JMIR Publications

ABSTRACT

Background:

The routine measurement of patient-reported outcomes in clinical cancer care using electronic patient-reported outcomes measures (ePROM) is gaining momentum worldwide. However, a deeper understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed.

Objective:

This study aimed to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes.

Methods:

A realist synthesis of the literature on ePROM interventions in clinical cancer care was performed. A conceptual framework of ePROM intervention was constructed to define the scope of the review and frame initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool (MMAT).

Results:

Sixty-one studies were included in the realist synthesis: 15 mixed-method studies, 9 qualitative studies, 13 descriptive studies, 21 randomised controlled trials and 3 quasi-experimental studies. Three initial program theories were developed concerning the salient components of ePROM interventions - remote self-reporting, real-time feedback to clinicians and clinician-patient telecommunication. The refined theories posit that: remote self-reporting enables patients to recognise and report symptoms accurately and empowers them to communicate these to clinicians; real-time feedback prompts clinicians to manage symptoms proactively; clinician-patient telephone and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them, and when real-time feedback to clinicians lacks relevance and increases workload.

Conclusions:

The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback is vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters. Clinical Trial: PROSPERO CRD42020221238