Background: Research has identified that the positive results from clinical trials of symptom patient reported outcome measures (PROMs) can be translated into routine Australian oncology outpatient care. Whilst the iPROMOS study also reported significant clinical outcomes such as increased symptom identification and multi-disciplinary engagement, these were reduced when systems were under pressure. In response, the Symptoms Pathway Project was initiated to improve the infrastructure for symptom management.
Methods: This work was designed using a theoretical implementation science approach. A collaborative of key stakeholders was brought together, including clinician researchers, oncology and haematology doctors, specialist nurses, nurse managers, cancer care coordinators, allied health professionals including a dietitian, physiotherapist, social worker, psychologists, occupational therapist, speech therapist, carer and patient consumer representatives and health service project officer. Mixed methods approaches were used to diagnose factors influencing symptom management. A Delphi study conducted over three rounds aimed to establish consensus on priority symptoms and the core components for quality symptom management. A pilot strategy was implemented into routine care, feasibility and acceptability was measured.
Results: Identified key components for quality symptom management included, (i) early assessment in the patient treatment pathway; (ii) multi-modal tailored patient and carer information resources; (iii) interdisciplinary knowledge sharing; (iv) structured communication pathways between clinical teams. Each component was co-designed and piloted. Early assessment in the treatment pathway was identified as neither feasible nor acceptable, despite 88% completion rates of assessments. Resource constraints in clinical workflows were identified as a strong factor influencing implementation. All other components were feasible (75%-92% of measures reported feasibility) and acceptable (76%-91% of measures reported acceptability).
Conclusion: Using PROMs in clinical care can improve not only individual patient outcomes, but also improve health services. Incorporating implementation research with the routine use of these measures can identify underlying mechanisms and inform quality multi-disciplinary symptom management.