How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis

TLDR: The findings show thatPROMs completion is not a neutral act of information retrieval but can change how patients think about their condition and reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries.

Abstract: In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians’ awareness of patients’ problems and prompts discussion and action We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships Individualised PROMs supported dialogue by enabling the patient to tell their story In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL) Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit This paper makes two important contributions to the literature First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making