Post-discharge monitoring with electronic patient-reported outcomes (ePROs): a qualitative study on implementation after thoracic surgery (Preprint)

BACKGROUND Thoracic surgery is a mainstay of therapy for lung cancer and other chronic pulmonary conditions, but recovery is often complicated. Digital systems to monitor postoperative symptom burden have been developed; however, barriers to routine clinical implementation remain, particularly in complex and vulnerable populations. This study sought to determine end-user (patient) barriers and facilitators of using an electronic patient-reported outcome (ePRO) monitoring platform designed to detect complications from thoracic surgery post-discharge. OBJECTIVE To determine the barriers to electronic patient-reported outcomes use after discharge from surgery METHODS Patients planned for thoracic surgery were recruited to participate in web-based ePRO monitoring. Participants experienced in ePRO use (n=16) underwent semi-structured interviews, which were analyzed by deductive team-based coding. Themes were mapped onto the three domains of the COM-B model of behavior framework (Capability, Opportunity, and Motivation). ePRO design and implementation improvements to respond to these themes were identified. RESULTS Analysis demonstrated seven dominant themes reported by ePRO participants. These included barriers (postoperative patient physical and mental health, lack of access to email and poor internet connectivity, lack of clarity on ePRO use in routine clinical care, and symptom item redundancy) and facilitators (ease of the ePRO assessment completion, engagement with the surgical care team on ePRO use, and increased awareness of symptom experience through ePRO use). The following ePRO intervention design improvements were identified: offering alternatives to web-based completion, tailoring symptom assessments to individual patients, and the need for patient-facing materials linking ePROs to other systems for perioperative care. CONCLUSIONS ePROs have the promise of improved care outcomes for postoperative patients. Addressable barriers and facilitators to implementation in the thoracic surgical patient population have been identified. Future work on testing the impact of intervention design improvements on implementation outcomes of feasibility and acceptability is ongoing. CLINICALTRIAL ClinicalTrials.gov NCT04342260