Taxonomy of themes, their definitions and excerpts from the studies
| Themes | Subthemes | Definition | Excerpts |
|---|---|---|---|
| Practical considerations | Time/workload | The impact of PROMs on workloads | Barrier: ‘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 |
| Administration | The difficulty or ease of collecting PROMs | Barrier: ‘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 | |
| Collaboration | The level of cooperation among colleagues | Barrier: ‘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 | |
| Guidelines | The provision of clear or flexible guidelines | Barrier: ‘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 data | The level of management involvement in the process, and the active use of the information to guide decision making | Barrier: ‘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 | |
| Training/ familiarisation | The provision of training and time to become familiar with measures prior to implementation | Barrier: ‘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 | |
| Technology | The use of technology for collecting and disseminating the data | Barrier: ‘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 | |
| Support | The provision of adequate support to correctly collect, analyse and interpret the data, and support from the wider service to help provide appropriate care | Barrier: ‘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 data | Transparent objectives | The provision of transparent objectives for collecting PROMs | Barrier: ‘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 change | The openness to receiving feedback and willingness to change practice | Barrier: ‘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 considerations | Interpretation | The ability to make sense of the feedback | Barrier: ‘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 measures | The belief that results were a true reflection of care | Barrier: ‘They were also aware of the potential for manipulating scores’43 | |
| Sensitivity | The sensitivity of the measures to detect change | Barrier: ‘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 care | Quality improvement | The impact of the information on patient care | Barrier: ‘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 effects | The additional factors that may impact on patient care | Barrier: ‘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.