF patients initiated 2379 PRO assessments, 2145 of which had all PRO measures completed (90%). The median completion time for all PRO measures per visit was 7.3 min (1st, 3rd quartiles: 6, 10). Overall, 38% of patients were female (n = 589), mean age was 68 (SD 12) years, and mean CHA2DS2-VASc score was 3.8 (SD 2.0). The mean AFSS symptom score was 8.6 (SD 6.6, 1st, 3rd quartiles: 3, 13), and the full range of values was observed (0, 35). Generic PROs of physical function, general health, and depression were impacted at the most severe quartiles of AF symptom score (P < 0.0001 for each vs. AFSS quartile). Conclusion Routine clinic-based, PRO collection for AF is feasible in clinical practice and patient time investment was acceptable. Disease-specific AF PROs add value to generic HRQoL instruments. Further research into the relationship between PROs, heart rhythm, and AF burden, as well as PRO-guided management, is necessary to optimize PRO utilization.

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Patient-reported outcomes in cancer care – hearing the patient voice at greater volume

BDJ ◽

10.1038/sj.bdj.2018.723 ◽

2018 ◽

Vol 225 (4) ◽

pp. 313-313

Keyword(s):

Cancer Care ◽

Patient Reported Outcomes ◽

Patient Voice ◽

Patient Reported

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Introducing Decision Aids into Routine Prostate Cancer Care in The Netherlands: Implementation and Patient Evaluations from the Multi-regional JIPPA Initiative

Journal of Cancer Education ◽

10.1007/s13187-019-01572-9 ◽

2019 ◽

Vol 35 (6) ◽

pp. 1141-1148

Author(s):

Maarten Cuypers ◽

Hoda H. M. Al-Itejawi ◽

Cornelia F. van Uden-Kraan ◽

Peep F. M. Stalmeier ◽

Romy E. D. Lamers ◽

...

Keyword(s):

Prostate Cancer ◽

The Netherlands ◽

Cancer Care ◽

Large Scale ◽

Decision Aids ◽

Routine Care ◽

Perceived Barriers ◽

Barriers And Facilitators ◽

Daily Routine ◽

Clinical Routine

AbstractUptake of decision aids (DAs) in daily routine is low, resulting in limited knowledge about successful DA implementation at a large scale. We assessed implementation rates after multi-regional implementation of three different prostate cancer (PCa) treatment DAs and patient-perceived barriers and facilitators to use a DA. Thirty-three hospitals implemented one out of the three DAs in routine care. Implementation rates for each DA were calculated per hospital. After deciding about PCa treatment, patients (n = 1033) completed a survey on pre-formulated barriers and facilitators to use a DA. Overall DA implementation was 40%. For each DA alike, implementation within hospitals varied from incidental (< 10% of eligible patients receiving a DA) to high rates of implementation (> 80%). All three DAs were evaluated positively by patients, although concise and paper DAs yielded higher satisfaction scores compared with an elaborate online DA. Patients were most satisfied when they received the DA within a week after diagnosis. Pre-formulated barriers to DA usage were experienced by less than 10% of the patients, and most patients confirmed the facilitators. Many patients received a DA during treatment counseling, although a wide variation in uptake across hospitals was observed for each DA. Most patients were satisfied with the DA they received. Sustained implementation of DAs in clinical routine requires further encouragement and attention.

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