Table 2

Taxonomy of themes, their definitions and excerpts from the studies

Practical considerationsTime/workloadThe impact of PROMs on workloadsBarrier: ‘I think time is the critical issue and that we are being asked to spend more and more time on collecting information and filling out forms’8
Facilitator: ‘Some doctors claimed that this intervention might save time, since it provides information in a systematic, time-effec­tive way’49
AdministrationThe difficulty or ease of collecting PROMsBarrier: ‘There were a number of nurses who reported difficulties administering the HQLI. The primary difficulty was patient's confusion with the answer scales’47
Facilitator: ‘Participants reported POS to be easy to use, brief and relevant’41
CollaborationThe level of cooperation among colleaguesBarrier: ‘I tried to leave [POS] questionnaires for people in the diary and it just didn't work. I actually came in [on days off] to do it because I rang up to see if anyone had bothered and they hadn't’48
GuidelinesThe provision of clear or flexible guidelinesBarrier: ‘The hospice ARC (Action Research Collaboration) debated the frequency of POS administration at most meetings’42
Facilitator: ‘They expressed the need for user flexibility when using it’51
Involvement of management/use of dataThe level of management involvement in the process, and the active use of the information to guide decision makingBarrier: ‘Many staff were frustrated that senior medical staff did not fully appreciate the process’9
Facilitator: ‘Senior staff had pre-empted these concerns by discussing POS scores at weekly team meetings so enabling all staff to see the importance and relevance of the data’42
The provision of training and time to become familiar with measures prior to implementationBarrier: ‘I think we had little education about it really, they've just said this is QOF, this is what you've got to ask and they're the questions. We didn't really have any training’44
Facilitator: ‘It was recognized that as one became familiar with the measures the time required for data entry was considerably reduced’9
TechnologyThe use of technology for collecting and disseminating the dataBarrier: ‘Access to computers, slowness of the computer networks, lack of computer skills among staff, forgetting passwords and understanding the summary graphs were frequently mentioned’9
Facilitator: ‘Allowing the patient to complete the test at home and having the results transferred directly to the doctor's computer before the consultation’49
SupportThe provision of adequate support to correctly collect, analyse and interpret the data, and support from the wider service to help provide appropriate careBarrier: ‘This required more statistical analysis than was available to both settings’42
Facilitator: ‘There are many things that crop up once you start collecting the data …it's great to have someone to call on for help’9
Valuing the dataTransparent objectivesThe provision of transparent objectives for collecting PROMsBarrier: ‘Staff became disappointed in its performance as a patient-assessment tool, the staff's perception of its purpose became ambiguous, and there was uncertainty as to whether POS was an audit tool by which their effectiveness would be monitored by management’53
Open to feedback and changeThe openness to receiving feedback and willingness to change practiceBarrier: ‘I have my own way of doing things’54
Facilitator: ‘The cornerstone of good practice… a type of psychiatric X-ray that shows you where the problems are and how good our treatment… interventions are at sorting out these problems’9
Methodological considerationsInterpretationThe ability to make sense of the feedbackBarrier: ‘Your gut feeling about how depressed someone is and their PHQ-9 score often don't marry up’44
Facilitator: ‘Some clinicians were seeking more sophisticated feedback than just graphs showing current or current-compared-with-past ratings’8
Validity of measuresThe belief that results were a true reflection of careBarrier: ‘They were also aware of the potential for manipulating scores’43
SensitivityThe sensitivity of the measures to detect changeBarrier: ‘Direct clinical benefits of using the POS were less apparent to hospice staff, probably owing to the complex clinical needs of their patients that the POS is not sensitive enough to detect’42
Impact on patient careQuality improvementThe impact of the information on patient careBarrier: ‘QOF tick-box exercise as far as I'm concerned’44
Facilitator: ‘Clients were given the opportunity to identify their own problems, and to make priorities according to what was meaningful to them, this resulted in more distinct goals than before they started to use the COPM’52
Indirect effectsThe additional factors that may impact on patient careBarrier: ‘I've actually had people say it, they just make them feel worse…I know how bad I feel and I don't need to see it written down’50
Facilitator: ‘I think that people will develop a respect for your clinical judgement if you spend time listening to them’45
  • PROMS, patient-reported outcome measures.