Table 3

Theme 2—concerns around PROM use and implementation

Concerns around PROM use and implementationPROM implementation:
Engaging patients and practitioners
If we're talking about clinicians (…) [they] need to feel ownership of the measures they use—they need to feel that, you know, I'm using this because I feel it's the right thing to do; I'm convinced by its validity and I think it works with my patients (P 20, Voluntary Organisation)
Part of the buy-in is to get the patients to take control of it and feel like it's useful to them first (…) if it's seen as some kind of measure of them at a point in time, they might think it was, you know, it could be used against them or it might be used to justify doing or not doing something that they want to do (P29, GP)
There's no good me handing a questionnaire to a patient in a meeting asking them to rate the quality of the service I'm now giving them (…) and asking them to hand it back to me, that's not going to work (…) If it's something about am I [the patient] actually achieving some of my goals and you've got a properly collaborative relationship with them, that shouldn't be a problem (P30, Healthcare Provider)
PROM implementation:
Divisions across services
We happen to historically have built a wall around something we call health (…) And we've built a wall around something that we call social care (…) [but] if we're being person centred, we want to understand all of those domains around [people with LTCs] and to think about how that…how support to that individual can be provided and that will then involve relationships between things—services—which we have compartmentalised (P8, Voluntary Organisation)
What would be really nice would be if barriers between the different organisations that look after people with long-term conditions were easier to overcome (P11, GP)
The issues that we've encountered with social care and health mixing is boundaries really (P29, GP)
PROM use: Interpretability and usability of PROM dataThere needs to be a set of principles, there needs to be an agreement, there needs to be some sort of broader oversight around all of that [interpretation] because lots of different parts of the system will want to use the data (…) I think there needs to be an agreement about how we manage the analysis and the interpretation (P14, Regulator)
Interpretation of any data has to sit within a wider understanding of what's going on because reported measures in any way can be misinterpreted (P25, Social Care)
A measure may be designed for a purpose but if the beliefs and behaviours of the people in the system are driven by a different purpose (…) then that measure will be captured and re-interpreted into that purpose (P9, GP and Voluntary Organisation)
Unless people understand the context of the data (…) you can make sweeping assumptions about the data (P30, Healthcare Provider)
You have to be really sure that it's doing the job you want to do and not just becoming a reporting measure within the, you know, for instance within the commissioning system (Participant 20, Voluntary Organisation)
  • GP, general practitioner; LTC PROM, long-term conditions patient-reported outcome measures; NHS, National Health Service.