How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis

Joanne Greenhalgh, Kate Gooding, Elizabeth Gibbons, Sonia Dalkin, Judy Wright, Jose Valderas, Nick Black, Joanne Greenhalgh, Kate Gooding, Elizabeth Gibbons, Sonia Dalkin, Judy Wright, Jose Valderas, Nick Black

Abstract

Background: In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care. We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians' awareness of patients' problems and prompts discussion and action. We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes.

Results: PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians. However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication. In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships. Individualised PROMs supported dialogue by enabling the patient to tell their story. In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL). Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit.

Conclusions: This paper makes two important contributions to the literature. First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition. Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries. Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making.

Keywords: Clinician-patient communication; Feedback; Patient reported outcome measures; Realist synthesis.

Conflict of interest statement

Our review did not require that we collected data from human subjects. NHS managers, clinicians and patients helped shape the focus of the review through workshops and we applied for light touch ethical review and were given ethical approval from the University of Leeds Ethics Committee, Reference: LTSSP-019. Our review was registered on the PROSPERO database: CRD42013005938.N/AWe confirm that all authors have approved the final manuscript and have no conflicts of interest.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Selection of papers that contributed to the development of the initial programme theories
Fig. 2
Fig. 2
Process of paper review and selection for synthesis reported in this paper
Fig. 3
Fig. 3
Selection of papers from citation searches conducted in February 2018
Fig. 4
Fig. 4
PROMs feedback in the care of individual patients: Implementation chain at start of synthesis

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Source: PubMed

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