Dr Rachel Campbell

Dr Rachel Campbell is a post-doctoral researcher at the Quality of Life Office at University of Sydney. Her research focusses on optimising the use of patent-reported outcome measures (PROMs) in oncology research and clinical practice. She is particularly interested in the implementation of PROMs in clinic to improve patient outcomes.

Abstract

Implementing patient-reported outcome measures (PROMs) in clinical practice: A meta-review of reviews

Rachel Campbell1*, Claudia Rutherford1,2, Fabiola Müller1, Natasha Roberts3,4,5, Melissa Tinsley6, Robyn Speerin6, Linda Soars7, Anna Butcher8, Madeleine King1

1 Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
2 Sydney Nursing School, Cancer Nursing Research Unit (CNRU), The University of Sydney, Camperdown, Australia
3 Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
4 Queensland University of Technology, Brisbane, QLD, Austrlia
5 Metro North Health Service, Brisbane, QLD, Austalia
6 NSW Agency for Clinical Innovation, Chatswood, NSW, Australia
7 Western Sydney Local Health District, North Parramatta, NSW, Australia
8 Northern Sydney Local Health District, St Leonards, NSW, Australia

Implementation of PROMs in clinical practice can improve care at the micro-level (i.e. by informing and improving the management of individual patients) and at the meso- and macro-levels (i.e. where aggregated data can help to guide improvements in clinical care and inform health policy). However, various practical, methodological and attitudinal barriers can hinder their effective implementation.

This meta-review of reviews aimed to synthesise evidence about (1) why PROMs are used in clinical practice (e.g. for what purpose); (2) their effectiveness in improving care and outcomes; and (3) the barriers to implementing PROMs at micro, meso and macro levels.

In accordance with methods for umbrella reviews, we searched five electronic databases for reviews that met the following criteria: published in English; comprehensively or systematically examined the use or implementation of PROMs in any health condition, setting, and geographical location; published between 1999 and February 2019. Two independent reviewers applied the inclusion criteria. Data was extracted by one reviewer and cross-checked by another. Key findings were qualitatively synthesised.

We identified 48 reviews. There is convincing evidence that using PROMs in clinic improves processes of care (i.e. patient-clinician communication and patient satisfaction). There is emerging evidence that PROMs can predict prognosis, and accurately screen for mental health issues and unmet needs. However, the evidence that PROM assessment improves patient health outcomes is equivocal. Barriers to PROM implementation include: 1) pre-existing clinical practice, culture and behaviours; 2) difficulty in choosing appropriate and informative PROMs for a given context; 3) lack of knowledge/understanding of PROMs (e.g. how to use and interpret PROM data) and their value in the clinical context (e.g. how to use PROMs in real-time to inform care). There is a dearth of studies examining the utility of PROM data for decision making at meso- and macro-levels.

Conclusive evidence supports the use of PROMs in clinical practice for treatment planning and decision-making for individual patients. Use of PROMs facilitates the provision of timely person-centred care, improves patient-clinician communication, and the provision of tailored referrals based on patient needs. However, evidence is equivocal about whether patient outcomes also improve. This is possibly due to a multitude of context-specific factors. The effective implementation of PROMs may be key to availing of their full potential. More research is needed to examine the use of PROM data for quality assurance and policy-making.