Lyu Jianxia, Zhang Hao, Wang Hua, Liu Xia, Jing Yunhua, Yin Li, Wang Aiping
Department of Head and Neck Radiation Oncology, Sichuan Cancer Hospital, Chengdu, China.
School of Nursing, Chengdu Medical College, Chengdu, China.
Implement Sci Commun. 2024 Oct 29;5(1):120. doi: 10.1186/s43058-024-00654-0.
In clinical oncology practice, patient-reported outcomes (PROs) are essential for assessing the symptom burden, quality of life, and psychological status of patients. However, there remains a gap between the use of PROs in an oncologic setting and its implementation. Furthermore, numerous reviews in PRO implementation are often based on one particular technology, setting, or health condition, making it difficult to obtain a comprehensive and coherent summary of available evidence to help plan and undertake implementation. This systematic review aims to identify and integrate enablers and barriers to PRO implementation through the comprehensive framework for implementation research (CFIR) to provide a reference for implementing patient-reported outcomes management in oncology settings.
This review strictly observed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed, Web of Science, CINAHL, Embase, and PsycINFO databases were systematically searched using a three-step search strategy. The search was limited from the inception of each database to April 2024. Articles describing facilitators and barriers to implementing PROs in clinical oncology practice were included. Two researchers screened the literature independently, and the quality assessment of cross-sectional, qualitative, and mixed studies was completed using the critical appraisal tools recommended by Joanna Briggs Institute (JBI) and the mixed methods assessment tool, respectively. Basic information about the included studies and determinants affecting PRO implementation was extracted, and coding categorization of facilitators and barriers was completed based on the 48 constructs provided by the CFIR framework.
We included 30 studies from 5,649 search results, including 25 original and 5 review studies. The quality of the literature for qualitative studies was generally good, and the quality for quantitative and mixed studies was assessed as fair. We identified 52 facilitators and 50 barriers in the included literature, covering the domains used in the CFIR framework and 39 constructs, mainly including "Innovation Evidence-Base", "Innovation Complexity", "Innovation Design", "Structural Characteristics", "Compatibility", "Incentive Systems", "Access to Knowledge & Information", "Innovation Deliverers", "Innovation Recipients", and "Planning".
This systematic review integrated facilitators and barriers affecting PRO implementation in routine oncology clinical practice settings and categorized them through the CFIR framework. These influencing factors should be fully considered in future clinical practice to ensure the successful implementation of PROs.
It has been registered prospectively in PROSPERO under the registration number 42024532983.
在临床肿瘤学实践中，患者报告的结局（PROs）对于评估患者的症状负担、生活质量和心理状态至关重要。然而，PROs在肿瘤学环境中的应用与实施之间仍存在差距。此外，许多关于PROs实施的综述往往基于一种特定的技术、环境或健康状况，因此难以获得全面连贯的现有证据总结，以帮助规划和开展实施工作。本系统综述旨在通过实施研究综合框架（CFIR）识别并整合PROs实施的促进因素和障碍，为在肿瘤学环境中实施患者报告结局管理提供参考。
本综述严格遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。使用三步搜索策略对PubMed、Web of Science、CINAHL、Embase和PsycINFO数据库进行系统检索。检索范围限制为各数据库建库至2024年4月。纳入描述临床肿瘤学实践中实施PROs的促进因素和障碍的文章。两名研究人员独立筛选文献，分别使用乔安娜·布里格斯研究所（JBI）推荐的批判性评价工具和混合方法评价工具完成横断面研究、定性研究和混合研究的质量评估。提取纳入研究的基本信息以及影响PROs实施的决定因素，并根据CFIR框架提供的48个构建模块完成促进因素和障碍的编码分类。
我们从5649条检索结果中纳入了30项研究，包括25项原创研究和5项综述研究。定性研究的文献质量总体良好，定量研究和混合研究的质量评估为中等。我们在纳入文献中确定了52个促进因素和50个障碍，涵盖CFIR框架中使用的领域和39个构建模块，主要包括“创新证据基础”“创新复杂性”“创新设计”“结构特征”“兼容性”“激励系统”“知识与信息获取”“创新实施者”“创新接受者”和“规划”。
本系统综述整合了影响常规肿瘤临床实践环境中PROs实施的促进因素和障碍，并通过CFIR框架对其进行了分类。在未来的临床实践中应充分考虑这些影响因素，以确保PROs的成功实施。
已在PROSPERO上进行前瞻性注册，注册号为42024532983。
