Implementation of patient-reported outcome measures in oncology practice: a communication-centered qualitative study on patient and healthcare professional perspectives

Abstract

Patient-reported outcome measures (PROMs) are increasingly used in oncology to support patient-centered care, yet their implementation in routine practice remains inconsistent. Using a communication-centered perspective which conceptualizes PROMs implementation as a process of meaning exchange between patients, clinicians, and implementation staff, this study examined PROMs implementation as a multi-stage process and explored how it unfolds in real-life oncology care, drawing on both patient and healthcare professional perspectives. A qualitative interview study was conducted in the Netherlands with patients with cancer (n = 10) and healthcare professionals and implementation staff in oncology care (n = 7). Semi-structured interviews were informed by a communication-centered framework conceptualizing PROMs implementation as a multi-stage process. Data were analyzed using hybrid inductive-deductive thematic analysis. Six interrelated stages of PROMs implementation were identified: (1) selecting and organizing PROMs use, (2) establishing purpose and motivation, (3) experiencing PROMs as a task, (4) making sense of results together, (5) applying PROMs information in care, and (6) evaluating and improving PROMs implementation. Findings showed that experiences at different stages were interconnected: processes occurring earlier in the implementation influence how PROMs were later understood, discussed, and used in care. Across roles, participants recognized PROMs’ potential to support communication beyond clinical indicators, while also describing frustration when PROMs were collected but not meaningfully used. Patient and clinician engagement influenced one another across stages, reflecting the reciprocal nature of PROMs as a communication tool. PROMs implementation should be viewed as an interdependent, sequential process. Improving connections between stages is essential to realizing PROMs’ communicative and patient-centered potential in oncology care. Practical strategies such as personalizing PROMs invitations, completing the feedback loop between PROMs results and patients, and integrating supportive tools for clinicians can help translate PROMs data into meaningful patient-centered dialogue. Patient-reported outcome measures (PROMs)—questionnaires about symptoms and quality of life—are increasingly used in cancer care. These questionnaires, often completed by patients before or between appointments, are meant to help healthcare professionals understand how patients are really doing beyond medical test results. However, in daily practice, these questionnaires are not always used in a consistent or meaningful way. This study was needed to understand why this happens. We examined how these questionnaires are introduced, completed, discussed, and used in real-life oncology care. In particular, we asked: at which points in this process do problems arise, and how do these problems affect patient care? We interviewed cancer patients and healthcare professionals in the Netherlands. We found that using these questionnaires is not a single action, but a series of connected steps. When early steps, such as clearly explaining the purpose, are not well communicated, later steps, such as discussing results during consultations, are also less effective. Both patients and professionals acknowledged the potential of these questionnaires to improve communication, but they were frustrated when answers were collected without follow-up. Our findings suggest that improving how these steps connect in practice can help turn questionnaires into more meaningful conversations and more patient-centered cancer care.