Understanding providers' perspectives using patient-reported outcomes in a pain management setting: a pilot study

Abstract

Aim: This pilot study evaluated an electronic patient-reported outcomes collection system in pain management to understand providers' experiences using the data, and how it affects their patient interaction and guides their clinical decision-making. Materials & methods: Using stratified convenience sampling, nine semi-structured interviews were conducted with consented pain physicians. The transcribed, de-identified interviews were coded and analyzed. Results: Although most physicians utilized patient reported outcomes (PROs), one-third reported no significant change in their practice since implementation and 56% stated it does not influence their treatment recommendations. Conclusion: Despite the importance of measuring the impact of chronic pain on quality of life, there are significant limitations to the real-world use of PRO that may limit the patient's assessment and care.

Summary points

• The importance of measuring the impact of chronic pain on overall functioning and health-related quality of life outcomes in chronic pain management has been established and is recommended by almost every consensus guideline.

• Patient reported outcomes (PROs) can be useful in objectively measuring these domains and guiding clinical decision-making at point-of-care; however, the perspectives of pain management physicians in using these PROs have not previously been reported but are paramount in understanding how it can be best implemented and used in clinical practice.

• The Pain Management division at Weill Cornell Medicine implemented a patient-reported outcomes collection and reporting system using the Patient Reported Outcomes Measurement Information System (PROMIS^®).

• Using stratified convenience sampling, nine semi-structured interviews were conducted on consented chronic pain physicians practicing at Weill Cornell Medicine's Multidisciplinary Spine Center and the transcribed interviews were de-identified, coded, and analyzed.

• Since the integration of PROs, 67% of the physicians report utilizing the data while 33% report not using it or not regularly using it.

• Despite following consensus guidelines in implementing the PROs, a third of the physicians interviewed did not report a significant change in their practice since its implementation and a majority reported that it does not influence their treatment recommendations.

• There were many physician-perceived benefits of the PRO data, including that it provides more detailed information that may have been missed during the clinical encounter, and it helps provide objective value in patients' trends in pain scores and the functional impact of their chronic pain.

• There were several physician, patient and technical-level barriers that were discussed, including that the physicians still need to confirm the questionnaire data with the patients, low patient completion rates and clinician time constraints.

• Despite the value of PROs in measuring the impact of chronic pain on quality of life, further research is still needed to streamline the process for meaningful and efficient PRO data capture in order to improve individualized patient care, treatment outcomes and the impact of chronic pain on a population level.

Keywords: :

• chronic pain
• health related quality of life
• HRQoL
• physician perspectives
• PRO
• PROMIS

Author contributions

LR Witkin, SY Jiang and R Gotian conceptualized the study and developed the study methodology. All authors conducted participant data collection. LR Witkin and A Kasubhai contributed to the analysis and interpretation of the data. LR Witkin prepared the manuscript. All authors critically edited, reviewed, and approved the final draft of the submitted manuscript.

Financial disclosure

A grant from The Applebaum Foundation (Grant Number: 61500265) awarded to LR Witkin supported the study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval from Weill Cornell Medicine for the research described. In addition, they have obtained written informed consent from the participants involved.

Additional information

Funding

A grant from The Applebaum Foundation (Grant Number: 61500265) awarded to LR Witkin supported the study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.