Physician and patient perspectives on PROM implementation barriers in spine care and pain management: a mixed-methods...

Patient-Reported Outcome Measures (PROMs) are vital for patient-centred care but face implementation challenges. Within the participating academic medical centre's spine care and pain management clinics, PROMs were collected but underused, indicating a quality gap.

To identify and compare physician and patient perspectives on priorities, barriers and preferences for PROM implementation to inform a quality improvement initiative.

We conducted a mixed-methods evaluation (October 2024-December 2024) in two outpatient clinics. Data included quantitative surveys assessing priorities and challenges from physicians (N=8) and patients (N=35), and qualitative data from physician meeting field notes, patient interaction field notes and open-ended survey responses. Quantitative data were analysed descriptively; qualitative data underwent thematic analysis. Findings were integrated using triangulation.

Physicians and patients aligned on prioritising pain interference and physical function. However, patients prioritised pain severity and personal goals more highly than physicians. While 70% of patients found PROMs useful, only 24% reported discussing PROM findings with providers, and 75% of clinicians responded 'not at all confident' to a question about score interpretation. Implementation challenges diverged significantly: physicians universally (100%) cited perceived patient time burden as a barrier, but this concern was infrequently shared by patients (11.4%). Physicians also cited workflow integration as a barrier (87.5%), while patients primarily prioritised PROM format/design (37.1%) and relevance (28.6%). Five qualitative themes emerged across patients and physicians: (1) critiques of PROM content/fidelity; (2) disconnect between data collection and clinical integration; (3) prioritising function and patient-centred goals; (4) need for flexibility, customisation and communication and (5) system-level barriers influencing implementation.

Gaps exist between PROM collection and meaningful clinical use in this setting, driven by content limitations, workflow barriers, system issues and divergent stakeholder perspectives. Improving PROM implementation requires a multistakeholder approach prioritising function-focused, relevant measures integrated effectively into clinical workflows and support by system-level changes.