Photo Credit: Aree Sarak

Patients found high value in integrating patient-reported outcomes into electronic health records, but expressed several areas of confusion.

A recent mixed methods study published in the Journal of Patient-Reported Outcomes explored patient perspectives on implementing a computer-based patient-reported outcomes (cPRO) program in a healthcare system’s EHRs as part of oncology care.

Madison J. Lyleroehr and colleagues aimed to identify facilitators and barriers to patient uptake and adherence, using insights to improve the program’s reach, adoption, sustainability, and effectiveness. They conducted the study using qualitative, semi-structured discussions and a quantitative survey.

“Findings aligned with what we had learned anecdotally from clinicians, administrators, and patients during cPRO implementation, but there were some unexpected results that contribute to the literature on facilitators and barriers to implementing electronic patient-reported symptom monitoring programs,” Lyleroehr and colleagues reported.

The findings showed that patients generally valued cPRO, noting improved communication with care teams and enhanced self-efficacy. Despite low engagement from care teams, 42% of patients felt cPRO helped them manage their symptoms more effectively. Many patients appreciated how cPRO facilitated reflection on symptoms and better prepared them for medical visits.

However, a significant portion of respondents (27.7% to 56.7%) reported rarely being asked about common physical and psychological symptoms during routine care.

Using patients’ feedback, the researchers made several changes to improve cPRO implementation. They designed a shorter version of the tool, which yielded higher completion rates. To address the gap in patient education, the researchers planned to expand educational materials, which is now feasible with eased COVID-19 restrictions. The investigators are developing a patient-facing video, clinician talking points, and better educational material distribution tracking.

Efforts to boost clinician engagement are also underway, according to the authors, who noted that increased communication from clinicians about cPRO can improve patient compliance and experience.

The study’s limitations include variability in the time between cPRO completion and feedback session participation, which could have impacted recall. The study participants had high technology literacy, and the setting was a well-resourced academic health center. Additionally, most data collection occurred during the COVID-19 pandemic, which affected in-clinic cPRO administration and the feasibility of higher-touch implementation strategies.

Nevertheless, the researchers concluded that adult patients found cPRO easy to use and valuable but highlighted the need for better education and clinician engagement to sustain regular use.

“Informed by these data, future cPRO implementation strategies and modifications should target increasing clinician engagement and patient education to further enhance perceived value, compliance, and, ultimately, higher quality, patient-centered cancer care,” Lyleroehr and colleagues concluded.