Developing feasible and acceptable strategies for integrating the use of patient-reported outcome measures (PROMs) in gender-affirming care: An implementation study

Abstract

Objective Use CFIR guidance to create comprehensive, evidence-based, feasible, and acceptable gender-affirming care PROM implementation strategies. Design, setting, participants A 3-Phase participatory process was followed to design feasible and acceptable strategies for integrating PROMs in gender-affirming care. In Phase 1, barriers and enablers to PROM implementation for gender-affirming care were identified from a previous systematic review and our prior qualitative study. We used the CFIR-ERIC tool to match previously identified barriers and enablers with expert-endorsed implementation strategies. In Phase 2, implementation strategy outputs from CFIR-ERIC were organised according to cumulative percentage value. In Phase 3, gender-affirming care PROM implementation strategies underwent iterative refinement based on rounds of stakeholder feedback with seven patient and public partners and a gender-affirming healthcare professional. Results The systematic review and qualitative study identified barriers and enablers to PROM implementation spanning all five CFIR domains, and 30 CFIR constructs. The top healthcare professional-relevant strategies to PROM implementation from the CFIR-ERIC output include: identifying and preparing implementation champions, collecting feedback on PROM implementation, and capturing and sharing local knowledge between clinics on implementation. Top patient-relevant strategies include: having educational material on PROMs, ensuring adaptability of PROMs, and collaborating with key local organisations who may be able to support patients. Conclusions This study developed evidence-based, feasible, and acceptable strategies for integrating PROMs in gender-affirming care, representing evidence from a systematic review of 286 international articles, a qualitative study of 24 gender-affirming care patients and healthcare professionals, and iteration from 7 patient and public partners and a gender-affirming healthcare professional. The finalised strategies include patient- and healthcare professional-relevant strategies for implementing PROMs in gender-affirming care. Clinicians and researchers can select and tailor implementation strategies best applying to their gender-affirming care setting.

Patient and healthcare professional perspectives on the Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC): analysis of open-ended responses from patients and healthcare professionals

“…The PG-PROM-GAC contains two tables with sections which can help guide PROM implementation: one section focuses on patient-relevant strategies, and another section focuses on healthcare professional (HCP)-relevant strategies. 7 The PG-PROM-GAC is also being used by the leads of a National Health System (NHS) England workstream for PROMs in gender clinics to help implement PROMs in NHS gender clinics. The PG-PROM-GAC has been developed over the past 3 years and is an output of previously reported projects from a University of Oxford doctorate including the following: ► A systematic review of 286 international articles (representing 85 395 transgender and gender-diverse (TGD) patients).…”

“…The Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC) is a resource which can help clinicians, researchers and policymakers implement PROMs more effectively and consistently for their gender-affirming care setting. 7 Over 200 different PROMs for adult gender-affirming care and 38 different PROMs for paediatric gender-affirming care have been identified which have the potential to be implemented into clinical practice. 1 8 This large number of existing PROMs contributes to potential redundancy and complexity with PROM implementation as guidance is lacking on the best PROMs to implement for gender-affirming care.…”

Practical guide to implementing patient-reported outcome measures in gender-affirming care: evaluating acceptability, appropriateness and feasibility

“…[10][11][12][13] The Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC) comprises evidence-based, patient-relevant and healthcare professional-relevant strategies developed to aid PROM implementation for gender-affirming care. 14 The PG-PROM-GAC has been developed through a systematic review of 286 studies representing over 85 000 transgender and gender diverse (TGD) patients, a qualitative study of 14 TGD patients and 10 gender-affirming healthcare professionals, and iterative refinement with 7 TGD patients and 1 gender-affirming healthcare professional. 14 The PG-PROM-GAC can be used to guide and maximise implementation of one of the 200+ identified PROMs available for specific needs in gender-affirming care settings.…”

“…14 The PG-PROM-GAC has been developed through a systematic review of 286 studies representing over 85 000 transgender and gender diverse (TGD) patients, a qualitative study of 14 TGD patients and 10 gender-affirming healthcare professionals, and iterative refinement with 7 TGD patients and 1 gender-affirming healthcare professional. 14 The PG-PROM-GAC can be used to guide and maximise implementation of one of the 200+ identified PROMs available for specific needs in gender-affirming care settings. 14 15 Before the PG-PROM-GAC can be used by clinicians and researchers, it is essential to evaluate its acceptability, appropriateness and feasibility.…”

“…The resource for this study is the PG-PROM-GAC, 14 which comprises two tables with evidence-based strategies that might improve PROM uptake. One table focuses on patient-relevant strategies for PROM implementation and the other focuses on healthcare professional strategies for PROM implementation (online supplemental appendix 1).…”