Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada.
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.
JCO Oncol Pract. 2024 Jun;20(6):816-826. doi: 10.1200/OP.23.00715. Epub 2024 Mar 8.
Implementation of patient-reported outcomes (PROs) collection is an important priority in cancer care. We examined perceived barriers toward implementing PRO collection between centers with and without PRO infrastructure and administrators and nonadministrators.
We performed a multinational survey of oncology practitioners on their perceived barriers to PRO implementations. Multivariable regression models evaluated for differences in perceived barriers to PRO implementation between groups, adjusted for demographic and institutional variables.
Among 358 oncology practitioners representing six geographic regions, 31% worked at centers that did not have PRO infrastructure and 26% self-reported as administrators. Administrators were more likely to perceive concerns with liability issues (aOR, 2.00 [95% CI, 1.12 to 3.57]; = .02) while having nonsignificant trend toward less likely perceiving concerns with disruption of workflow (aOR, 0.58 [95% CI, 0.32 to 1.03]; = .06) and nonadherence of PRO reporting (aOR, 0.53 [95% CI, 0.26 to 1.08]; = .08) as barriers. Respondents from centers without PRO infrastructure were more likely to perceive that not having access to a local PRO expert (aOR, 6.59 [95% CI, 3.81 to 11.42]; < .001), being unsure how to apply PROs in clinical decisions (aOR, 4.20 [95% CI, 2.32 to 7.63]; < .001), and being unsure about selecting PRO measures (aOR, 3.36 [95% CI, 2.00 to 5.66]; < .001) as barriers. Heat map analyses identified the largest differences between participants from centers with and without PRO infrastructure in agreed-upon barriers were (1) not having a local PRO expert, (2) being unsure about selecting PRO measures, and (3) not recognizing the role of PROs at the institutional level.
Perceived barriers toward PRO implementation differ between administrators and nonadministrators and practitioners at centers with and without PRO infrastructure. PRO implementation teams should consider as part of a comprehensive strategy including frontline clinicians and administrators and members with PRO experience within teams.
患者报告结局（PROs）的收集实施是癌症护理的一个重要优先事项。我们研究了有和没有 PRO 基础设施和管理员的中心之间的实施 PRO 收集的感知障碍。
我们对肿瘤医师进行了一项多国家的调查，以了解他们对 PRO 实施的感知障碍。多变量回归模型评估了两组之间实施 PRO 的感知障碍差异，调整了人口统计学和机构变量。
在代表六个地理区域的 358 名肿瘤医师中，31%的人在没有 PRO 基础设施的中心工作，26%的人自我报告为管理员。管理员更有可能认为存在责任问题的担忧（比值比，2.00 [95%置信区间，1.12 至 3.57]；.02），而对于工作流程中断（比值比，0.58 [95%置信区间，0.32 至 1.03]；.06）和 PRO 报告不依从性（比值比，0.53 [95%置信区间，0.26 至 1.08]；.08）的感知障碍，则呈下降趋势。没有 PRO 基础设施的中心的受访者更有可能认为无法获得当地的 PRO 专家（比值比，6.59 [95%置信区间，3.81 至 11.42]； <.001），不确定如何将 PRO 应用于临床决策（比值比，4.20 [95%置信区间，2.32 至 7.63]； <.001），以及不确定如何选择 PRO 措施（比值比，3.36 [95%置信区间，2.00 至 5.66]； <.001）作为障碍。热点图分析确定了有和没有 PRO 基础设施的中心之间参与者在认同的障碍方面的最大差异为：（1）没有当地的 PRO 专家；（2）不确定如何选择 PRO 措施；（3）没有认识到 PRO 在机构层面的作用。
实施 PRO 的感知障碍在管理员和非管理员以及有和没有 PRO 基础设施的中心的医生之间存在差异。PRO 实施团队应将其作为全面战略的一部分，包括一线临床医生和管理员以及团队中具有 PRO 经验的成员。
