Table 2.

Recommendations for future research

Healthcare systems: Approaches to PROM collection and corresponding clinical use have an overarching influence on how PROMs are introduced/collected, and ultimately how actively patients and clinical teams engage with them	1. Building on case study findings, researchers should identify implementation evidence that addresses patient adherence to completion of PROMs, including educational initiatives and health service outcomes 2. Conduct research on the design and features of electronic systems chosen for the healthcare system that influence patient adherence to PROMs [22]
Patients: Understanding the patient experience/expectations can help to inform appropriate education/support which will reinforce engagement	1. Work side by side with patient collaborators to co-design and co-evaluate PROM procedures in clinical care. This is an essential step to improve sustainable use of routine PROMs 2. Reflecting on patient quotes from Case Studies 1 and 2 about their energy levels and motivation for completing PROMs, it is important to include approaches that reduce patient burden. This can extend to the frequency of PROMs assessments, and the number of PROMs to be completed at one time. A brief and pragmatic PROM may improve adherence and accessibility
Clinical teams: The utility of PROMs and the tangible benefit or value from PROM completions is of paramount importance for clinical teams	1.Work toward identifying evidence-based ways to improve engagement with clinical teams, as the literature and case study findings indicate that this directly influences patient adherence to PROMs completion [33, 18, 34] 2. Further research is needed on training with teams to support patient adherence to PROMs completion) [35]. 3. From the literature, we identified that the number of patients seen per day by clinical teams can influence completion of PROMs in clinical care, with higher volume associated with lower completion rates [36, 20]. The underlying factors for why patient volume influences PROM completion are unknown, and future research should identify these factors and work to address the modifiable factors, including clinical team/time constraints, and treatment/wait times
PROMs: Much work relating to PROMs is collated through quality improvement projects and individual case studies across a range of healthcare systems	1. Studies define PROM completion rates differently (e.g., complete one time, complete throughout the entire study, complete some or all items). Therefore, we recommend improved standards of reporting in publications on patient PROM completion rates 2. Patients are more likely to complete PROMs provided at the beginning of a battery of questionnaires [12]. Work is needed to identify optimal thresholds for PROM length to reduce patient burden and ensure PROM completion, which could vary by patient health status. Consistent with the literature and Case Study 1, when time is made available from long waiting times in clinics, patient completion are improved, demonstrating that completion may depend largely on making the time available Identify evaluation measures that consider adherence to PROMs completion [37]