Implementation Of Patient-reported Outcome Measures Research Articles

Implementation of patient-reported outcome measures into health care for men with localized prostate cancer.

Measuring treatment-related quality of life (QOL) has become an increasingly requisite component of delivering high-quality care for patients with prostate cancer. Patient-reported outcome measures (PROMs) have, therefore, become an important tool for understanding the adverse effects of radical prostate cancer treatment and have been widely integrated into clinical practice. By providing real-time symptom monitoring and improved clinical feedback to patients and providers, PRO assessment has led to meaningful gains in prostate cancer care delivery and quality improvement worldwide. By providing an avenue for benchmarking, collaboration and population health monitoring, PROMs have delivered substantial improvements beyond providing individual symptom feedback. However, multilevel barriers exist that need to be addressed before the routine implementation of PROMs is achieved. Improvements in collection, interpretation, standardization and reporting will be crucial for the continued implementation of PROM instruments in prostate cancer pathways.

Community Engagement and Patient-Centered Implementation of Patient-Reported Outcome Measures (PROMs) in Gender Affirming Surgery: a Systematic Review

Community Engagement and Patient-Centered Implementation of Patient-Reported Outcome Measures (PROMs) in Gender Affirming Surgery: a Systematic Review

Preliminary development of recommendations for the inclusion of patient-reported outcome measures in clinical quality registries

BackgroundClinical quality registries (CQRs) monitor compliance against optimal practice and provide feedback to the clinical community and wider stakeholder groups. Despite a number of CQRs having incorporated the patient perspective to support the evaluation of healthcare delivery, no recommendations for inclusion of patient-reported outcome measures (PROMs) in CQRs exist. The aim of this study was to develop a core set of recommendations for PROMs inclusion of in CQRs.MethodAn online two-round Delphi survey was performed among CQR data custodians, quality of life researchers, biostatisticians and clinicians largely recruited in Australia. A list of statements for the recommendations was identified from a literature and survey of the Australian registries conducted in 2019. The statements were grouped into the following domains: rationale, setting, ethics, instrument, administration, data management, statistical methods, and feedback and reporting. Eighteen experts were invited to participate, 11 agreed to undertake the first online survey (round 1). Of these, nine experts completed the online survey for round 2.ResultsFrom 117 statements presented to the Delphi panel in round 1, a total of 72 recommendations (55 from round 1 and 17 from round 2) with median importance (MI) ≥ 7 and disagreement index (DI) < 1 were proposed for inclusion into the final draft set and were reviewed by the project team. Recommendations were refined for clarity and to read as stand-alone statements. Ten overlapped conceptually and, therefore, were merged to reduce repetition. The final 62 recommendations were sent for review to the panel members for their feedback, which was incorporated into the final set.ConclusionThis is the first study to develop preliminary recommendations for PROMs inclusion in CQRs. Recommendations for PROMs implementation are critically important for registries to assure meaningful PROMs data capture, use, interpretation, and reporting to improve health outcomes and healthcare value.

Assessment of Patient-reported Outcomes in Routine Medical Care: Patient-reported Outcome Measures (PROMs) and Patient-reported Experience Measures (PREMs)

Information from patients about their own quality of life, experiences in care, and individual assessments of treatment processes and outcomes are becoming increasingly important. Patient-reported characteristics can refer to subjective information about their own health (Patient-Reported Outcome Measures [PROMs]) or to objective information about their experience during the treatment process (Patient-Reported Experience Measures [PREMs]). This article provides an overview of the similarities and differences between PROMs and PREMs. Subsequently, ways to collect PROMs and PREMs are presented and in doing so, an insight into probabilistic testing theory (item response theory) and computer adaptive testing is given. Using national and international initiatives as examples, the implementation of PROMs and PREMs in health care systems is presented and future implementation strategies are discussed within an outlook.

Implementing patient-reported outcomes into routine care: an audit of cancer patients from two local health districts in New South Wales to understand their capabilities and preferences.

Objective It has been established that the implementation of patient-reported outcome measures (PROMs) in routine care provides significant benefits to patients, providers and health services. However, there are patient-level barriers that must be identified and addressed for the successful implementation of PROMs. This study aimed to understand the capabilities and preferences of our cancer patient population prior to implementation of electronically collected PROMs (ePROMs). Specifically, we conducted a clinic audit to determine the proportion of patients in clinics with access to out-of-clinic internet; those preferring to complete PROMs on paper or via an electronic device; those capable of completing PROMs in English; and those anticipating requiring assistance to complete PROMs. Methods Patients receiving cancer treatment or follow-up care at two Local Health Districts (LHDs) in New South Wales, Australia, completed a questionnaire (audit form) with items about internet and mobile access, communication preferences and assistance needed to complete PROMs. Participant demographic and treatment information were extracted from their electronic medical records. Results Across both LHDs, 637 of 1668 participants (38%) completed the audit forms. Mean participant age was 65 years (range = 23-98), 53% were female, and 92% were outpatients. Patients in the two LHDs differed in their levels of internet and email access, and ability to complete PROMs independently in English, suggesting that some LHD-specific tailoring of implementation strategies is necessary to optimise ePROMs uptake. Conclusion This study highlights the importance of understanding the specific local contexts and patient populations, including potential technology and language barriers, which can influence patient ability to complete ePROMs.

Place of patient-reported outcomes & experiences measurements (PROMS/PREMS) in the assessment and pricing of Health technologies in France

In the context of health technologies assessment, patient-reported outcome measures (PROMs) have become assessment criteria that are expected by evaluation agencies along with the other usual clinical criteria. PROMs instruments measure all aspects of patient experience in connection with their health: symptoms, activities of daily living (physical function, sleep, etc.), various aspects of health-related quality of life (QoL), compliance, global impression of change in wellbeing. PROMs are useful both as 1) a primary or secondary efficacy endpoints, and 2) a tolerability criterion to supplement vigilance data reported by clinicians. Measurement of PROMs must be subject to methodological rigor that is identical to that of other assessment criteria measured by an observer. Scales must be validated, suitable for the objective, and where possible specific to a disease. In addition to standard measures of quality of life, PROMs are taken into consideration in the assessments performed by the HAS, even if their impact on the conclusions is difficult to isolate, as assessments are multifactorial and take into account all data available with regard to the medical context. The CEPS will indirectly take into account PROMs in the fixing of the price or tariff only if they have contributed to the award of the ASA/ASMR by the ad hoc committee of the HAS. The working group has formulated three recommendations which aim to further the implementation of patient-reported outcome measures: (1) Better information for all parties involved in a dossier for technology assessment, (2) Systematization of the collection of PROMs for evaluation of health products, (3) Improved quality of dossiers thanks to the use of relevant and validated tools.

Development of the &#x2018;AusPROM&#x2019; recommendations for elective surgery patients.

Objective Implementing the routine collection of patient reported outcome measures (PROMs) is key to improving healthcare quality and patient satisfaction. The implementation process can be strengthened through staff and patient co-design. The aim of this project was to develop a set of Australian PROM implementation recommendations ('AusPROM') to guide rapid translation into practice. Methods Staff working across 29 Australian private hospitals participated in the project. The hospitals provided elective surgery and spanned each state and territory of Australia. Staff engaged in a Delphi technique to develop the AusPROM, which involved three iterative focus groups. To ensure full disclosure, staff were also provided with additional project-related data sources throughout the Delphi technique. This included data from a patient focus group (patient co-design), patient survey, technical feasibility testing, 3 months of pilot testing (four sites), 3 months of national implementation (29 sites) and global evidence. This process ensured that staff and patient feedback was used to co-design the three iterations of the AusPROM recommendations until the final agreed version was established. Results A total of 22 AusPROM recommendations were included in the final iteration. The recommendations covered the domains of PROM characteristics, healthcare organisation characteristics, external influences, staff and patient characteristics, and facilitators to implementing AusPROMS in routine practice. Conclusion The AusPROM recommendations offer practical considerations for the implementation of PROMs in hospitals. The iterative nature of the Delphi technique ensured that staff and patient co-design were central to the development of the AusPROM recommendations.

Patient‐reported outcome measures (PROMs) to guide clinical care: recommendations and challenges

PROMs collection is encouraged to involve patients in their health care The patient is the most reliable reporter of their symptoms, function and health-related quality of life, and can provide a holistic viewpoint of the benefits and risks of treatments or the severity of their conditions. Including the patient’s voice is critical for shared decision making and patient-centred care. Patient-reported outcomes (PROs) are defined as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else”.1 Patient-reported outcome measures (PROMs) are validated tools or questionnaires used to collect PROs. PROMs can complement traditional methods of clinical assessment, such as medical history and physical examination. The use of systematically collected PROMs to inform the delivery of care has been researched for many years,2, 3 with patient and health service impacts including reduced symptom burden, improved quality of life and increased survival of patients with advanced cancer,4 and reduced emergency department presentations in a broad population of patients with cancer.5 As research suggests, the collection of PROMs in the clinical setting could better measure differences in the effects of health care interventions.6 PROMs collection is encouraged in the 2020–25 National Health Reform Agreement to empower patients to be involved in their health care, improve care across the health system, and focus on outcomes that matter to patients.7 This article outlines recommendations from the Health Services Research Association of Australia and New Zealand (HSRAANZ) for implementing PROMs to guide clinical care. It also describes the challenges that may arise and future research that may assist in the effective implementation of PROMs. The recommendations presented in this article have been developed by members of the HSRAANZ PROMs Special Interest Group. Health systems are encouraged to provide incentives to clinicians and practices (eg, funding through the National Health Reform Agreement) to implement these measures effectively. This will motivate clinicians to routinely incorporate their patients’ perspective into their busy schedules. They will be more likely to implement PROMs if there is a benefit to patient care and their clinical practice, by making care easier and more timely and reducing the administrative burden. There are several challenges to consider when integrating PROMs into clinical care. As patients are recruited to PROMs collection, challenges can arise at different time points through the journey of their care (Box). It is important to note that while these exist, they are not insurmountable and can be overcome with further research on implementation in general practice and hospital clinics. Already, research into the integration of PROMs in clinical care in Australia has shown that implementation is feasible and effective. The New South Wales Agency for Clinical Innovation Patient Reported Measures program completed a pilot study8 and demonstrated the feasibility of implementing PROMs in local health districts, community services and general practice. Principles to support the analysis and use of PROMs have been developed.9 CALD = culturally and linguistically diverse population. CALD = culturally and linguistically diverse population. There is increased focus by health care systems to improve the value of care in terms of both value for investment and outcomes that patients value. Embedding patient-reported measures into the clinical setting is a key component towards achieving this. Further research is underway to evaluate the applicability and benefits and harms of collecting PROMs in routine clinical care.10 Future research should focus on investigating the feasibility of prompt feedback of patient-reported data to clinicians and incorporating the results of patient-reported measures into clinical practice. With advances in technology and increased engagement by clinicians and health systems, the implementation of PROMs will be a routine part of health care provision in the future. Rachael Morton receives salary support from a University of Sydney Robinson Fellowship and a National Health and Medical Research Council Investigator Award (APP1194703). The funding source has no role in the planning, writing or publication of this work. No relevant disclosures. Not commissioned; externally peer reviewed.

Benefits, Challenges, and Opportunities of Integrating Patient-Reported Outcome Measures in Geriatric Oncology to Advance Patient Screening for Functional Fitness for Treatment.

To discuss potential benefits, challenges, and opportunities of integrating patient-reported outcome measures in geriatric oncology, with the goal being to advance patient screening for 'functional fitness for treatment.' This is narrative review of the relevant literature using PubMed. Patient screening in geriatric cancer care can be driven by patient self-reports. Most of the research on patient-reported outcome measures in cancer care to date has involved, in different proportions and to different extents, older patients with cancer (≥70 years of age). However, reports specifically targeting implementation of patient-reported outcome measures in geriatric cancer care are surprisingly fewer. The International Society of Geriatric Oncology Priorities Initiative calls for more research into the use of patient-reported outcome measures for older adults with cancer. More feasibility studies will be required to evaluate patient-reported outcome measures as fit-for-purpose, reporting frequency, patient burden, integration and display of patient-reported information, and workflow impact. Developing, adapting, and validating patient-reported outcome measures for use in geriatric oncology will be key to ensure adequacy of measurement. Groundwork involving consultation of all potential end users of patient-reported information is paramount because there is no one size fits all. When the ground is ready for implementation adequate preparation, training, resources, and ongoing support will be needed. Working within the multidisciplinary team, nurses can promote patient screening that is led by the patient. Nursing roles can be developed, supported, expanded, or repurposed to involve greater use of patient-reported outcome measures for several key patient outcomes in geriatric cancer care.

Current status of patient-reported outcome measures in vascular surgery

A previously published review focused on generic and disease-specific patient-reported outcome measures (PROMs) relevant to vascular surgery but limited to arterial conditions. The objective of this project was to identify all available PROMs relevant to diseases treated by vascular surgeons and to evaluate vascular surgeon perceptions, barriers to widespread implementation, and concerns regarding PROMs. We provide an overview of what a PROM is and how they are developed, and summarize currently available PROMs specific to vascular surgeons. We also report results from a survey of 78 Society for Vascular Surgery members serving on committees within the Policy and Advocacy Council addressing the barriers and facilitators to using PROMs in clinical practice. Finally, we report the qualitative results of two focus groups conducted to assess granular perceptions of PROMS and preparedness of vascular surgeons for widespread implementation of PROMs. These focus groups identified a lack of awareness of existing PROMs, knowledge of how PROMs are developed and validated, and clarity around how PROMs should be used by the clinician as main subthemes for barriers to PROM implementation in clinical practice.

Facilitators and barriers for implementing patient-reported outcome measures in clinical care: An academic center's initial experience

Objectives The aim of this study was to explore the perspectives of healthcare providers and researchers in a large academic hospital on facilitators and barriers for implementing patient-reported outcome measures (PROMs) in clinical care.Methods A customized web-based questionnaire was developed and disseminated to healthcare providers and researchers across multiple medical departments involved in a value-based health care initiative in the hospital. Questionnaire statements were rated using a 5-point Likert scale ranging from “strongly agree” to “strongly disagree”. In addition, 8 open-ended questions were included allowing respondents to mention additional facilitators and barriers for implementing PROMs. Descriptive statistics were used to summarize the results.Results In total, 61 participants from both surgical and non-surgical departments completed the survey. Most respondents (51%) were medical specialists and the median employment duration was 14 years. Frequently reported facilitators were the presence of a PROM coordinator in the (outpatient) clinic (85%), the integration of PROMs in the electronic health record (81%), and the intrinsic motivation of members involved in the implementation (N=9 open responses). Commonly reported barriers were language barriers (76%), IT issues (N=17 open responses), and time constraints (N=14 open responses).Conclusions For the successful implementation of PROMs in clinical practice, it is imperative that healthcare organizations consider supporting motivated healthcare professionals, involving PROMs coordinators, and investing in an adequate IT infrastructure, and removal of language barriers.

Acceptability of patient reported outcome measures (PROMs) in a cystic fibrosis data registry

IntroductionImprovements in the treatment of cystic fibrosis (CF) have resulted in longer survival and an increased focus on optimising daily functioning with the condition. Patient-reported outcome measures (PROMs) are valuable...

Strategies for Effective Implementation of Patient-Reported Outcome Measures in Arthroplasty Practice.

Patient-reported outcome measures (PROMs) will be an important component of real-world evidence, but best practices for capture and integration are not yet defined. While digital tools support patients, clinicians, and researchers to collect PROMs, PROM capture in clinical care remains challenging. We synthesized PROM implementation strategies that are successfully used by hundreds of arthroplasty surgeons and early PROM-adopter clinical systems. This information can guide health systems that are preparing to implement PROMs to inform clinical care, drive quality-improvement activities, and support reporting for payer-sponsored incentives. Specific information is included to guide each step in the implementation process, including selecting PROMs, redesigning office procedures, programming of information technology, and informing interpretation and clinical use. While no one solution exists for successful PROM implementation in total hip and total knee replacement, referred to as total joint replacement, these guidelines can inform optimal PROM deployment and the capture of complete PROM data. In addition, we outline future research that is needed to define methods for optimal patient engagement, technology infrastructure, and operational systems to seamlessly integrate PROM collection in clinical care.

Patient-reported outcomes and patient-reported outcome measures in interstitial lung disease: where to go from here?

Patient-reported outcome measures (PROMs), tools to assess patient self-report of health status, are now increasingly used in research, care and policymaking. While there are two well-developed disease-specific PROMs for interstitial lung diseases (ILD) and idiopathic pulmonary fibrosis (IPF), many unmet and urgent needs remain. In December 2019, 64 international ILD experts convened in Erice, Italy to deliberate on many topics, including PROMs in ILD. This review summarises the history of PROMs in ILD, shortcomings of the existing tools, challenges of development, validation and implementation of their use in clinical trials, and the discussion held during the meeting. Development of disease-specific PROMs for ILD including IPF with robust methodology and validation in concordance with guidance from regulatory authorities have increased user confidence in PROMs. Minimal clinically important difference for bidirectional changes may need to be developed. Cross-cultural validation and linguistic adaptations are necessary in addition to robust psychometric properties for effective PROM use in multinational clinical trials. PROM burden of use should be reduced through appropriate use of digital technologies and computerised adaptive testing. Active patient engagement in all stages from development, testing, choosing and implementation of PROMs can help improve probability of success and further growth.

Patient-reported outcome measures (PROMs) use in post-stroke patient care and clinical practice: a realist synthesis protocol

BackgroundThere is growing interest in the use of routine patient-reported outcome measures (PROMs) to influence the care of individual patients with stroke. However, there are significant gaps in our understanding as to how PROMs influence post-stroke patient care and clinical practice. This is due to factors including the number of purported uses for PROMs and that PROMs are complex interventions, which attempt to stimulate varied actions or behaviours. Therefore, the objective of this realist synthesis is to offer theory-based explanations as to how PROMs influence post-stroke clinical practice and patient care.MethodsThis is a protocol for a realist synthesis, which involves three distinct phases: theory building (phase 1), theory testing and refinement (phase 2) and synthesis (phase 3). Phase 1 will develop initial rough programme theories (IRPTs), through literature searches (from January 2000 onwards) of MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and the grey literature. Only secondary sources will be included that contribute to the development of IRPTs. Only two IRPTs, prioritised by the stakeholder group, will be taken forward to be tested and refined during phase 2. Further novel searches will be employed in phase 2, utilising the same criteria as phase 1; however, phase 2 searches will not utilise grey literature searches, and only primary research studies that contribute to the refinement of programme theories under investigation will be included. Two independent reviewers will screen and select all returned results. The reviewers will code and annotate relevant sources, resulting in ‘fragments’ to be extracted and graded based on the richness of their contribution to explanation and causal insight. Further, these fragments will be organised into ‘Context-Mechanism-Outcome’ configurations. Phase 3 of the review will involve the synthesis of context-mechanism-outcome configurations to form middle-range theory-based explanations and developed logic models for stakeholders to understand how PROMs in post-stroke clinical practice and patient care work for whom, how and under what circumstances.DiscussionThe resulting realist synthesis will provide guidance on the implementation of PROMs within routine post-stroke clinical practice and patient care and act as a touchstone for further testing and refinement of PROMs programmes.Systematic review registrationPROSPERO CRD42020138649.

Features Associated With Quality of Life Impairment in Hidradenitis Suppurativa Patients.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with an adverse impact on patients' quality of life (QoL).Objectives: To quantify QoL impairment in patients in Germany suffering from HS and to identify the parameters associated with QoL impairment.Methods: A non-interventional, cross-sectional, mono-centric study with 500 HS patients. QoL data (measured using the Dermatology Life Quality Index; DLQI) and demographic, anamnestic, clinical, and blood parameters were collected. All patients were examined by dermatologists that documented the skin alterations. QoL data from 462 HS patients were available and evaluated.Results: The mean (± standard deviation) DLQI score of HS patients was 13.18 ± 7.99. Approximately 40% and 20% of HS patients declared very large and extremely large QoL impairment, respectively. The degree of QoL disturbance correlated with the severity of skin alterations, blood leucocyte count and, in particular, with anogenital localization and the presence of nodules and fistulas. Furthermore, QoL impairment was associated with specific comorbidities, such as adiposity and back pain, but not with HS family history. QoL impairment was not influenced by whether or not the patients had undergone resection surgery or antibiotic treatment but was more severe in HS patients that had undergone abscess lancing compared to patients without such treatment in the past.Limitations: It was a mono-centric study and most data were obtained from self-administered patient questionnaires. The association of QoL with type of treatment was analyzed for abscess lancing, resection surgery, and antibiotic treatment. Further therapeutic modalities recommended in the guidelines were not investigated.Conclusion: A profound impairment in QoL was present in patients with HS, and this was higher than that observed in other studied dermatoses. The degree of impairment correlated with the extent of cutaneous and some extra-cutaneous alterations. Surgical and conventional medicamentous therapies of HS were not associated with long-lasting reduction of QoL impairment. Our data support the implementation of patient-reported outcome measures for the assessment of therapy responses.

The Role of Patient-reported Outcomes and Medication Adherence Assessment in Patient-focused Drug Development for Solid Organ Transplantation.

The Role of Patient-reported Outcomes and Medication Adherence Assessment in Patient-focused Drug Development for Solid Organ Transplantation.

Development of a patient-reported outcome measure for patients who have recovered from a subarachnoid hemorrhage: the \u201cquestionnaire for the screening of symptoms in aneurysmal subarachnoid hemorrhage\u201d (SOS-SAH)

BackgroundPatients who have been successfully treated for an aneurysmal subarachnoid hemorrhage (aSAH) often retain multiple health complaints, including mood disorders, cognitive complaints, fatigue, and problems with social participation. These problems are not always fully addressed during hospital visits or in current outcome measures, such as the modified Rankin score and the Glasgow Outcome Scale. Here, we present the development of the “Questionnaire for the Screening of Symptoms in aneurysmal Subarachnoid Hemorrhage” (SOS-SAH), which screens for the self-reported symptoms of patients with mild disabilities.MethodsDuring the development of the SOS-SAH we adhered to the PROM-cycle framework for the selection and implementation of patient-reported outcome measures (PROMs). The SOS-SAH was developed in an iterative process informed by a literature study. Patients and healthcare professionals were involved in the development process through participating in a working group, interviews, and a cognitive validation study.Results and conclusionsRelevant patient-reported outcomes (PROs) were identified for patients with aSAH. The SOS-SAH was developed primarily using domains and items from existing PROMs and, if necessary, by developing new items. The SOS-SAH consists of 40 items and covers 14 domains: cognitive abilities, hypersensitivity to stimuli, anxiety, depression, fatigue, social roles, personality change, language, vision, taste, smell, hearing, headache, and sexual function. It also includes a proxy measurement for use by family members to assess cognitive functioning and personality change.

A Tiered Approach for Integrating Patient Outcome Measures into the Curriculum

Context Knowledge and understanding of effective practices for integration of patient-reported outcome measures (PROMs) within athletic training curricula are necessary to bridge the gaps between didactic application, content assessment, and clinical implementation. Objective To provide athletic training educators with a tiered approach to implement content and assessments related to PROMs in the athletic training curriculum. Background An emphasis in the athletic training community is the need to incorporate patient-oriented evidence that matters into clinical practice. One way of achieving this transfer of knowledge is incorporating PROMs into athletic training curriculum. The 2020 Commission on Accreditation of Athletic Training Education (CAATE) Standards include PROMs and strategies to evaluate them for use in clinical practice to improve patient care. Thus, stakeholders responsible for students' education must have the knowledge and ability to properly address these standards in order for students to utilize these skills as future athletic trainers. Description This article offers an approach for educators to teach and assess PROMs within their athletic training curriculum. Clinical Advantages By utilizing an effective teaching approach for the implementation of PROMs, educators, preceptors, and students may collectively integrate these validated tools accurately into patient care to provide a more holistic practice. In addition, using a tiered approach will increase understanding and confidence for athletic trainers who have identified barriers and may not have prior clinical experience in the implementation of PROMs with patient care. Conclusions The knowledge and use of PROMs are expected of students in CAATE-accredited athletic training programs. In order to ensure and enhance the transfer of knowledge from the didactic setting to clinical practice, the use of a tiered approach may benefit athletic training educators as they integrate this content into coursework. In turn, perhaps future clinicians may be more apt to value the benefits of PROMs.

POS-517 IMPLEMENTING PATIENT-REPORTED OUTCOME MEASURES IN ROUTINE HEMODIALYSIS CARE: A QUALITATIVE STUDY OF PATIENT AND HEALTHCARE PROVIDER PERCEPTIONS

Patient-reported outcome measures (PROMs) are questionnaires that enable patients to self-report symptoms and quality of life. While PROMs can help individualize management in chronic disease settings, it is unclear how to optimally integrate them in the care of people with complex chronic diseases, including those receiving chronic hemodialysis. The aim of this study was to explore the perceptions of healthcare providers and patients surrounding the implementation of PROMs and symptom management protocols for people undergoing hemodialysis. In this qualitative descriptive study, we purposively sampled across 10 outpatient hemodialysis centres in Southern Alberta that were part of the “Evaluation of routinely Measured PATient reported outcomes in HemodialYsis care” (EMPATHY) pragmatic, cluster randomized controlled trial. We used the Consolidated Framework for Implementation Research to inform data collection, which provides an approach to conceptualizing how the intervention, setting, individuals, and process might influence PROM implementation. We conducted semi-structured interviews with hemodialysis patients and healthcare providers and in-person observations of PROM administration during hemodialysis sessions. Data were coded in duplicate and analyzed using an inductive, thematic analysis approach. We interviewed 22 patients and 32 healthcare providers (21 nurses, 6 nephrologists, 5 allied health professionals) and conducted 19 observations of PROM-related interactions. Across participant types, PROM use was described as a means of formalizing hemodialysis care processes: “I feel it’s reflective of what we already do… but it seems more informal when we are doing it in our everyday [care]” (Nurse). Four themes related to PROM implementation within hemodialysis care processes emerged from the data: (1) Integrating PROMs within existing clinical rounding structures; (2) Creating additional opportunities for conversation about symptoms; (3) Establishing a process for symptom surveillance and follow-up; and (4) Retaining flexibility to adapt the process to suit site-specific needs. In this study, the implementation of PROMs with symptom management protocols in outpatient hemodialysis care provided a mechanism to formalize assessment and evaluation of patient’s symptoms into routine hemodialysis care processes. Sustaining PROM use should consider individual and contextual factors unique to the hemodialysis care setting.