Optimizing Patient Engagement with Patient-Reported Outcome Measures Across the Cancer Continuum: A Qualitative Study.

Abstract

Background: Patient-reported outcome measures (PROMs) enhance patient-centered care but routine implementation in oncology settings remains challenging. This study seeks to explore patients' experiences with routine PROM integration within a health care setting with employed strategies to maximize uptake and inclusivity.

Methods: A qualitative study employing a phenomenological approach was conducted at the National Cancer Centre Singapore. Seven breast cancer patients receiving routine screening using the Distress Thermometer and Problem List (DTPL) as part of a larger supportive care program were purposively sampled. Semi-structured interviews explored how implementation strategies influenced patients' experiences with PROM usability, accessibility, and perceived impact. Data were analyzed using thematic analysis based on the Consolidated Framework for Implementation Research.

Results: Participants perceived the DTPL as a meaningful PROM that validated their emotions but highlighted that presentation formats greatly influenced perceived simplicity of the tool. While multilingual and hybrid formats improved accessibility, digital literacy and cognitive burden remained as barriers. Education pamphlets provided initial awareness, but sustained engagement was impeded by a lack of time, reminders, and a conducive environment. PROMs were most useful during active treatment when symptoms fluctuated, yet frequent completion led to response fatigue. Timely responses to PROMs reinforced engagement, particularly when linked to referrals or symptom management. Some participants felt that formal PROM reviews by oncologists were unnecessary due to time constraints.

Conclusion: Successful PROM implementation requires balancing simplicity, accessibility, and clinical relevance. Embedding PROMs within broader supportive care programs ensures clinical responsiveness and improves patient outcomes in oncology care.