Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 19;16(4):e58611.
doi: 10.7759/cureus.58611. eCollection 2024 Apr.

Barriers and Facilitators to the Implementation of an Electronic Patient-Reported Outcome System at Cancer Hospitals in Japan

Yu Uneno  1 , Keita Fukuyama  2 , Ayumi Nishimura  3 , Kana Eguchi  4 , Hideki Kojima  5 , Takeshi Umino  6 , Kikuko Miyazaki  3 , Eiju Negora  7 , Keiko Minashi  8 , Osamu Sugiyama  9 , Taichi Shimazu  10 , Manabu Muto  1 , Shigemi Matsumoto  4
Affiliations

Barriers and Facilitators to the Implementation of an Electronic Patient-Reported Outcome System at Cancer Hospitals in Japan

Yu Uneno et al. Cureus. .

Abstract

Background and objective Implementing electronic patient-reported outcomes (ePROs) in oncology practice has shown substantial clinical benefits. However, it can be challenging in routine practice, warranting strategies to adapt to different clinical contexts. In light of this, this study aimed to describe the implementation process of the ePRO system and elucidate the provider-level implementation barriers and facilitators to a novel ePRO system at cancer hospitals in Japan. Methods We implemented an ePRO system linked to electronic medical records at three cancer hospitals. Fifteen patients with solid cancers at the outpatient oncology unit were asked to regularly complete the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™) questionnaire and European Organization for Research and Treatment Core Quality of Life questionnaire (EORTC QLQ C30) by using the smartphone app between October 2021 and June 2022. Thirteen healthcare professionals were interviewed to identify implementation barriers and facilitators to the ePRO system by using the Consolidated Framework for Implementation Research framework. Results The healthcare professionals identified a lack of clinical resources and a culture and system that emphasizes treatment over care as the main barriers; however, the accumulation of successful cases, the leadership of managers, and the growing needs of patients can serve as facilitators to the implementation. Conclusions Our experience implementing an ePRO system in a few Japanese oncology practices revealed comprehensive barriers and facilitators. Further efforts are warranted to develop more successful implementation strategies.

Keywords: cancer; health; implementation barriers; implementation facilitators; patient-reported outcome; treatment.

PubMed Disclaimer

Conflict of interest statement

This work was supported by INTAGE Healthcare Inc., NIPPON TELEGRAPH AND TELEPHONE CORPORATION, and the Ministry of Health, Labour and Welfare of Japan (Health Labor Science Research Grant [Grant Number: 202103002A]). HK and TU, employees of INTAGE Healthcare Inc., played roles in the conception and design of the study, interpretation of data, and drafting of the manuscript. The other funders had no role in the conception and/or design of the study; acquisition, analysis, interpretation of data; and/or drafting of this manuscript.

Figures

Figure 1
Figure 1. Overview of the electronic patient-reported outcome (ePRO) system for oncology practice
An individualized QR code was generated from CyberOncology, which was linked to the electronic medical record, and the patient’s ePRO data and private information were merged. Moreover, the QR code can be generated from a patient’s smartphone and shared with informal caregivers. Anonymized patient data were stored in a cloud server, which could be viewed from within the hospital by connecting to the cloud server via the Internet. In addition, for research purposes, data were accumulated in a data warehouse (DWH) at the study site. Appropriate security was ensured for each system Image credits: Shigemi Matsumoto and INTAGE Healthcare Inc. EMR: electronic medical record; DWH: data warehouse
Figure 2
Figure 2. Summary of barriers and future strategies related to the ePRO system implementation in Japanese clinical context
ePRO: electronic patient-reported outcomes
Figure 3
Figure 3. eReQo system usage logs for patients, informal caregivers, and HCPs
15 study participants showed three different behaviors, which are defined as "low responder (n=6, yellow)", "heavy user (n=5, orange)" and "light user (n=4, blue)." Each column represents the individual study participants' behaviors, with the horizontal axis as time course and the vertical axis as HCPs monitoring, CTCAE, and EORTC QLQ 30 responses CTCAE: Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events; EORTC QLQ C30: European Organization for Research and Treatment Core Quality of Life questionnaire; HCPs: healthcare professionals
Figure 4
Figure 4. Classification based on eReQo log data
Classification cutoff values were defined post hoc based on a visual assessment of the distribution of the plots
See this image and copyright information in PMC

References

    1. Symptom burden in the first year after cancer diagnosis: an analysis of patient-reported outcomes. Bubis LD, Davis L, Mahar A, et al. J Clin Oncol. 2018;36:1103–1111. - PubMed
    1. Trajectories of health-related quality of life and symptom burden in patients with advanced cancer towards the end of life: longitudinal results from the eQuiPe study. Versluis MA, Raijmakers NJ, Baars A, et al. Cancer. 2024;130:609–617. - PubMed
    1. Health-related quality of life among cancer patients in their last year of life: results from the PROFILES registry. Raijmakers NJ, Zijlstra M, van Roij J, Husson O, Oerlemans S, van de Poll-Franse LV. Support Care Cancer. 2018;26:3397–3404. - PubMed
    1. Quality of life and symptom intensity over time in people with cancer receiving palliative care: results from the international European Palliative Care Cancer Symptom study. Verkissen MN, Hjermstad MJ, Van Belle S, Kaasa S, Deliens L, Pardon K. PLoS One. 2019;14:0. - PMC - PubMed
    1. The missing voice of patients in drug-safety reporting. Basch E. N Engl J Med. 2010;362:865–869. - PMC - PubMed

LinkOut - more resources