PRO-based follow-up as a means of self-management support – an interpretive description of the patient perspective

Mejdahl, Caroline Trillingsgaard; Schougaard, Liv Marit Valen; Hjøllund, Niels Henrik; Riiskjær, Erik; Thorne, Sally; Lomborg, Kirsten

doi:10.1186/s41687-018-0067-0

Cited by 43 publications

(68 citation statements)

References 28 publications

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“…A qualitative study has documented a variation in patients' preferences for being active and taking responsibility in PRO-based follow-up, as some patients experienced a lack of confidence in their own capability to participate [46]. In addition, a study regarding the clinician perspective indicated that some clinicians had concerns regarding some patients' capability to participate in PRO-based follow-up, even though the patient had already been referred [43].…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic, personal, and disease-related determinants of referral to patient-reported outcome-based follow-up of remote outpatients: a prospective cohort study

et al. 2020

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Purpose We examined the association between sociodemographic, personal, and disease-related determinants and referral to a new model of health care that uses patient-reported outcomes (PRO) measures for remote outpatient follow-up (PRObased follow-up). Methods We conducted a prospective cohort study among outpatients with epilepsy at the Department of Neurology at Aarhus University Hospital, Denmark. Included were all persons aged ≥ 15 years visiting the department for the first time during the period from May 2016 to May 2018. Patients received a questionnaire containing questions about health literacy, self-efficacy, patient activation, well-being, and general health. We also collected data regarding sociodemographic status, labour market affiliation, and co-morbidity from nationwide registers. Associations were analysed as time-to-event using the pseudo-value approach. Missing data were handled using multiple imputations. Results A total of 802 eligible patients were included in the register-based analyses and 411 patients (51%) responded to the questionnaire. The results based on data from registers indicated that patients were less likely to be referred to PRO-based follow-up if they lived alone, had low education or household income, received temporary or permanent social benefits, or if they had a psychiatric diagnosis. The results based on data from the questionnaire indicated that patients were less likely to be referred to PRO-based follow-up if they reported low levels of health literacy, self-efficacy, patient activation, wellbeing, or general health. Conclusion Both self-reported and register-based analyses indicated that socioeconomically advantaged patients were referred more often to PRO-based follow-up than socioeconomically disadvantaged patients.

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Section: Discussionmentioning

confidence: 99%

Sociodemographic, personal, and disease-related determinants of referral to patient-reported outcome-based follow-up of remote outpatients: a prospective cohort study

et al. 2020

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“…Furthermore, PROs may facilitate patient-centred consultations by providing patients with an opportunity to communicate on topics they find important and that may otherwise not be addressed [19,20]. However, the use of PROs in the clinic is not able in itself to ensure patient involvement and patientcentred consultations [21,22]. If clinicians do not value PROs or consider patients' assessment of the situation and of their illness as important knowledge, then PROs are suggested not to make a difference to the dialogue [23].…”

Section: Patient-reported Outcomesmentioning

confidence: 99%

“…For clinicians, the harms may include information overload, spending time on finding and reviewing PRO data and identifying problems without being able to use the data in the consultation or having access to appropriate interventions [30]. For patients, answering PRO measures without receiving any or only superficial response to the problems reported, can leave them with a feeling of being abandoned and alone, and may cause decreased motivation for filling in the PRO measures [21]. Therefore, the first step towards success is to devise implementation strategies, including training of clinicians in using PROs in a clinical context.…”

Section: Patient-reported Outcomesmentioning

confidence: 99%

The development of PROmunication: a training-tool for clinicians using patient-reported outcomes to promote patient-centred communication in clinical cancer settings

Skovlund

Ravn

Seibæk

et al. 2020

J Patient Rep Outcomes

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Background: The value of using real-time patient-reported outcome (PRO) measures in cancer communication has gained attention both in the clinic and in research. Despite this, no internationally accepted guidelines or training programs for clinicians on how to engage in patient-centred communication based on PROs exist. Lack of training may complicate implementation and systematic use of PROs in the clinic. We aimed to develop a short and feasible manual and training session in PRO-based dialogue rooted in patient-centred communication, coined PROmunication. Methods: PROmunication was implemented in two studies using PROs in different clinical cancer settings. We interviewed clinicians twice during the development phase. First, adopting a clinical perspective, they provided ideas for content, length and structure of the training session and the manual. Second, they approved the draft of the manual with minor adjustments on how to document clinician-patient communication. The final version of the PROmunication tool was built on clinicians' input, theory on patientcentred communication, a literature review, and didactic considerations. Results: The one-page manual gave clinicians a brief and clear overview of how to prepare for, undergo and document a PRO-based consultation. Illustrations and verbal phrases were offered to operationalize and facilitate patient-centred communication. The training session included elements like evidence-based knowledge about the rationale, benefits and challenges of using PROs and comprised theory, experimental training and instructions for the use of the manual in clinical practice. Ad hoc training and feedback in the clinic followed the training session. Conclusions: This paper presents the development of a short, theory-driven manual and training session intended to support and engage clinicians in PRO-based dialogue leading to patient-centred communication. Further testing of the tool is necessary and adjustments may be required if the PROmunication tool should

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“…In outpatient settings, PRO measures can be seen as a precursor of the upcoming consultation, legitimizing its relevance. Although PRO measures hold much potential, research shows that applying PRO measures in clinical practice does not automatically promote patient involvement and improve communication [21,22]. A number of barriers impeding the improvement of healthcare quality through PRO measures have been identified.…”

Section: Introductionmentioning

confidence: 99%

Patient-reported outcome measures in the interaction between patient and clinician – a multi-perspective qualitative study

Mejdahl

Schougaard

Hjøllund

et al. 2020

J Patient Rep Outcomes

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Background: This article addresses patient-reported outcome (PRO)-based follow-up used as a substitute for regularly scheduled follow-ups. In PRO-based follow-up, patients' PRO data filled in by the patients at home are used by clinicians as a decision aid to identify those who need clinical attention based on an automated PRO algorithm, clinical attention being either a phone call or a physical consultation. A physical consultation in the outpatient clinic prompted by the patient's PRO is termed a "PRO consultation." In this multi-perspective qualitative study, we explored the influence of patients' self-reported data on patientclinician interaction during PRO consultations in epilepsy outpatient clinics. Interpretive description was the methodological approach, applying data from participant observations, informal interviews with clinicians, and semi-structured interviews with clinicians and patients. Results: We found that application and deliberate use of patients' PRO measures can affect patient-clinician interaction, promoting patient involvement in terms of improved communication and increased patient activation. These findings reflect the general patterns that have been reported in the literature. In addition, we found that PRO measures also may induce unmet expectations among some patients that can have a negative effect on patients' experiences of the interaction and their follow-up experience in general. We extracted two thematic patterns that represent PRO measures' potential for patient involvement in the patient-clinician interaction. The first pattern represents enablers, and the second pattern represents barriers for PRO measures to affect patient involvement. Conclusions: Applying PRO measures in clinical practice does not automatically enhance the patient-clinician interaction. To strengthen the benefits of PRO measures, the following supplementary clinical initiatives are suggested: summarizing and reporting the PRO measures back to the patient, considering carefully which PRO measures to include, training clinicians and assuring that the patients' introduction to PRO-based followup clarifies expectations.

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PRO-based follow-up as a means of self-management support – an interpretive description of the patient perspective

Cited by 43 publications

References 28 publications

Sociodemographic, personal, and disease-related determinants of referral to patient-reported outcome-based follow-up of remote outpatients: a prospective cohort study

Sociodemographic, personal, and disease-related determinants of referral to patient-reported outcome-based follow-up of remote outpatients: a prospective cohort study

The development of PROmunication: a training-tool for clinicians using patient-reported outcomes to promote patient-centred communication in clinical cancer settings

Patient-reported outcome measures in the interaction between patient and clinician – a multi-perspective qualitative study

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