110 Chapter 4 Discussion This study provided insight into the experiences of clinicians with the use of the KLIK PROM portal in daily clinical care, at a group level. Overall, clinicians were satisfied with discussing PROMs in the consultation room via the KLK PROM portal. Clinicians indicated that discussing PROMs helps them to gain more insight into patient functioning, to improve the communication with patients, to detect psychosocial or physical problems, and to empower patients. These benefits are in line with previous effectiveness studies [3, 4, 6]. In addition, clinicians valued specific characteristics of the KLIK ePROfile, such as ease of use and the well-developed and insightful feedback. Regarding this feedback, clinicians mentioned they appreciated and looked at the individual item feedback in traffic light colors most often. This preference was also found in previous research on the feedback of the QLIC-ON Profile [19]. Although clinicians indicated that the KLIK training sufficiently prepared them to use KLIK in clinical practice, they also indicated that the training did not fully meet their needs. More explanation about the interpretation of PROM results and the use of cut-off scores would increase their sense of competence. In addition, a refresher course every few years would be desirable. For this reason, the KLIK expert team is now revising the KLIK training. More information and tips and tricks about the interpretation and communication of PROM results will be included. Clinicians indicated that they do not always discuss the PROMs with patients and/ or parents due to lack of time, technical problems or lack of clarity regarding the workflow. For some clinicians it is unclear which team member of the multidisciplinary team discusses the PROMs with patients and/or parents or who sends invitations. This indicates that continuous support with the implementation process and annual evaluation meetings with all team members of a multidisciplinary team remains necessary. Also, patients do not always complete PROMs prior to the outpatient consultation. Forgetting, loss of motivation or no Internet access were reasons from the clinicians’ perspective. In supporting the implementation process, a commonly heard argument from patients for not completing the PROMs is that the clinician does not discuss the PROMs during the consultation. This indicates how important it is for clinicians to discuss the PROMs with patients and/or parents. In addition, it was mentioned that for patients (or parents) with low health literacy skills and for nonnative Dutch speakers it is sometimes difficult to complete the PROMs. Although the most frequently used generic PROMs in KLIK are available in multiple languages, this is not the case for all PROMs. When compiling the PROMs outcome sets with
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