Table 2

Details of the PRO measure interventions (n=7)

Study, countryIntervention namePRO measure focusElements, items and domains of the PRO measures in the interventionsIntervention mode and practicalities
Bachmeier et al,29 AustraliaDPATPsychosocial needsDPAT comprises three questionnaires, an agenda-setting tool and additional questions:
PAID-20 to identify diabetes-related distress
PHQ-4 assessing potential anxiety and depression and WHO-5 assessing emotional well-being
Social support, financial, weight, shape and eating concerns Hypoglycemia concerns
Agenda-setting tool
Participants were given the DPAT form by the clinic staff and completed it independently prior to their clinic appointment. It was unclear whether it was paper-based or web-based or how much time was spent completing it.
Predefined referral pathways: a PAID-20 score ≥30 prompted diabetes educator review, a PHQ-4 score ≥3 for questions 1 and 2 or questions 3 and 4 was the cut-off for referral to a psychologist or activation of a mental healthcare plan with the participant’s general practitioner. WHO-5 score ≤50 led to a referral to a diabetes educator and ≤28 to a psychologist or a general practitioner for activation of a mental health plan. Scoring 1 or 2 items for weight, shape or eating, concerns prompted a dietician review. Positive scores on social support concerns or finances prompted a review of social work.
Haugstvedt et al,*30 NorwayDiaPROMDiabetes distressPAIDElectronic PAID before annual consultation. A score of 3 (somewhat serious) or 4 (serious) for items on the PAID scale or a total score ≥30 led to follow-up to prevent worsening of diabetes distress.
Hernar et al,*33 NorwayDiaPROMDiabetes distressPAIDA touchscreen computer (17′′ screen) in the outpatient clinic’s waiting area to ensure visibility for the patients. Patients could go back or change their responses. Patients were not required to log in using personal identification; instead, the application generated a four-character code with a mix of letters and numbers for each session. The patient gave this code during the consultation. The healthcare provider downloaded the PRO measures data from the secure data repository to store in the patients’ records.
Hernar et al,*27 Norway ADiaPROMDiabetes distressPAIDElectronic PRO measures prior to annual diabetes consultation.
Physicians reviewed diabetes PAID scores and referred individuals with scores ≥30 or ≥3 for single items to at least two diabetes nurse consultations where reported problems were reviewed and discussed.
Hernar et al,*31 Norway BDiaPROMDiabetes distressPAIDParticipants completed the PAID on an in-clinic touchscreen computer.
Physicians reviewed and discussed the PAID results with the participants, guided by a manual. To lessen or prevent severe distress, the nurses reviewed and discussed reported problem areas with the participants, guided by a study manual with specific person-cenetred communication techniques (active listening, asking open questions, responding, summing up and agreeing on goals and actions to take).
Jensen et al,†34 DenmarkDiabetesFlexMultidimensional diabetes specificWell-being (SF-36 general health question, WHO-5), HbA1c, blood pressure, weight, incidents of hypoglycemia, diabetes-related complications, diabetes distress (PAID), topics for the consultation, need for diabetes care, choice of a healthcare professionalTwo weeks prior to each consultation, participants completed the internet-based AmbuFlex diabetes-specific, patient-reported outcome questionnaire. A more extensive questionnaire was used for the annual visit (45 items) and a shorter form (17 items) for optional visits.
Based on their responses to the AmbuFlex questionnaire, a specialist diabetes nurse evaluated whether it was clinically safe to change or cancel a consultation in accordance with the participant’s request. The first consultation in DiabetesFlex care was face-to-face with an endocrinologist and a specialist diabetes nurse. The last two consultations in the annual cycle were optional, and participants could choose to have a face-to-face consultation, change to a telephone consultation or cancel the visit.
Laurberg et al,†28 DenmarkDiabetesFlexMultidimensional diabetes specificThe questionnaire consisted of items on general health perceptions (one item from SF-36) and well-being (WHO-5), self-monitoring, diabetes complications, diabetes distress (PAID), topics individuals may wish to discuss and the individual’s preferences in relation to diabetes care and type of healthcare providerSame mode and practicalities as reported in the study by Jensen et al.34
Skovlund et al,32 DenmarkDiaProfilMultidimensional diabetes specificThe diabetes questionnaire consisted of 33–71 items (depending on the activation of branch logic) that measured health, life situation, social support, psychological well-being, depression, symptom distress, worries about diabetes, confidence in diabetes self-management, blood sugar regulation, medical experience and satisfaction, access to healthcare personnel, priority issues for support and preferred topics to discussParticipants completed the digital PRO questionnaire 2–10 days prior to the consultation through an email link.
During the visit, the healthcare personnel used the PRO dashboard in DiaProfil to review the patient’s priorities and issues of concern and collaboratively draw up a plan. The healthcare personnel were advised to review the PRO dashboard in advance, share the screen for mutual viewing, explain the PRO dashboard and the color coding, maintain non-verbal communication and eye contact, use open-ended questions and active listening to prompt more information and confirm findings and cover all flagged PRO issues.
  • *Reports from the same project intervention.

  • †Reports from the same project intervention.

  • DiaPROM, Diabetes Patient-Related Outcome Measures; DPAT, Diabetes Psychosocial Assessment Tool; HbA1c, hemoglobin A1c; PAID, Problem Areas in Diabetes; PHQ-4, Patient Health Questionnaire-4; SF-36, 36-Item Short Form Health Survey.