Table 3

Findings and experiences on the use of PRO measure interventions (n=7)

Study, countryMain findingsExperiences of the PRO measure interventions
Bachmeier et al,29 AustraliaThe PRO measure may help identify depression, anxiety, diabetes-related stressors, social, financial and dietary concerns and highlight clinical care needs. PRO measures may also help streamline referrals to relevant members of a multidisciplinary team.The Diabetes Psychosocial Assessment Tool was easy to use and was accepted by the young adults who completed the form.
Haugstvedt et al,*30 NorwayThree themes, each with two subthemes:
  1. Conflicting demands and priorities: (i) balancing guideline recommendations with patients’ main concerns and (ii) experiencing that patients need more support to disclose their emotional concerns.

  2. Insights into using dialogue tools: (i) the benefits and challenges of using the PAID questionnaire as a dialogue tool and (ii) the usefulness of communication techniques.

  3. Challenges associated with facilitating new interventions: (i) unclear roles and responsibilities in multidisciplinary teams and (ii) the capacity sets the limit, not the willingness.

Physicians and nurses experienced substantial challenges related to time and resources in using dialogue tools to support patients’ emotional concerns in clinical diabetes consultations.
Hernar et al,*33 NorwayGenerally, the touchscreen computer functioned well technically. The median time spent completing the PRO measures was 8 min, 19 s. Twenty-nine (42.0%) participants completed the PRO measures without missing items, with an 81.4% average instrument completion rate. Participants reported that the PRO measures were comprehensible (n=62) and relevant (n=46) to a large or very large degree, with an acceptable number of items (n=51). Moreover, 54 participants were willing to complete PRO measures annually. Participants commented that the focus of the PRO measures on living with diabetes was valuable.Capturing PRO measures on a touchscreen computer in an outpatient clinic was technically and practically feasible. The participants found the PRO measures to be relevant and acceptable with a manageable number of items and reported willingness to complete PRO measures annually.
Hernar et al,*27 NorwayThroughout the study, 23/39 intervention arm participants qualified for additional consultations, of which 17 attended. Sixty-seven of 79 participants attended the 12-month follow-up (15.2% attrition), and 5/17 referred to additional consultations were lost to follow-up (29.4% attrition). Participants reported PRO measures as relevant (84.6%) and acceptable (97.4%) but rated the usefulness of consultations as moderate to low.Completing electronic PRO measures was generally accepted and technically feasible.
Implementation fidelity and difficulties in delivering the intervention as designed appeared challenging for the clinic.
Hernar et al,*31 NorwayThree themes, each with two subthemes:
  1. Follow-up with limitations: (i) marginal dialogue about everyday challenges and (ii) the value of supportive relationships and continuity.

  2. New insights and raised awareness: (i) more life-oriented insights and (ii) moving out of the comfort zone.

  3. Addressing problem areas with an open mind: (i) need for elaboration and (ii) preparedness for dialogue.

Completing and using the PAID questionnaire was somewhat uncomfortable yet worthwhile. By using diabetes distress data, together with health and biomedical data, consultations became more attuned to the young adults’ wishes and needs, mainly because the dialogue was more focused and direct. Hence, the PAID questionnaire has the potential to facilitate person centeredness and improve patient-provider relationships.
Jensen et al,†34 DenmarkThree themes with no subthemes: (1) increased reflection on living with diabetes; (2) involvement brings more flexibility and a strengthened sense of responsibility and (3) changed conditions for diabetes care.The DiabetesFlex Care could enable patients to take responsibility for their diabetes management and help healthcare professionals to support user involvement and self-management. In addition, it could reduce how healthcare services disrupt patients’ daily lives.
Laurberg et al,†28 DenmarkMean difference in hemoglobin A1c between standard care and DiabetesFlex was similar. No intergroup mean changes in lipid profiles or blood pressure were observed. Conversely, DiabetesFlex participants had increased mean WHO-5 and decreased PAID scores compared with standard care participants. DiabetesFlex participants changed 23% of face-to-face visits to telephone consultations, canceled more visits (17% vs 9%) than standard care participants and failed to turn up without canceling their appointment less often than standard care participants (2% vs 8%).Flexible patient-controlled visits, combined with PROs, improved diabetes-related well-being and decreased face-to-face visits while maintaining safe diabetes management among participants with type 1 diabetes.
Skovlund et al,32 DenmarkPeople with diabetes found the PRO diabetes questionnaire to be relevant, acceptable and feasible to complete from home. People with diabetes and healthcare personnel found the digital PRO tool to be feasible and acceptable for use during diabetes-related visits and would like to continue using it. Healthcare personnel could use the tool in a person-cenetred manner, as intended. For several people with diabetes, completing the questionnaire facilitated positive reflection and better preparation for their visits. The PRO tool primarily improved the quality of dialogue by improving the identification of issues and focusing on the issues most important to the person with diabetes. People with diabetes did not report any negative aspects of the PRO tool. In contrast, healthcare personnel highlighted that it was demanding when the person with diabetes had many PRO issues that required attention within the predefined time allocated for a visit.The Danish PRO diabetes questionnaire and the digital tool, DiaProfil, are feasible and acceptable solutions for routine diabetes visits.
  • *Reports from the same project intervention.

  • †Reports from the same project intervention.

  • PAID, Problem Areas in Diabetes; PRO, patient-reported outcome.