Implementing patient-reported outcome surveys as part of routine care: Lessons from an academic radiation oncology department.

97 Background: We sought to implement patient reported outcomes (PRO) surveys to measure the acute and late effects of radiation treatment at a multisite academic medical center.

METHODS: Over the course of 18 months we addressed survey identification and implementation hurdles. Many existing validated instruments were designed for clinical research and are not ideally suited for either routine care or for the tracking of acute toxicities of radiation therapy. A physician and a nurse champion for each disease site identified or created situation- and site-specific tools based on validated questionnaires form the literature. Our aim was for questionnaires to be no longer than 20 - 30 questions. Using iPads, we deployed an institutionally-developed survey platform integrated with scheduling within the clinic. We surveyed physicians, nurses, and residents 3 months following the implementation of PROMs to assess their general response to the initiative.

RESULTS: Thirty-seven PRO measures comprised of 640 questions were implemented for all disease sites in adult patients at 6 departmental locations treating a total of 350 patients daily. Following implementation in January of 2015, > 13,000 surveys have been completed through the end of September 2015. Each question took on average approximately 14 seconds to complete and common surveys took approximately 10 minutes. Of 36 departmental provider respondents (50% response rate overall), 47% stated that they use the PROMs in their daily practice. The majority of respondents felt that the PROs were valuable (67%) and relevant (75%) either usually, most of the time or always. Only 33% felt the quality of their care was enhanced usually or most of the time while 53% felt the PROs engaged patients in a better understanding of their own care.

CONCLUSIONS: We successfully implemented disease site- and context-specific PROs across a large, academic radiation oncology department. Although we have achieved widespread adoption and some subjective impression of care improvement among providers, further work is necessary to reduce barriers to their clinical use and to leverage them for systematic improvements in care.