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