Introduction PROMs have potential to improve care at the micro level (management of individual patients) and in the evaluation of health services at meso and macro levels. But this promise may be hampered by practical, methodological and attitudinal barriers. We aimed to synthesise evidence about how PROMs are used in practice, their effectiveness in improving care and outcomes, and barriers and enablers to implementing PROMs at micro, meso and macro levels.
Methods Following methods for umbrella reviews, we searched five electronic databases for reviews published in English that comprehensively or systematically reported on the use or implementation of PROMs in any health condition, setting, and geographical location, published 1999 to February 2019. Two reviewers independently applied inclusion criteria. Data was extracted by one reviewer and cross-checked by another. Key results were qualitatively synthesised.
Results From 48 reviews we found convincing evidence that PROMs improve communication between patients and clinicians, and patient satisfaction. There is emerging evidence that PROMs can predict prognosis, and successfully screen for unmet needs, and equivocal evidence that PROMs collected in clinical practice improve patient outcomes. PROM implementation can be hampered by: 1) pre-existing clinical practice, culture and behaviours; 2) lack of knowledge/understanding of PROMs (e.g. how to use and interpret PROM data) and their value in the clinical context (e.g. how to use PROMs in real-time to inform care); and 3) difficulty choosing appropriate and informative PROMs for a given context.
Conclusions Conclusive evidence supports use of PROMs for care planning and decision-making for individual patients to provide timely person-centred care, improve communication between patient and provider, and ensure appropriate referrals based on identified patient need. However, evidence is equivocal about whether patient outcomes also improve. How PROs are implemented may be the key to their full potential.