Moving beyond barriers: a mixed-method study to develop evidence-based strategies to improve implementation of PROMs in clinical oncology care.

IF 3.3 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES Quality of Life Research Pub Date : 2025-01-01 Epub Date: 2024-09-20 DOI:10.1007/s11136-024-03787-w

Eva Boomstra, Iris Walraven, Iris M C van der Ploeg, Michel W J M Wouters, Maaike W van de Kamp, Richard Dirven, Elaine Albers, Itske Fraterman, Marit Poulissen, Lonneke V van de Poll-Franse, Kelly M de Ligt

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Abstract

Purpose: This study aimed to identify feasible, evidence-based strategies to improve the use of Patient-reported outcome measures (PROMs) implemented in clinical oncology practice.

Methods: A mixed-method study involving observations of consultations and semi-structured interviews with patients and healthcare professionals (HCPs) was conducted to identify facilitators and barriers for using PROMs; barriers and facilitators were structured following the Theoretical Domains Framework. For each barrier, evidence-based improvement strategies were selected using the Behaviour Change Techniques Taxonomy v1. Subsequently, improvement strategies were ranked on priority and feasibility by an expert panel of HCPs, information technology professionals, and PROMs implementation specialists, creating an implementation improvement strategy.

Results: Ten consultations were observed and 14 interviews conducted. Barriers for implementation included that the electronic health record and PROMs did not align to the individual needs of end users, the HCPs' hesitance to advice patients about health-related quality-of-life issues, and a lack of consensus on which HCPs were responsible for discussing PROMs with patients. Forty-one improvement strategies were identified, of which 25 remained after ranking. These included: redesigning the PROMs dashboard by including patient management advice, enhancing patient support to complete PROMs, and clarifying HCPs' responsibilities for discussing PROMs. Strategies currently considered less feasible were: improving user-friendliness of the patient portal due to technical constraints, aligning PROMs assessment frequency with clinical courses, and using baseline PROMs for early identification of vulnerabilities and supportive care needs. These will be studied in future research.

Conclusion: Evidence-based improvement strategies to ensure lasting adoption of PROMs in clinical practice were identified.

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超越障碍：一项混合方法研究，旨在制定以证据为基础的策略，以改善肿瘤临床护理中 PROMs 的实施。

目的：本研究旨在确定可行的循证策略，以改进临床肿瘤学实践中患者报告结果测量（PROMs）的使用：方法：本研究采用混合方法，通过观察会诊情况以及对患者和医护人员（HCPs）进行半结构化访谈，来确定使用患者报告结果指标（PROMs）的促进因素和障碍。随后，由医护人员、信息技术专业人员和 PROMs 实施专家组成的专家小组根据优先级和可行性对改进策略进行了排序，并制定了实施改进策略：结果：观察了 10 次会诊，进行了 14 次访谈。实施障碍包括：电子健康记录和 PROMs 与最终用户的个性化需求不一致；医疗保健人员不愿就与健康相关的生活质量问题向患者提供建议；在由哪位医疗保健人员负责与患者讨论 PROMs 的问题上缺乏共识。最终确定了 41 项改进策略，其中 25 项经过排序后仍然有效。这些策略包括：重新设计 PROMs 面板，加入患者管理建议；加强对患者完成 PROMs 的支持；明确 HCP 讨论 PROMs 的责任。目前认为可行性较低的策略包括：由于技术限制，改善患者门户网站的用户友好性，使 PROMs 评估频率与临床课程保持一致，以及利用基线 PROMs 及早识别薄弱环节和支持性护理需求。这些都将在今后的研究中加以探讨：结论：确定了以证据为基础的改进策略，以确保在临床实践中持久采用 PROMs。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Quality of Life Research 医学-公共卫生、环境卫生与职业卫生

CiteScore

6.50

自引率

8.60%

发文量

224

审稿时长

3-8 weeks

期刊介绍： Quality of Life Research is an international, multidisciplinary journal devoted to the rapid communication of original research, theoretical articles and methodological reports related to the field of quality of life, in all the health sciences. The journal also offers editorials, literature, book and software reviews, correspondence and abstracts of conferences. Quality of life has become a prominent issue in biometry, philosophy, social science, clinical medicine, health services and outcomes research. The journal''s scope reflects the wide application of quality of life assessment and research in the biological and social sciences. All original work is subject to peer review for originality, scientific quality and relevance to a broad readership. This is an official journal of the International Society of Quality of Life Research.