Patients' acceptability of a patient-reported outcome measure in cardiac rehabilitation (the PRO-Heart-DK)-a mixed methods study using the Theoretical Framework of Acceptability

BACKGROUND: The integration of Patient Reported Outcome Measures (PROM) in cardiac rehabilitation practice has potential to enhance patient involvement and management. User acceptance is crucial for successful implementation of healthcare interventions, but limited literature addresses PROM acceptability among cardiovascular patients. This study explored the acceptability of a new national PROM in cardiac rehabilitation clinical practice for patients with ischemic heart disease (IHD) in Denmark.

METHODS: Patients who responded to the PROM were invited to complete two brief surveys evaluating perceived relevance, usefulness, and satisfaction. A purposefully selected subsample participated in semi structured interviews to gather in-depth experiences. A parallel convergent mixed-methods design was used with the Theoretical Framework of Acceptability applied to structure and interpret findings.

RESULTS: 105 and 119 patients respectively responded to the two evaluation surveys (response-rates 56.5% and 53.4% respectively) and 25 patients were interviewed. The study showed a strong willingness to engage with PROMs, indicating a high overall acceptability. Most patients perceived the PROM helpful for preparation and enhancing communication during consultations. A minority of patients reported emotional reactions and experienced issues with questionnaire comprehensiveness, structure, and relevance.

CONCLUSION: The findings indicate that most IHD patients find PROM relevant and useful in cardiac rehabilitation. To enhance acceptability and, hence, future implementation, improvements are needed in clinical settings by providing adequate patient information, effectively using PRO results, and addressing patients' emotional reactions. Additionally, PROM development should focus on ensuring the questionnaire's relevance, comprehensiveness, and structure.