Implementing electronic Patient-Reported Outcome Measures in Chronic Kidney Disease: a qualitative systematic review...

This systematic review investigates the barriers, enablers and mechanisms affecting ePROMs implementation in CKD (chronic kidney disease) management, with a focus on the perspectives of patients and healthcare providers.

A qualitative systematic review was conducted using the UK Medical Research Council's Process Evaluation Framework to analyze studies on ePROM implementation in CKD care. We systematically searched databases for peer-reviewed qualitative studies published from inception to October 2025. Thematic analysis, guided by the Process Evaluation Framework, was used to synthesize the findings. Studies from PubMed, Embase, Scopus, CINAHL, and APA PsycINFO were included.

Results Eleven studies met the inclusion criteria. The synthesis identified distinct barriers and mechanisms of impact. Key barriers included structural and technical obstacles: digital literacy gaps, cognitive overload in vulnerable populations, misalignment with clinical IT systems, interface usability issues, and inconsistent implementation protocols. Regarding Enablers and Mechanisms, the review revealed a paradox. While ePROMs acted as enablers for personalized treatment and improved symptom awareness, their effectiveness was mediated by complex relational mechanisms. Both patients and clinicians expressed skepticism regarding utility in routine care. Furthermore, relational tensions arose when patient input was perceived as overlooked, highlighting that patient empowerment is conditional on the quality of the therapeutic alliance.

ePROMs have the potential to enhance CKD care by providing valuable insights into patient experiences. However, their adoption is hindered by digital literacy, technological issues, and inconsistent protocols. To optimize adoption, policymakers must prioritize IT integration and standardized protocols, while clinicians should actively incorporate results into consultations to validate patient input. Future research should focus on mixed-methods studies in diverse populations to ensure equitable and effective implementation.