| PROMs are relatively easy to complete. |
For most patients, completion of PROMs is not burdensome. |
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“I think the survey seems to address relevant symptoms and would be not particularly burdensome for the vast majority of patients.” (physician 5,
non-JH
academic practice)
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“I think you’ve kind of hit the high points on potential illness. You do a general quality of life assessment, which is good. You check for mental health issues a little bit, which is good. I like it. I think it covers what it needs to cover without being too intrusive.” (patient 9, CKD G3b)
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| PROMs may need optimization to be more user friendly. |
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“I would probably try to make this a little bit more user friendly and also shorter, so if we can—if they can start with maybe three questions, and if one of those is a yes and that’s possibly for depression or for any other symptom, then more questions come up after that. And probably that would help screen patients that would benefit more from a more detailed survey.” (physician 7, JH academic practice)
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“Just make certain that it's really easy to complete, that it doesn’t involve long and drawn-out thought on a subject because you’re already there at the doctor’s, with a certain amount of anxiety and concern. So, to have something that's difficult and hard to get you along with what you're already experiencing, that would pose problems…Just a simple, maybe a yes or no, questions that are yes or no.” (patient 12, CKD G4)
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| PROMs should allow multiple potential methods of data collection. |
PROMs could be collected in-person on clinic check in. |
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“I think the tablet in the clinic is a good place because you're really focused on your kidneys at that point, where getting to [EHR patient portal] requires a bit of a discipline.” (patient 17, CKD G4)
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| Clinic staff could assist patients in completing PROMs. |
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“I can imagine subgroups of patients, the very elderly patients with cognitive impairment, patients with visual impairment or other physical impairment for whom completion of an electronic questionnaire would be more challenging. In that case, another option I think would be just to have it administered by support staff as part of say, for example, the initial vital sign measurements.” (physician 5,
non-JH
academic practice)
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| Review of PROMs data is limited by time constrains of clinic. |
Physicians require additional time to review and discuss PROMs data with patients. |
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“…to me, the challenge with these conversations, it doesn’t have anything to do with whether I’m willing to bring it up and talk about even things like hospice care or other ways to manage end-stage type disease because I do that pretty regularly and I do feel comfortable doing that. But sometimes I think that it requires a lot more time than what we build into our day.” (physician 4,
independent
practice)
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“I think that they’re important questions to get from a patient. But my downside concern is they’re going to answer a lot of them positive. And then you’re obliged to address that. And I wouldn’t ignore them because that’s not my personality. But now a 30-minute visit becomes a 45-minute visit. And I’m running late for everyone else.” (physician 8, JH academic practice)
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“There’s a real drive to get to the stuff that we need to discuss before we run out of time in clinic: kidney function, hypertension control, anemia, bone disease, and, often, quality of life, mental health, these things often take a back seat to those issues, simply because there's so much to go through…It's almost always, okay, we've got to check this box, or we’ve got to check that box…Often, because of that, these issues take a back seat and are not frequently addressed.” (physician 9,
non-JH
academic practice)
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| PROMs could be collected before clinic visits via the EHR. |
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“I think if the survey is given to the patient beforehand, like we said, like they get a reminder text to fill out the survey before their appointment, then we can just review the results on the day of instead of having them fill it out during the appointment time.” (physician 14,
independent
practice)
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| Clinic staff could help ensure that PROMs data are reviewed. |
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“I don’t know if it would help if, for example, when they’re checked in, if they answered the questionnaire through the iPad if you’re alerted as well that they, if the [medical assistant] who’s checking in the patient, adds that, in addition to vital signs, it said they answered the [PROM]…” (physician 15, JH academic practice)
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| PROM results should be easily understandable. |
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“…if I have the three scores, the global summary score, the physical, and the mental, specifically, and these are the scores, and it will appear green, yellow, or red, based on the score. And if it’s red or yellow, I know it’s not great, but if it’s red I know it’s bad, then I can click on that tab, and then get the detail of what’s giving that score. And I can look into the detail of it and focus on it more.” (physician 1, JH academic practice)
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“Well, one would be if there was some kind of automatic way to, like let’s say somebody has a high or a low score or something stands out that signals that they’re having some substantial symptoms. If there’s any way that if the score surpasses a certain number, you know, you get like an alert.” (physician 12,
independent
practice)
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