Use of patient-reported outcomes in outpatient settings as a means of patient involvement and self-management support : a qualitative study of the patient perspective

Rationale, aims and objectives Patient-reported outcomes (PRO) is being implemented in clinical practice across different healthcare settings with various purposes. Involving the patients in reporting outcomes may increase their attention to symptoms and thereby support their self-management. The aim of the present study was to describe patients’ experiences with a web-based PRO system where patients fill in a PRO questionnaire at home or in the outpatient clinic prior to a consultation. Moreover, the study aimed to explore how PRO influenced the interaction between patients and clinicians during the consultation.

Methods Through participant observations of nine consultations and 12 semi-structured interviews with patients after the consultation this interpretive description study explored patients’ experiences with the PRO system. The PRO included self-assessment on health-related quality of life, symptoms, and well-being. Patients who visited the outpatient clinic at Department of Renal Medicine at Aarhus University Hospital in the Central Denmark Region in February and March 2014 and in March and August 2015 were invited to participate. We used a convenience sampling approach to recruit patients who had completed at least two PRO questionnaires.

Results The analysis revealed rudiments of PRO in clinical practice leading to an increased understanding of their chronic disease, patient-centred communication and an additional focus on psychosocial problems. However, the very application of PRO in the outpatient clinic and the patient attitudes were substantial and crucial barriers for PRO as a method to achieve patient involvement and self-management.
Conclusion The use of PRO in outpatient consultations may support patients' self-management by a) impelling patient-centred communication in the consultation, b) legitimising talk about psychosocial problems, and c) increasing the patients' understanding of their disease. Yet, applying PRO into clinical practice does not automatically involve the patients and support their self-management. We suggest supplementary clinical initiatives to strengthen the patient involving benefits of PRO.