6. Implementation of PRO assessment in clinical practice
Engage relevant interest-holders (2)
Interest-holders have different roles and priorities. Engaging all relevant groups helps surface competing interests and find workable solutions.
Key groups for implementing PRO assessment:
Role: primarily to complete PROMs and may use PRO data for self-management.
Needs: relevance of PROMs, easy handling, minimal burden of completion.
Challenges:
doubts about usefulness
concerns about mode (e.g., technology, data security)
physical/cognitive impairments
high symptom burden.
Engagement strategies:
brief, clear introduction as part of standard care (what/why/how; room for questions)
supportive materials (e.g. covering purpose, handling, data protection).
relevant, concise, and user-friendly PRO assessment
most importantly:use the data—take PROs seriously, discuss them, and act on them! (PRO-based clinical communication: chapter 8, PRO-based initiation of clinical interventions: chapter 9).
Role:
decision on/approval of scope/mode, resources, acquisitions, responsibilities of implementation
relevant for the motivation of all parties involved.
Needs: understanding of PROM concept/value/benefits, intended workflow integration and feasibility.
Challenges:
limited PROM knowledge
doubts about value/benefit vs cost
competing priorities
reluctance to fund uncertain projects.
Engagement strategies:
early information including tailored rationale and rough idea of workflow
discussion of their expectations
confirming relevance of support and permission
Healthcare professionals
Role: key users who
introduce PROMs to patients
use PRO data for communication and clinical decisions
know setting-specific workflows and are impacted by changes.
Needs:
Understanding of PROMs and their benefits
Perception of the relevance and usefulness of PRO data for personal practice
confidence in the feasibility of implementation and integration into workflows
competence in PRO data collection
competence in the communication and clinical use of PRO data.
Challenges:
high workload
limited knowledge (benefits, interpretation)
negative attitudes
reluctance to changing routines.
Engagement strategies:
open discussion
involvement in key decisions (goals, PROM selection, mode, responsibilities)
information/training (Step 6)
minimisation of workload (embed in routines, support staff, simple logins, easy usabilty);
recruitment of especially motivated HCPs as clinical champions to model PROM use and motivate peers.
Administrators
Role: enabling of infrastructure and process integration (software/devices, interoperability, security).
Needs: understanding of
purpose and benefits of PRO assessment,
workflow requirements, feasibility and impact on existing systems.
Challenges:
limited time
limited PROM knowledge
concerns about workload/priority.
Engagement strategies:
early involvement in workflow and procurement decisions
clear definition of responsibilities
adequate allocation of resources.
If available, persons with previous PROM implementation experience should be involved, particularly to guide the planning process.
Antunes, Harding, Higginson, & EUROIMPACT, 2014; E. Basch et al., 2012; Ethan Basch, Rogak, & Dueck, 2016; Nordhausen et al., 2022; Skivington et al., 2021; Snyder et al., 2012; Wintner et al., 2016; ISOQOL, 2015
