Real-world implementation of electronic patient-reported outcomes in outpatient pediatric cancer care

Abstract

Objective

The KLIK method is an online tool to monitor and discuss electronic patient-reported outcomes (ePROs), which has been shown to enhance outcomes. This study aimed to (1) determine the fidelity (i.e., extent to which used as intended) of the KLIK method as implemented in outpatient pediatric cancer care, and (2) study healthcare professional (HCP)-reported barriers and facilitators for implementation.

Methods

Two hundred and five children with newly-diagnosed cancer (enrollment rate 85%) participated. At one (T1), three (T2) and six (T3) months post-diagnosis, patients (8–18 years) or parents (of patients 0–7 years) completed health-related quality of life (HRQoL) questionnaires, which were transformed into an ePROfile and discussed by their HCP during consultations. Fidelity was determined by: percentage of website registrations, HRQoL-questionnaires completed, and ePROfiles discussed. Implementation determinants were assessed with HCPs after the final T3 with the Measurement Instrument for Determinants of Innovations.

Results

Depending on time point (T1-T3), fidelity was 86-89% for website registration, 66-85% for completed HRQoL-questionnaires, and 56-62% for ePROfile discussion. Barriers were mainly related to organizational issues (e.g. organizational change) and less frequently to users (e.g. motivation to comply) or the intervention (compatibility). Facilitators were related to the user (e.g. positive outcome expectations) and intervention (simplicity), but not to the organization.

Conclusions

When implementing ePROs in outpatient pediatric oncology practice, HCPs report determinants that influence ePRO integration. To improve implementation and outcomes, tailored organizational (e.g. formal ratification by management, time) and specific local (e.g. individualized assessments) strategies should be developed to achieve optimal ePRO discussion. This article is protected by copyright. All rights reserved.

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