Background: Electronic patient-reported outcomes (ePROs) have proven effective in reducing symptom burden and improve quality of life in cancer patients. However, patient adherence to the tool in real-world practice remains suboptimal, posing challenges to the implementation of ePROs-based symptom management.
Objectives: We aimed to develop implementation strategies based on implementation science theories and the Delphi method, thereby promoting the use of ePROs in symptom management for cancer patients.
Methods: Semi-structured interviews were conducted at hospitals with both high and low patient adherence to ePROs in China. Guided by the Consolidated Framework for Implementation Research (CFIR), the barriers and facilitators to ePROs-based symptom management were identified. We used the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool to initially map theory-informed implementation strategies addressing key barriers and refined them through group discussions. A two-round Delphi expert consultation was conducted to evaluate the importance and feasibility of the strategies and further optimize their content. Finally, the Dynamic Sustainability Framework (DSF) was used to categorize the strategies into implementation domains.
Results: A total of 47 individuals were interviewed, including 17 cancer patients, 10 family caregivers, 17 oncologists, and 3 nutritionists. 32 facilitators and 26 barriers were identified, of which 15 were defined as key barriers, and subsequently preliminary operational implementation strategies were developed. These were optimized through a two-round Delphi consultation involving 18 experts in clinical epidemiology, implementation science and other relevant fields, with response rates of 100% for both rounds. The authority coefficients were 0.84 and 0.86, while the coordination coefficients (Kendall's W) for importance were 0.12 and 0.32, and for feasibility were 0.11 and 0.34, indicating consensus among the experts. 9 implementation strategies were ultimately finalized, including: promoting adaptability, obtaining and using patient and caregiver feedback, developing a formal implementation blueprint, conducting educational meetings, establishing incentive and reward mechanisms, identifying and preparing champions, conducting educational outreach, building and maintaining coalitions, and developing academic partnerships. According to the DSF, these strategies were categorized into three dimensions: intervention, practice setting, and ecological system.
Conclusions: This study developed nine implementation strategies that can targetedly address the key barriers currently encountered, providing a theoretical foundation and practical guidance for improving ePROs adherence and enhancing symptom management in cancer care.