"Unspoken Questions:" A Qualitative Study of Rheumatologists' Perspectives on the Clinical Implementation of Patient-Reported Outcome Measures.

To identify rheumatologists' views on perceived barriers and facilitators to the clinical implementation of patient-reported outcome measures (PROMs).Semi-structured interviews were conducted with academically affiliated clinical rheumatologists. Interviews were audio-recorded and transcribed. De-identified transcripts were independently coded and analyzed for themes.Fifteen attending rheumatologists, 8 women (53%) and 7 men (47%) with a median of 15 years in practice (range 5 to 43) at two urban academic medical centers participated in interviews. Rheumatologists identified several barriers to integrating PROMs in clinical care, highlighting physician buy-in and culture change as significant challenges beyond logistical considerations. They further underscored the lack of effective interventions and resources for addressing the domains of most interest to patients. Physicians also recognized significant benefits of PROMs in clinical care, including contributing to the clinical impression by providing the patient perspective, and promoting agenda setting by uncovering "unspoken questions." They additionally noted that PROMs could support treatment planning, build patient-physician relationships, and facilitate patient engagement. Participants suggested that technology, physician education, and team-based care could facilitate the effective implementation of PROMs.Rheumatologists identified multiple mechanisms through which PROMs could augment clinical care, but also noted several obstacles to implementation, questioning the added value of PROMs and the limited availability of interventions to improve patient-centered outcomes. Programs seeking to successfully integrate PROMs to enhance patient-centered care and meet quality benchmarks should prioritize physician buy-in and training and provide resources to address the outcomes that are measured.

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