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Using Stakeholder Engagement to Overcome Barriers to Implementing Patient-reported Outcomes (PROs) in Cancer Care
Angela M Stover1,2, Carrie Tompkins Stricker3, Karen Hammelef3
1Department of Health Policy and Management.
Medical Care
|April 16, 2019
Summary
Patient-reported outcome (PRO) measures improve cancer care communication and symptom management. Engaging stakeholders was key to overcoming barriers and successfully implementing PROs in clinical settings.
Area of Science:
- Oncology
- Health Services Research
- Digital Health
Background:
- Patient-reported outcome (PRO) measures enhance cancer care delivery by improving patient-clinician communication and reducing service utilization for uncontrolled symptoms.
- Despite proven benefits, the adoption of PROs in routine cancer care has been limited.
Purpose of the Study:
- To describe stakeholder engagement strategies for overcoming barriers to PRO implementation in cancer care.
- To detail the implementation of PROs in two distinct settings: visit-based for multiple myeloma and remote monitoring between chemotherapy visits.
Main Methods:
- Involved clinician and patient input to identify key symptoms, select PRO measures, and define clinically concerning responses.
- Developed PRO-based clinical decision support (CDS) tools tailored to clinician feedback.
- Trained healthcare staff on PRO interpretation and software use.
- Monitored implementation impact, including the frequency of concerning PROs and subsequent nursing actions.
Main Results:
- Stakeholder input was crucial for tailoring PRO measures and CDS.
- Visit-based PROs displayed symptom scores on a clinician dashboard with available CDS for concerning responses.
- Remote PROs utilized automated email alerts and CDS for nurses when concerning symptoms were reported, with alert rates varying from 13% to 36% across sites.
- The most common nursing intervention for concerning PROs was patient counseling on symptom self-management.
Conclusions:
- Implementing PROs into cancer care facilitates tailored management based on identified patient issues.
- A stakeholder-driven approach is essential for successful PRO implementation and overcoming adoption challenges.
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