141 Patient’s and parents’ perspective on PROM implementation of the consultation were positive points they agreed on, and content of PROMs was the most important point of improvement mentioned by both user groups. However, patients/parents and clinicians mentioned a different PROM completion rate. Patients and parents indicated a very high completion rate, whereas clinicians estimated that this completion rate is much lower and that it takes a lot of effort to motivate patients to complete PROMs [16]. A possible reason for this difference might be a bias in the current sample, as only patients and parents that were part of the KLIK panel were invited for participation. These patients/parents might be more assertive in comparison to the other KLIK users, which might have resulted in an overestimation of the PROM completion rate. Therefore, continuous support and explanation about the goal of the use of KLIK remains very important to both user groups. There are some limitations to this study that should be mentioned. First, there was a low response rate in the evaluation questionnaire (around 20%) which was unexpected as this questionnaire was sent to participants of the KLIK panel (who indicated that they were willing to be invited for research projects). Possible reasons for the low response rate might be that (1) the willingness of patients and parents has changed as participation in the KLIK panel was only asked during registration, (2) patients and parents do not actively use the KLIK PROM portal anymore, or (3) patients and parents might be tired of completing surveys. Second, it was also difficult to motivate patients to participate in the focus groups. This resulted in a small number of participants per patient focus group (2 to 3 participants) with two moderators, which may have influenced the dynamics. Additionally, we noticed that pediatric patients found it very difficult to formulate and express their opinion and needed a lot of guidance which could have led to a bias in the results. Third, we used a self-developed questionnaire which makes comparisons with other evaluation studies difficult. However, other studies also made use of self-conducted questionnaires [44] or adapted questionnaires from prior studies [29-31], as the questions needed to be specific about features of the tool used. In conclusion, pediatric patients and parents were satisfied with the usability and effect of the KLIK PROM portal in clinical care. KLIK provides them insight into their functioning and helps them to communicate with the clinician. However, some points of improvement were also identified, which are currently being addressed. We now have insight into the experiences of the most important stakeholders (patients/ parents and clinicians) of KLIK. In the future it is important to continuously evaluate 5
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