Schougaard Liv Marit Valen, Friis Rasmus Blechingberg, Grytnes Regine, Grove Birgith Engelst, Hjollund Niels Henrik, Pappot Helle, Skuladottir Halla, Mejdahl Caroline Trillingsgaard
AmbuFlex - Centre for Patient-reported Outcomes, Gødstrup Hospital, Herning, Denmark.
Department of Oncology, Gødstrup Hospital, Herning, Denmark.
Semin Oncol Nurs. 2023 Oct 26:151517. doi: 10.1016/j.soncn.2023.151517.
Patient-reported outcome (PRO) measures are commonly used in clinical practice, and an important aspect is how healthcare professionals use these measures to make clinical decisions. This study aimed 1) to understand how remote electronic symptom monitoring using PRO measures can support oncology nurses' clinical decision-making in patients with metastatic lung cancer and 2) to explore factors that potentially can influence how remote symptom monitoring supports clinical decision-making.
A qualitative approach using semistructured interviews was conducted with 18 registered nurses working with remote symptom monitoring at oncology departments at eight Danish hospitals.
Nurses reported that remote symptom monitoring supports clinical decision-making because it assisted in identifying relevant problems, monitoring relevant changes over time, and prompting relevant clinical actions. Factors that affected how remote symptom monitoring could support clinical decision-making were access to supplemental information, the trustworthiness of PRO data, nursing competencies and responsibilities, working conditions, and care at a distance.
The use of PRO data in the clinical decision-making process is highly dependent on the nurses' professional competencies, the organizational structure, and the trustworthiness of PRO data. Thus, we recommend considering these factors before implementing PRO data in routine care. For example, train clinical staff in using PRO data in their clinical decision-making, develop guidance for how to use PRO data with other forms of data to make sound clinical actions, and ensure that organizational resources are sufficient.
患者报告结局(PRO)指标在临床实践中普遍使用,一个重要方面是医疗保健专业人员如何使用这些指标来做出临床决策。本研究旨在:1)了解使用PRO指标的远程电子症状监测如何支持肿瘤专科护士对转移性肺癌患者的临床决策;2)探讨可能影响远程症状监测支持临床决策方式的因素。
采用半结构化访谈的定性方法,对丹麦八家医院肿瘤科从事远程症状监测工作的18名注册护士进行了访谈。
护士报告称,远程症状监测支持临床决策,因为它有助于识别相关问题、监测随时间的相关变化并促使采取相关临床行动。影响远程症状监测支持临床决策方式的因素包括获取补充信息、PRO数据的可信度、护理能力和职责、工作条件以及远程护理。
在临床决策过程中使用PRO数据高度依赖于护士的专业能力、组织结构以及PRO数据的可信度。因此,我们建议在将PRO数据应用于常规护理之前考虑这些因素。例如,培训临床工作人员在临床决策中使用PRO数据,制定如何将PRO数据与其他形式的数据结合使用以做出合理临床行动的指南,并确保组织资源充足。