title: Improving an electronic system for measuring PROs in routine oncology practice.
abstract: Our aim was to study how patients and their clinicians evaluated the usability of PatientViewpoint, a webtool designed to allow patient-reported outcome (PRO) measures to be used in clinical practice.
  
  
  
  As part of a two-round quality improvement study, breast and prostate cancer patients and their medical and radiation oncology clinicians completed semi-structured interviews about their use of PatientViewpoint. The patient interview addressed different phases of the PRO completion workflow: reminders, completing the survey, and viewing the results. The clinician interviews asked about use of PatientViewpoint, integration with the clinical workflow, barriers to use, and helpful and desired features. Responses were recorded, categorized, and reviewed. After both rounds of interviews, modifications were made to PatientViewpoint.
  
  
  
  Across the two rounds, 42 unique patients (n = 19 in round 1, n = 23 in round 2) and 12 clinicians (all in both rounds) completed interviews. For patients, median age was 65, 81 % were white, 69 % were college graduates, 80 % had performance status of 0, 69 % had loco-regional disease, and 81 % were regular computer users. In the quality improvement interviews, patients identified numerous strengths of the system, including its ability to flag issues for discussion with their provider. Comments included confusion about how scores were presented and that the value of the system was diminished if the doctor did not look at the results. Requests included tailoring questions to be applicable to the individual and providing more explanation about the score meaning, including having higher scores consistently indicating either better or worse status. Clinicians also provided primarily positive feedback about the system, finding it helpful in some cases, and confirmatory in others. Their primary concern was with impact on their workflow.
  
  
  
  Systematically collected feedback from patients and clinicians was useful to identify ways to improve a system to incorporate PRO measures into oncology practice. The findings and evaluation methods should be useful to others in efforts to integrate PRO assessments into ambulatory care.
  
  
  
  Systems to routinely collect patient-reported information can be incorporated into oncology practices and provide useful information that promote patient and clinician partnership to improve the quality of care.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. awu@jhu.edu.|Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. awu@jhu.edu.|Center for Health Services & Outcomes Research, 624 N. Broadway, Room 653, Baltimore, MD, 21205, USA. awu@jhu.edu.
authors.forename: Albert W
authors.initials: AW
authors.lastname: Wu
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: White
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Blackford
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Wolff
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carducci
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
authors.forename: Claire F
authors.initials: CF
authors.lastname: Snyder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000534:rehabilitation* / Q000628:therapy; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D057240:Patient Preference / Q000706:statistics & numerical data; D010820:Physicians; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000534:rehabilitation*; D058996:Quality Improvement; D011788:Quality of Life; D057566:Self Report / Q000592:standards*; D011795:Surveys and Questionnaires / Q000592:standards; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Clinical practice; Electronic health record; Oncology; Patient-reported outcome; Quality improvement; Quality of life