Using electronic patient reported outcomes (ePROs) to improve supportive care in ambulatory oncology care: a CFIR-guided pre-implementation formative evaluation.

backgroundSystematic collection of patient-reported outcomes via electronic health records can improve symptom assessment and supportive care delivery in oncology, yet implementation is often hindered by inadequate attention to end-user needs and organizational context. Guided by an implementation science framework, we conducted a formative evaluation to inform design and implementation planning of an electronic patient-reported outcome supportive care screening system in ambulatory oncology care, using head and neck cancer as a use case.

methodsA prospective mixed-methods observational study was conducted using semi-structured interviews as part of a pre-implementation formative evaluation. Eligible participants were target users of the proposed supportive care screening system, including (1) clinical staff and (2) patients with head and neck cancer from a single health care system. Using the Consolidated Framework for Implementation Research as a guiding framework, we elicited user feedback through interview and prototype engagement. Quantitative measures included patient symptom burden and validated pre-implementation measures of acceptability, appropriateness, feasibility, and usability. For data analyses, we used directed content analysis and matrix analysis for qualitative data, and descriptive and comparative statistics for quantitative assessments.

resultsForty-six target users (20 clinical staff, 26 patients) participated. Both groups expressed strong tension for change, recognizing many inadequacies of the current approach to symptom assessment. Clinical staff described current practices as "haphazard," while patients recounted missed opportunities for support and preventable harm. Electronic health record integration enhanced perceived compatibility, though time constraints and alert fatigue emerged as potential barriers. Clinical staff emphasized the need for clear symptom thresholds and actionable referral criteria; patients emphasized that their sustained engagement depended on evidence of clinicians using the data in their care. Pre-implementation scores indicated strong readiness across both groups: acceptability (clinical staff 4.47/5, patients 4.21/5), appropriateness (4.46/5, 4.24/5), feasibility (4.41/5, 4.35/5), and usability (82.2/100, 85.6/100). Findings informed key design priorities and implementation strategies.

conclusionsSystematic pre-implementation formative evaluation revealed important barriers, facilitators, and contextual insights that shaped both intervention design and implementation approach. High scores on leading indicators suggest strong organizational readiness and perceived value. This user-informed development process provides a replicable model for optimizing electronic patient-reported outcome systems before deployment.