Providers' perspectives on implementing alert-based patient-reported outcome monitoring for stage IV breast cancer

Using digital patient monitoring with patient-reported outcomes (PROs) is increasing. However, these new digital care tools have not yet been adequately implemented in routine cancer care. To address this issue, we conducted a process evaluation to accompany the PRO B study, a multicenter randomized and controlled trial across Germany, which examined the impact of alert-based PRO monitoring in stage IV breast cancer patients. This article presents the results of this process evaluation from the perspective of participating health-care providers, focusing on determinants for successful implementation.

Semi-structured interviews with 15 interviewees from 12 certified breast cancer centers across Germany participating in the PRO B study were conducted. Interviews were structured by content analysis using the Consolidated Framework for Implementation Research (CFIR).

Key findings include the pivotal role of study nurses in managing the PRO monitoring system and its alerts, engaging patients, and ensuring continuity of care, alongside the providers' generally favorable views of the intervention. However, challenges such as limited digital infrastructure and the need for integration into existing hospital information systems were noted.

The study highlights the crucial role of nurses, existing infrastructure, and streamlined processes for integrating PRO monitoring into routine clinical practice. Providers' experiences with the intervention highlighted the need for workflow adjustments and additional training for effective implementation in routine cancer care. Tailored solutions, including integration into existing digital patient record systems and processes, as well as resource allocation, are essential for the successful adoption of PRO monitoring in a health-care system.