Implementation of Patient-Reported Outcomes in Routine Medical Care

Patient-reported outcomes encompass data reported directly by people about how they feel and function, such as symptoms, physical function, and quality of life. Although many PRO questionnaires were initially developed for use in clinical trials, there is rapidly growing interest to integrate PROs into routine clinical practice for monitoring patient clinical status. An impetus for this movement is the body of evidence demonstrating that clinicians miss about half of their patients’ symptoms during treatment.1,2 Downstream consequences of missing symptoms include patient suffering due to poor symptom control, missed treatments, emergency department visits and hospitalizations, and physical debility. Indeed, poorly controlled symptoms are a principal driver of preventable emergency department visits, such as for pain, dyspnea, dehydration, nausea or vomiting, diarrhea, and fatigue.3,4 Multiple studies show that systematic monitoring of patients’ symptoms using PROs closes this gap, improving patient-clinician communication, clinician awareness of symptoms, symptom management, patient satisfaction, quality of life, and overall survival.5-7 Despite the clear benefits, there are challenges with integrating PROs into practice for monitoring patient status, as there are with any modifications to existing clinical processes. These challenges range from administrative to technical to workflow issues. A session at the 2018 ASCO Annual Meeting was dedicated to the implementation of PROs in clinical practice. The session focused on practical examples of PRO implementations, with honest reflections on barriers and strategies that may be generalizable to other systems looking to implement PROs. Panelists for that session are the authors of this paper, and each has summarized his or her respective content in the below sections. THE eRAPID SYSTEM IN ENGLAND (GALINA VELIKOVA, MD, PhD) Section: ChooseTop of pageAbstractTHE eRAPID SYSTEM IN ENGL... <