Dorudi, Sina

Abstract Aim The aim of this review was to synthesise qualitative research evidence on factors influencing the implementation of patient reported outcome measures (PROMs) in surgical population. Methods The following databases were searched: MEDLINE, Embase, Emcare, Allied and Complementary Medicine, Global Health, Health and Psychosocial Instruments, Health Management Information Consortium, APA PsycInfo, PubMed and Web of Science. Searches were carried out between 21st and 23rd February 2024. “Best fit” framework analysis was selected for evidence synthesis, necessitating two systematic reviews. The “Models review” focused on relevant theory, framework or conceptual model relating to implementation of PROMs. The “Primary research review” focused on studies describing factors affecting the implementation of PROMs. Case reports, editorial, reviews, meta-analysis, protocols, or studies, conducted in non-surgical or paediatric population, were excluded. Results 3,714 studies were identified in the Models review, of which 7 underwent full-text review and 2 were included in the analysis. Two relevant implementation frameworks were identified: the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research. TDF was selected as a priori framework for the coding of evidence. Primary research review identified 1,293 studies, of which 50 underwent full-text review and 18 were included in the analysis. Extracted data were coded against TDF, revealing multiple patient-, clinician- and provider-factors affecting the implementation of PROMs, including: beliefs about consequences and capabilities, environmental context and resources, knowledge, skills, social influences, decision processes, emotional and identity factors. Conclusions Successful implementation of PROMs into routine surgical practice requires careful consideration of patient-, clinician- and provider-factors.

Abstract Aim Major abdominal surgery (MAS) can have a diverse impact on patient’s life, including physical, emotional and socio-economic effects. At present, there is no patient reported outcome (PRO) instrument that was specifically developed for MAS population. The aim of this study was to develop a hypothesised conceptual framework of the key domains that underpin the process of recovery following major abdominal surgery in the adult population. This framework will serve as a foundation for developing a valid PRO instrument for the target population of interest. Method The development of the hypothesised conceptual framework included the following stages: 1) defining major abdominal surgery and verification of its discriminative properties, 2) systematic review of currently available PRO instruments, 3) mapping of the domains within identified PRO instruments to WHO International Classification of Functioning, Disability and Health (ICF) conceptual framework, 4) derivation of the hypothesised conceptual framework by linking of the ICF domains and the health-related quality of life theoretical framework. Results Fourteen PRO instruments were identified by the systematic review. The individual PRO items within each instrument collectively covered 25 ICF domains and 53 sub-domains. A hypothesised conceptual framework was derived based on the “conceptual model of health-related quality of life” and the ICF framework, applied within three principles of exposure, moderating factors and outcomes. Conclusions This study proposed a hypothesised conceptual framework for the development of PRO instruments to evaluate recovery following major abdominal surgery. However, its relevance, content validity and comprehensiveness remain to be examined in future studies.