JMIR Publications

ABSTRACT

Background:

The electronic patient reported outcomes (ePROs) based cancer management presenting an opportunity to improve patient’s outcomes by optimizing symptom detection and prompting interventions by clinician in the Tertiary hospitals. However, the real-world evidence is limited, especially in the primary health care (PHC) setting accompanied by more complexed and un-known influence factors.

Objective:

We conducted a qualitative study to identify the associated facilitators and barriers of the implementation of ePRO-based symptom management in the China's PHC settings under the (Implementation Science) IS framework. Further developed strategies and recommendations for real-world practices and health policies.

Methods:

This qualitative study was conducted from October to December 2023 in 9 purposively selected PHC institutions (5 urban, 4 rural) across 5 administrative districts of Yangzhou, Jiangsu Province, China. The community-dwelling cancer patients, PHC providers and medical supervisors involved in the semi-structured interview and focus group discussion. The Consolidated Framework for Implementation Research (CFIR) was used to guide the analysis of the data, after which the Expert Recommendations for Implementing Change (ERIC) to generate strategy.

Results:

A total of 72 individuals were invited to take part in the study, with 35 community-dwelling cancer patients (median [P25, P75], 66[60,71.5] years; 21 man [60%]) and 23 PHC personnel (45[27,51] years; 12 man [52.17%]) involved in the semi-structured interview, and 14 medical supervisors (47.5[36.5,54] years; 10 man [71.43%])involved in the focus-group discussion. The studies identified 34 barriers and 22 facilitators, then developed 13 strategies. The crucial challenges include the lack of nationally standardized implementation and quality evaluation criteria; the poor integration of ePRO with existing workflow and absence of performance incentive mechanisms; the outdated medical equipment and the limited range of medications. PHC providers’ low self-efficacy and unclear role identification, coupled with patients’ mistrust of primary care, cancer stigma, and fatalistic beliefs, further reduce motivation. Common challenges included poor information sharing, weak collaborative relationships, and insufficient funding.

Conclusions:

The study findings provided recommendation for ePRO-based cancer symptom management in PHC settings, including addressing the substantial motivational deficiencies through strengthened health education to resolve misconceptions and bridge knowledge gaps, along with establishing supportive incentive mechanisms; developing supportive medical partnerships and tiered management systems; and finally, creating standardized operational guidelines together with data-driven regulatory feedback mechanisms.