97 Clinicians’ perspective on PROM implementation Introduction In the past decades, there has been increased attention for the use of Patient Reported Outcome Measures (PROMs) in daily clinical practice enabling patientcentered care [1]. Discussing PROMs in the consultation room empowers patients, enhances patient-clinician communication and promotes shared decision making [2-5]. Monitoring patients by using PROMs increases awareness for patients’ concerns, facilitates recognition of physical or psychological problems, improves patient satisfaction with health care and is associated with improved treatment outcomes, including survival [3, 4, 6-8]. After two efficacy studies [9, 10], the KLIK PROM portal (www.hetklikt.nu) is being implemented in daily clinical practice since 2011. These studies showed that the feedback and discussion of PROMs in the consultation room resulted in more attention for, and improved identification of, psychosocial and emotional problems and increased satisfaction of pediatricians with the provided care [9, 10]. Within the KLIK PROM portal, pediatric patients (≥ 8 years) and/or their parents and adult patients are asked to complete PROMs regarding Health Related Quality of Life (HRQOL), symptoms and/or psychosocial functioning online at home prior to the outpatient consultation. The answers are converted into an electronic PROfile (KLIK ePROfile, Figure 1) that contains a broad range of feedback options tailored to each specific PROM [11]. The clinician discusses the KLIK ePROfile during the outpatient consultation with patients and/or parents in order to monitor well-being over time, detect problems at an early stage and provide tailored advice and interventions. Currently, more than 17,000 patients from 70 different patient groups (e.g., rheumatology, diabetes, oncology) have registered themselves on the KLIK website and around 1,000 clinicians (e.g., physicians, nurses, psychologists, social workers, physiotherapists, dieticians, and speech therapists) have been trained (around 800 active users) in the use of KLIK in daily clinical practice in > 20 different hospitals in the Netherlands [12] and 3 hospitals in the United Kingdom (www.klik-uk.org). Nevertheless, implementing a PROM portal in clinical practice is a challenging process in which the interests of different stakeholders are involved [12, 13]. For a successful implementation, different determinants can be distinguished on the level of intervention characteristics, the clinician, the patient (and parent), and the socio-political context. In the past years, the intervention characteristics of the KLIK PROM portal have been evaluated repeatedly and adapted so that identified barriers for implementation for this determinant have been addressed [12, 13]. 4
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