The utility of the implementation science framework \u201cIntegrated Promoting Action on Research Implementation in Health Services\u201d (i-PARIHS) and the facilitator role for introducing patient-reported outcome measures (PROMs) in a medical oncology outpatient department

Natasha A. Roberts,Alison Mudge,Angela M. Stover,Kimberly E. Alexander,David Wyld,Monika Janda

doi:10.1007/s11136-020-02669-1

Abstract

PurposeWe evaluated the utility of the implementation science framework “Integrated Promoting Action on Research Implementation in Health Services” (i-PARIHS) for introducing patient-reported outcome measures (PROMs) into a medical oncology outpatient department. The i-PARIHS framework identifies four core constructs for implementation, including Facilitation, Innovation, Context and Recipients.MethodsA pilot study used the i-PARIHS framework to identify PROM implementation barriers and enablers to inform facilitation support strategies, such as training clinicians and staff, workflow support, technical support and audit and feedback. Pre- and post-implementation surveys were completed by 83 and 72 staff, respectively, (nurses, doctors and allied health), to assess perceived knowledge, enablers, barriers and utility of PROMs; and acceptability of the PROM intervention was also assessed post-implementation.ResultsImportant barriers included time constraints and previous experiences with technology. Enablers included good leadership support and a culture of learning. Facilitation strategies were used to overcome barriers identified in the i-PARIHS core domains. Compared to before the intervention, staff surveys showed improvement in perceived usefulness, perceived understanding and interpretation skills for PROMs. Staff perceptions about lack of time to use PROMs during visits remained a major perceived barrier post-implementation.ConclusionThe i-PARIHS framework was useful for guiding the implementation of PROMs in routine oncology care. The four core i-PARIHS constructs (Facilitation, Innovation, Context and Recipients) identified factors that directly impacted implementation, with Facilitation having a particularly important role to overcome these barriers. Oncology clinics and health systems considering implementing PROMs should consider having a dedicated Facilitator available during PROM implementation.

Highlights

In clinical trials, patient-reported outcome measures (PROMs) improve communication between patients and clinicians, resulting in quality of life and survival benefits [1,2,3]
Implementation strategies are key to translating health innovations into practice [4], but little is known about the optimal implementation strategies for PROM integration in medical oncology outpatient departments
This paper reports on a pilot implementation case study using the constructs of i-PARIHS

Summary

Introduction

Patient-reported outcome measures (PROMs) improve communication between patients and clinicians, resulting in quality of life and survival benefits [1,2,3]. Care delivery transformation within the clinical environment of an outpatient oncology clinic is complex [5,6,7]. This complexity comes from the many levels of the larger health ecosystem [8] into which outpatient oncology wards are embedded [9], as well as the diverse needs of cancer patients undergoing a multitude of treatment protocols and follow-up [10]. In randomised controlled trials (RCTs) testing the value of PROMs, the clinical trial coordinator often played an invisible role facilitating uptake of the PROM innovation with patients and staff teams (e.g. conducting training sessions and running clinic-level reports) [13, 14]. To implement a new intervention into this type of an environment requires insight into the interplay of the innovation (PROMs), the context and setting and the people and roles involved [16]

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