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Micro-Meso-Macro Practice Tensions in Using Patient-Reported Outcome and Experience Measures in Hospital Palliative
Marian Krawczyk1, Richard Sawatzky1, Kara Schick-Makaroff2
1Trinity Western University, School of Nursing, Langley, British Columbia, Canada.
Abstract:
This article applies a micro-meso-macro analytical framework to understand clinicians' experiences and perspectives of using patient-reported outcome and experience measures (PROMs and PREMs) in routine hospital-based palliative care. We structure our discussion through qualitative analysis of a design and implementation project for using an electronic tablet-based tool among hospital-based palliative clinicians to assess patients' and their family caregivers' quality of life concerns and experiences of care. Our analysis identified three categories of practice tensions shaping clinicians' use of PROMs and PREMs in routine care: tensions surrounding implementation, tensions in standardization and quantification, and tensions that arose from scope of practice concerns. Our findings highlight that clinicians necessarily work within the confluence of multiple system priorities, that navigating these priorities can result in irreducible practice tensions, and that awareness of these tensions is a critical consideration when integrating PROMs and PREMs into routine practice.
Insights
Clinicians face practice tensions when using patient-reported outcome and experience measures (PROMs and PREMs) in palliative care. Understanding these implementation, standardization, and scope of practice tensions is crucial for effective integration.
Area of Science:
- Palliative Care
- Health Services Research
- Clinical Informatics
Background:
- Patient-reported outcome and experience measures (PROMs and PREMs) are increasingly used in healthcare.
- Integrating PROMs and PREMs into routine clinical practice presents challenges.
- Understanding clinician perspectives is vital for successful implementation.
Purpose of the Study:
- To explore clinicians' experiences and perspectives on using PROMs and PREMs in hospital-based palliative care.
- To identify practice tensions encountered by clinicians during the integration of PROMs and PREMs.
- To provide insights for optimizing the use of PROMs and PREMs in routine palliative care.
Main Methods:
- Qualitative analysis of a design and implementation project.
- Utilized an electronic tablet-based tool for assessing patient and family caregiver outcomes.
- Focused on hospital-based palliative care clinicians.
Main Results:
- Identified three categories of practice tensions: implementation, standardization/quantification, and scope of practice.
- Clinicians navigate multiple, often conflicting, system priorities.
- These competing priorities lead to irreducible practice tensions.
Conclusions:
- Awareness of practice tensions is critical for integrating PROMs and PREMs into routine palliative care.
- Successful implementation requires addressing the interplay between system priorities and clinical practice.
- Further research should focus on strategies to mitigate identified practice tensions.
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