Perceived Barriers Toward Patient-Reported Outcome Implementation in Cancer Care: An International Scoping Survey

Lawson Eng; Raymond J Chan; Alexandre Chan; Andreas Charalambous; H S Darling; Lisa Grech; Corina J G van den Hurk; Deborah Kirk; Sandra A Mitchell; Dagmara Poprawski; Elke Rammant; Imogen Ramsey; Margaret I Fitch; Yin Ting Cheung

doi:10.1200/OP.23.00715

Perceived Barriers Toward Patient-Reported Outcome Implementation in Cancer Care: An International Scoping Survey

JCO Oncol Pract. 2024 Mar 8:OP2300715. doi: 10.1200/OP.23.00715. Online ahead of print.

Authors

Lawson Eng¹, Raymond J Chan², Alexandre Chan³, Andreas Charalambous^{4

5}, H S Darling⁶, Lisa Grech⁷, Corina J G van den Hurk⁸, Deborah Kirk^{9

10}, Sandra A Mitchell¹¹, Dagmara Poprawski^{12

13}, Elke Rammant¹⁴, Imogen Ramsey², Margaret I Fitch¹⁵, Yin Ting Cheung^{16

17}

Affiliations

¹ Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada.
² Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.
³ Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, CA.
⁴ Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.
⁵ Department of Nursing, University of Turku, Turku, Finland.
⁶ Department of Medical Oncology, Command Hospital Air Force, Bangalore, India.
⁷ School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Medicine Monash Health, Monash University, Melbourne, VIC, Australia.
⁸ R&D Department, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
⁹ School of Nursing and Midwifery, Edith Cowan University, Bunbury, WA, Australia.
¹⁰ School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia.
¹¹ Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.
¹² Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia.
¹³ College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
¹⁴ Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
¹⁵ Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
¹⁶ School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
¹⁷ Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.

PMID: 38457755
DOI: 10.1200/OP.23.00715

Abstract

Purpose: Implementation of patient-reported outcomes (PROs) collection is an important priority in cancer care. We examined perceived barriers toward implementing PRO collection between centers with and without PRO infrastructure and administrators and nonadministrators.

Patients and methods: We performed a multinational survey of oncology practitioners on their perceived barriers to PRO implementations. Multivariable regression models evaluated for differences in perceived barriers to PRO implementation between groups, adjusted for demographic and institutional variables.

Results: Among 358 oncology practitioners representing six geographic regions, 31% worked at centers that did not have PRO infrastructure and 26% self-reported as administrators. Administrators were more likely to perceive concerns with liability issues (aOR, 2.00 [95% CI, 1.12 to 3.57]; P = .02) while having nonsignificant trend toward less likely perceiving concerns with disruption of workflow (aOR, 0.58 [95% CI, 0.32 to 1.03]; P = .06) and nonadherence of PRO reporting (aOR, 0.53 [95% CI, 0.26 to 1.08]; P = .08) as barriers. Respondents from centers without PRO infrastructure were more likely to perceive that not having access to a local PRO expert (aOR, 6.59 [95% CI, 3.81 to 11.42]; P < .001), being unsure how to apply PROs in clinical decisions (aOR, 4.20 [95% CI, 2.32 to 7.63]; P < .001), and being unsure about selecting PRO measures (aOR, 3.36 [95% CI, 2.00 to 5.66]; P < .001) as barriers. Heat map analyses identified the largest differences between participants from centers with and without PRO infrastructure in agreed-upon barriers were (1) not having a local PRO expert, (2) being unsure about selecting PRO measures, and (3) not recognizing the role of PROs at the institutional level.

Conclusion: Perceived barriers toward PRO implementation differ between administrators and nonadministrators and practitioners at centers with and without PRO infrastructure. PRO implementation teams should consider as part of a comprehensive strategy including frontline clinicians and administrators and members with PRO experience within teams.