A national survey of patient reported outcome measures (PROMS) use within radiotherapy in England

Abstract

Purpose or Objective Despite radiotherapy (RT) providing effective cancer treatment, many patients develop acute and late toxicities that significantly impact their quality of life (QOL). These are often underreported by clinicians, thus a more robust assessment warrants the use of patient reported outcome measures (PROMs). Advantages of PROMs include stratified follow-up and evaluation of clinical effectiveness, safety, and cost. The NHS England RT Service Specification calls for routine use of PROMs, however barriers exist at patient, healthcare professional (HCP) and service levels. These include lack of time and training on the use and interpretation of PROMs by HCPs, poor IT infrastructure and lack of integration of PROMs into existing systems. Facilitators to PROMs use have been studied, including use of electronic PROMs, automatic data interpretation and HCP training. This study aimed to determine the national use of PROMs within RT, to evaluate current attitudes, barriers and facilitators to PROMs use within practice, and to develop practical recommendations to implement PROMs within UK RT services. Materials and Methods A questionnaire was developed consisting of 12 multiple-choice questions relating to PROMs use. Free-text comment boxes were provided to ascertain both qualitative and quantitative results. The questionnaire was disseminated via email to all 11 RT Operational Delivery Networks (ODNs) across England. 182 participants were recruited across a range of RT professions including radiation therapists(RTTs), nurses and research staff. A mixed-methods approach was adopted; thematic analysis of free-text responses provided qualitative data, whilst descriptive statistics were used to analyse quantitative results. Results The current use of PROMs tools and data was analysed. The majority of respondents indicated PROMs were used within clinical trials only, whilst the second highest response indicated PROMs were not used at all within RT (figure 1). The most common PROMs format observed was completion of paper forms by patients. PROMs data were most commonly used to assess patients or obtained as part of a clinical trial. Key themes relating to the barriers and facilitators of PROMs use were derived from thematic analysis of free-text comments. Conclusion It is clear that PROMs are not widely used within RT practice. Here, we provide recommendations to mitigate the barriers identified and implement PROMs in RT. These include HCP training on the appropriate use and value of PROMs and development/integration of electronic systems. Standardisation of PROMs tools and storage of data in a central repository would provide effective means of capturing RT toxicity data nationally, informing future practice. In order to utilise PROMs results effectively to improve patient QOL, referral pathways to existing specialist services must first be established. This study provides a vital first step in driving the implementation of PROMs within UK RT services.