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Randomized Controlled Trial
. 2024 Nov 12;24(1):1386.
doi: 10.1186/s12913-024-11536-5.

Strategies for implementing an electronic patient-reported outcomes-based symptom management program across six cancer centers

Michael Hassett  1 , Samira Dias  2 , Christine Cronin  2 , Deborah Schrag  3 , Nadine McCleary  2 , Jaclyn Simpson  4 , Tiana Poirier-Shelton  4 , Jessica Bian  5 , James Reich  5 , Don Dizon  6 , Megan Begnoche  6 , Hannah Hazard Jenkins  7 , Laura Tasker  7 , Sandra Wong  8 , Loretta Pearson  9 , Roshan Paudel  2 , Raymond U Osarogiagbon  4
Affiliations
Randomized Controlled Trial

Strategies for implementing an electronic patient-reported outcomes-based symptom management program across six cancer centers

Michael Hassett et al. BMC Health Serv Res. .

Abstract

Background: Electronic patient-reported outcome (ePRO)-based symptom management improves cancer patients' outcomes. However, implementation of ePROs is challenging, requiring technical resources for integration into clinical systems, substantial buy-in from clinicians and patients, novel workflows to support between-visit symptom management, and institutional investment.

Methods: The SIMPRO Research Consortium developed eSyM, an electronic health record-integrated, ePRO-based symptom management program for medical oncology and surgery patients and deployed it at six cancer centers between August 2019 and April 2022 in a type II hybrid effectiveness-implementation cluster randomized stepped-wedge study. Sites documented implementation strategies monthly using REDCap, itemized them using the Expert Recommendations for Implementation Change (ERIC) list and mapped their target barriers using the Consolidated Framework for Implementation Research (CFIR) to inform eSyM program enhancement, facilitate inter-consortium knowledge sharing and guide future deployment efforts.

Results: We documented 226 implementation strategies: 35 'foundational' strategies were applied consortium-wide by the coordinating center and 191 other strategies were developed by individual sites. We consolidated these 191 site-developed strategies into 64 unique strategies (i.e., removed duplicates) and classified the remainder as either 'universal', consistently used by multiple sites (N = 29), or 'adaptive', used only by individual sites (N = 35). Universal strategies were perceived as having the highest impact; they addressed eSyM clinical preparation, training, engagement of patients/clinicians, and program evaluation. Across all documented SIMPRO strategies, 44 of the 73 ERIC strategies were addressed and all 5 CFIR barriers were addressed.

Conclusion: Methodical collection of theory-based implementation strategies fostered the identification of universal, high-impact strategies that facilitated adoption of a novel care-delivery intervention by patients, clinicians, and institutions. Attention to the high-impact strategies identified in this project could support implementation of ePROs as a component of routine cancer care at other institutions.

Trial registration: ClinicalTrials.gov. NCT03850912. February 22, 2019. https://clinicaltrials.gov/ct2/show/NCT03850912?term=hassett&draw=2&rank=1.

Keywords: Consolidated Framework for Implementation Research (CFIR); Expert Recommendations for Implementing Change (ERIC); Implementation science; Implementation strategy; Symptom management; ePROs (electronic patient-reported outcomes).

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Conflict of interest statement

Declarations Ethics approval and consent to participate The Western Institutional Review Board (WIRB) approved the protocol as a minimal risk research study on November 25, 2018 (protocol #20182593) with a waiver of individual authorization for release of health data and a waiver of informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Overview of SIMPRO strategy documentation, audit, and analysis process. This process was designed to inform eSyM program enhancements, facilitate inter-consortium knowledge sharing, and guide future deployment efforts
Fig. 2
Fig. 2
Example of SIMPRO strategies mapped using the CFIR-ERIC frameworks. Together, the CFIR and ERIC frameworks form a matching tool linking CFIR barriers with corresponding ERIC implementation strategies [20]. This allowed us to identify all the SIMPRO implementation strategies used to address each implementation barrier. The figure shows an example of how this mapping was applied to one implementation strategy
Fig. 3
Fig. 3
Summary of Implementation Strategy Documentation, Harmonization, and Classification. The study identified 109 unique strategies: 35 foundational (implemented by the coordinating center), 35 adaptive (implemented by one site), and 29 universal (implemented by multiple sites)
Fig. 4
Fig. 4
Summary of Thematic Sub-Classifications for Identified Universal (High Impact) Strategies. Focusing on the 29 strategies that were implemented by multiple sites, and therefore considered universal, each was characterized as either proactive or reactive and as either straightforward or challenging, to inform deployment strategies at other organizations
Fig. 5
Fig. 5
Implementation Strategies Inactivation Reasons. For the strategies that were inactivated, five reasons were identified
See this image and copyright information in PMC

Update of

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