Boomstra Eva, Walraven Iris, van der Ploeg Iris M C, Wouters Michel W J M, van de Kamp Maaike W, Dirven Richard, Albers Elaine, Fraterman Itske, Poulissen Marit, van de Poll-Franse Lonneke V, de Ligt Kelly M
Division of Psychosocial Research and Epidemiology , Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands.
Qual Life Res. 2025 Jan;34(1):173-188. doi: 10.1007/s11136-024-03787-w. Epub 2024 Sep 20.
This study aimed to identify feasible, evidence-based strategies to improve the use of Patient-reported outcome measures (PROMs) implemented in clinical oncology practice.
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.
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.
Evidence-based improvement strategies to ensure lasting adoption of PROMs in clinical practice were identified.
本研究旨在确定可行的、基于证据的策略，以改善临床肿瘤学实践中患者报告结局测量指标（PROMs）的使用情况。
开展了一项混合方法研究，包括观察会诊以及对患者和医疗保健专业人员（HCPs）进行半结构化访谈，以确定使用PROMs的促进因素和障碍；依据理论领域框架对障碍和促进因素进行了梳理。对于每个障碍，使用行为改变技术分类法v1选择基于证据的改进策略。随后，由HCPs、信息技术专业人员和PROMs实施专家组成的专家小组对改进策略的优先级和可行性进行排序，制定了一项实施改进策略。
观察了10次会诊并进行了14次访谈。实施的障碍包括电子健康记录和PROMs与终端用户的个体需求不一致、HCPs不愿就健康相关生活质量问题向患者提供建议，以及对于由哪些HCPs负责与患者讨论PROMs缺乏共识。确定了41项改进策略，排序后保留了25项。这些策略包括：通过纳入患者管理建议重新设计PROMs仪表板、加强患者完成PROMs的支持，以及明确HCPs讨论PROMs的职责。目前认为可行性较低的策略包括：由于技术限制提高患者门户的用户友好性、使PROMs评估频率与临床病程一致，以及使用基线PROMs早期识别脆弱性和支持性护理需求。这些将在未来研究中进行探讨。
确定了基于证据的改进策略，以确保PROMs在临床实践中得到持久采用。
