Implementation of PRO assessment in clinical practice
8. Evaluate to optimise and sustain
Evaluating the implementation serves:
- Optimisation of the PRO workflow by checking whether implementation goals are met and adjustments are needed.
- Support of sustainability through ongoing quality assurance and improvement.
The evaluation can be structured as a 4–5 step cycle.
- Set clear aims (e.g. feasibility, acceptance, clinical impact/benefit, resource needs).
- Make objectives specific and measurable.
according to the following considerations:
Match the outcomes with the respective objective
Examples:
- completion rates / level of integration for feasibility
- attitudes for acceptance
- initiated measures for clinical benefit
- time / cost for resources
Select evaluation methods that offer an appropriate balance between reliability, informative value, and resource requirements
Examples:
- surveys
- interviews
- clinical-documentation review
- data on PROM software use
Minimum: conduct and document individual or group discussions with relevant HCPs about usability, benefits, and problems.
- Use standardised procedures (forms, protocols) to ensure consistency.
- Minimise disruption to routine care and limit patient burden.
Depending on the data material:
- Apply quantitative methods (descriptive statistics, advanced analyses) and/or qualitative methods (narrative summaries, thematic analysis) as appropriate.
- Use suitable software where helpful; for ePROs, export PROM data directly from the system when possible.
Further information on the basics of quantitative and qualitative research
If indicated, based on findings, adjustments can be made to optimise the PRO assessment, e.g. regarding
- process (e.g. assessment instruments and times)
- target groups (e.g. patients, HCPs)
- resources (e.g. further acquisitions, personnel)
- equipment (e.g. software adaptation to increase usability)
- materials (e.g. instructions, algorithms to use PRO data)
Practical notes
- Agree early: Define the evaluation process during planning.
- Appropriate timing: Evaluation may begin at any implementation stage, depending on objectives and measures. E.g., evaluate clinical benefit only after routine PRO completion and clinical implementation reach a sufficient coverage to detect meaningful differences
- Pilot evaluation methods: Test the evaluation methods on a small scale to assess their feasibility, e.g. methods for measuring completion rates
- Share results: Discuss the findings with relevant interesrholders (HCPs, decision-makers, patients) to enhance acceptability and encourage further optimisation.
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