Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Barriers and Facilitators to Electronic Patient-Reported Outcome (ePRO) Symptom Monitoring in Routine Oncology Care- a qualitative study guided by the Consolidated Framework for Implementation Research (#372)

Julia Lai-Kwon 1 2 , Claudia Rutherford 3 , Michael Jefford 1 2 4 5 , Claire Gore 6 , Stephanie Best 2 4 7 8
  1. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  2. Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  3. Sydney Quality of Life Office, University of Sydney, Sydney, NSW, Australia
  4. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
  5. Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  6. Department of Psychology , Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  7. Victorian Comprehensive Cancer Centre Alliance , Melbourne, VIC, Australia
  8. Australian Genomics, Murdoch Childrens' Research Institute, Melbourne, VIC, Australia

Background: Electronic patient-reported outcomes (ePROs) are an evidence-based means of detecting symptoms earlier and improving patient outcomes. However, there are few examples of successful implementation of ePROs in routine cancer care.  Use of implementation science frameworks may support successful implementation.  We conducted a qualitative study to identify barriers and facilitators to implementing ePRO symptom monitoring in routine cancer care using the Consolidated Framework for Implementation Research (CFIR). 

Methods: Participants were adult cancer patients, their carers, and a range of healthcare professionals who might be involved in ePRO monitoring and processes.  Focus groups or individual interviews were conducted using a semi-structured approach informed by the CFIR, exploring barriers and facilitators to implementing ePRO monitoring.  Data was analysed deductively using the CFIR.  Barriers were matched to theory-informed implementation strategies using the CFIR-Expert Recommendations for Implementing Change (ERIC) matching tool.

Results: 30 participants were interviewed: 22 females (73%), 31-70 years old (28, 94%), comprising: patients (n=8), carers (n=2), medical oncologists (n=4), nurses (n=4), hospital leaders (n=6), clinic administrators (n=2), pharmacists (n=2) and IT specialists (n=2). 

Barriers pertaining to CFIR domains intervention characteristics (IC), inner setting (IS), and characteristics of individuals (CI) were identified and several were novel.  An example of a novel IC barrier was the challenge of adapting ePROs for toxicities associated with different anti-cancer treatments.  Facilitators pertaining to CFIR domains IC, outer setting, IS, CI, and process were also identified.  An example of a novel IS facilitator was leveraging technological advances in remote care post COVID-19 to drive implementation.  Conducting local consensus discussions, identifying/ preparing champions, and assessing readiness and identifying barriers and facilitators were the most frequently recommended implementation strategies. 

Conclusion: The CFIR facilitated identification of known and novel barriers and facilitators to implementing ePRO monitoring in routine cancer care.  Facilitators and theory-informed implementation strategies will be used to co-design an ePRO system for monitoring for possible side-effects of immunotherapy.