Implementation of Electronic Patient-Reported Outcomes in Routine Cancer Care at an Academic Center: Identifying Opportunities and Challenges
Open accessAbstract
PURPOSE: Electronic patient-reported outcomes (ePROs) can help clinicians proactively assess and manage their patients’ symptoms. Despite known benefits, there is limited adoption of ePROs into routine clinical care as a result of workflow and technologic challenges. This study identifies oncologists’ perspectives on factors that affect integration of ePROs into clinical workflows. METHODS: We conducted semistructured qualitative interviews with 16 oncologists from a large academic medical center, across diverse subspecialties and cancer types. Oncologists were asked how they currently use or could imagine using ePROs before, during, and after a patient visit. We used an inductive approach to thematically analyze these qualitative data. RESULTS: Results were categorized into the following three main themes: (1) selection and development of ePRO tool, (2) contextual drivers of adoption, and (3) patient-facing concerns. Respondents preferred diagnosis-based ePRO tools over more general symptom screeners. Although they noted information overload as a potential barrier, respondents described strong data visualization and ease of use as facilitators. Contextual drivers of oncologist adoption include identifying target early adopters, incentivizing uptake through use of ePRO data to support billing and documentation, and emphasizing benefits for patient care and efficiency. Respondents also indicated the need to focus on patient-facing issues, such as patient response rate, timing of survey distribution, and validity and reliability of responses. DISCUSSION: Respondents identified several barriers and facilitators to successful uptake of ePROs. Understanding oncologists’ perspectives is essential to inform both practice-level implementation strategies and policy-level decisions to include ePROs in alternative payment models for cancer care.
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Problems connecting digital technologies with electronic health records and existing oncology information systems were reported across ePRO systems, telehealth platforms, mobile applications, and decision-support tools.
“Problems connecting digital technologies with electronic health records and existing oncology information systems were reported across ePRO systems, telehealth platforms, mobile applications, and decision-support tools [8,32,41,45].”
From Digital health technologies in oncology services: A scoping review of clinical implementation, organisational evidence gaps, and policy implications (2026) · cites this paper as [32]
The Discussion reports ePRO workflow problems involving the EHR, including information overload and the lack of out-of-the-box ePRO visualization in widely used EHRs. This supports an EHR-related difficulty for ePROs, but the paper does not report problems connecting telehealth platforms, mobile applications, or decision-support tools to existing oncology systems. It also describes many ePRO barriers as anticipated concerns rather than observed connection failures. (LLM, conf=0.86)
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- Authors
- Sandhu, S., King, Z., Wong, M., Bissell, S., Sperling, J., Gray, M., Ratliff, W., Herring, K., & LeBlanc, T. W.
- Affiliations
- Duke University (US)
- Venue
- JCO Oncology Practice
- Published
- 2020-11
- Volume
- 16
- Issue
- 11
- Pages
- e1255-e1263
- ISSN
- 2688-1527 (ISSN-L)
- 2688-1535
- OpenAlex
- W3085488595
- Cited by
- 44
- References
- 19
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 15 · 2023: 10 · 2022: 6 · 2021: 3 · 2020: 1
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JCO Oncology Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- electronic patient-reported outcomes, cancer care, clinical workflow integration, oncologists' perspectives, symptom monitoring, information overload, data visualization, alternative payment models, academic medical centers
- MeSH terms
- Patient Reported Outcome Measures, Oncologists, Electronics, Humans, Neoplasms, Surveys and Questionnaires, Reproducibility of Results
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