Implementing digital patient-reported outcomes in routine cancer care: barriers and facilitators

In cancer care research, there exists a gap between patient-reported outcomes (PROs) and health care personnel-reported outcomes. PROs have shown significant benefits in terms of symptoms, quality of life, reduced hospital admissions and increased overall survival. However, throughout the past decade, PROS have been used mainly in clinical trials and slowly implemented in routine cancer care. We wanted to review specific published experiences identified as barriers to and facilitators of the implementation of digital PROs in routine cancer care.

A literature search was conducted in PubMed and Ovid Medline Evidence-Based Medicine Reviews (EBMRs) from 1 January 2017 to 29 August 2023. A total of 313 records were screened, of which 15 records were included. Facilitators identified were a user-friendly electronic PRO (ePRO) solution routinely used by care providers in a revised workflow that engaged key stakeholders and provided sufficient support and infrastructure. Common barriers were lack of information about benefits, time constraints, literacy or lack of access to text or information technology (IT) together with a negative impact on workflow, inadequate IT infrastructure, not engaging staff and costs.

Successful implementation of ePRO systems needs to address identified barriers and leverage facilitators. Using implementation frameworks and guidelines with quality improvement methods can enhance successful implementation as they address both local barriers and facilitators in a system thinking perspective. There is still an unmet need for real-world evidence on how sustainable PROs can be implemented most efficiently over time, thus highlighting the need for a bridge between medical and implementation science.