Dr Joanne Greenhalgh from the University of Leeds. “For whom and in what circumstances does the feedback of individual patient reported outcome measures (PROMs) improve the patient care?”
We conducted a realist synthesis to explore the contexts in which and processes through which PROMs enable patients to share concerns with clinicians and change clinicians’ communication practices. We identified the ideas and assumptions (program theories) underlying how PROMs use was intended to work and developed an overall model to act as a framework for the review. Electronic databases were searched and backwards and forward citation tracking were carried out on key systematic reviews. We selected papers relevant to testing our theories and 36 papers were included.
PROMs completion prompts patients to engage in self-reflection and identify then prioritise issues of importance to them. Whether PROMs supported or constrained patients in sharing issues with clinicians depended on the structure of the PROM and the existing clinician-patient relationship. Clinicians perceived standardised PROMs constrained their relationship with patients and were difficult to incorporate into the flow of consultations. Clinicians avoided using them or adapted the PROM, which may compromise their validity. Individualised PROMs supported consultations by allowing patients to ‘tell their story’ but were less useful as an outcome measure to measure change over time. PROMs may support the care of individual patients through acting as a ‘conversation opener’.
Acknowledgements: Functionality and Feedback: a realist synthesis of the collation, interpretation and use of PROMs data to improve patient care is funded by National Institute for Health Research Health Services and Delivery Research Programme 12/136/31
The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.