German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany.
BMC Health Serv Res. 2021 May 11;21(1):448. doi: 10.1186/s12913-021-06457-6.
There has been increasing interest in integrating patient-reported outcomes (PROs) into routine oncological practice. To date, however, PROs have rarely been implemented in Germany. Currently, PROs are being used as performance measures in colorectal cancer centers in Germany. This content analysis identified factors that may inhibit or facilitate the additional use of PROMs for individual patient management.
The analysis follows an exploratory approach. Out of 103 centers that participated in a multicentric PRO quality management and benchmarking program in Germany, twelve oncological health-care providers from eight certified colorectal cancer centers were interviewed using a semi-structured interview guide. The interviewees were clinicians (physicians, nurses, psycho-oncologist and physician assistant) who care for colorectal cancer patients. This analysis evaluated whether and how PROs that are primarily collected for quality management/benchmarking reasons could also be used for the management of individual patients. The data was analyzed using a content-analysis approach.
The interviewees were not using PRO in their routine clinical work, but they recognized its added value and pointed out potential example uses. Identified inhibiting factors for the use of PROs in clinical routine work were effortful access to PRO reports, lacking coordinating structures, time delays and time points of measurements as well as redundancy with other instruments. Facilitating factors for the use of PROs in clinical routine work that were identified included access via electronic patient records, implementation of coordinating structures for PRO processes in the center, clear PRO reports that are easy to interpret, and measurements at relevant time points.
Clinicians had quite a positive attitude toward PROs and recognized their added value. Inhibiting and facilitating factors of an organizational and technical nature were identified.
These findings indicate how PROs used for quality management purposes may also be used for the management of individual patients. Therefore, existing structures and processes in the certified colorectal cancer centers, as well as lessons learned from the literature on the implementation of PROs monitoring individual patients need to be taken into account.
将患者报告的结局（PROs）纳入常规肿瘤学实践的兴趣日益浓厚。然而，迄今为止，PRO 在德国很少得到实施。目前，PRO 正在德国的结直肠癌中心用作绩效衡量标准。本内容分析确定了可能抑制或促进额外使用患者报告结果（PROMs）进行个体患者管理的因素。
该分析采用探索性方法。在德国一项多中心 PRO 质量管理和基准测试计划中，有 103 个参与中心，其中有 12 名来自 8 个经认证的结直肠癌中心的肿瘤学医疗保健提供者，使用半结构化访谈指南进行了访谈。受访者是照顾结直肠癌患者的临床医生（医生、护士、心理肿瘤学家和医师助理）。本分析评估了主要出于质量管理/基准测试原因而收集的 PRO 是否也可用于个体患者的管理，以及如何用于管理个体患者。使用内容分析方法对数据进行分析。
受访者未将 PRO 用于其常规临床工作，但他们认识到其附加值，并指出了潜在的实际用途。确定在临床常规工作中使用 PRO 的抑制因素包括费力获取 PRO 报告、缺乏协调结构、时间延迟和测量时间点以及与其他仪器的冗余。确定在临床常规工作中使用 PRO 的促进因素包括通过电子患者记录访问、在中心实施 PRO 流程的协调结构、易于解释的清晰 PRO 报告以及在相关时间点进行测量。
临床医生对 PRO 持相当积极的态度，并认识到其附加值。确定了组织和技术性质的抑制和促进因素。
这些发现表明，用于质量管理目的的 PRO 也可用于个体患者的管理。因此，需要考虑认证结直肠癌中心的现有结构和流程，以及从文献中获得的关于实施 PRO 监测个体患者的经验教训。
