Micro-meso-macro practice tensions in using patient-reported outcome and experience measures in hospital palliative care

Krawczyk, M. , Sawatzky, R., Schick-Makaroff, K., Stajduhar, K., Öhlen, J., Reimer-Kirkham, S., Mercedes Laforest, E. and Cohen, R. (2019) Micro-meso-macro practice tensions in using patient-reported outcome and experience measures in hospital palliative care. Qualitative Health Research, 29(4), pp. 510-521. (doi: 10.1177/1049732318761366) (PMID:29542400)

Abstract

This article applies a micro-meso-macro analytical framework to understand clinicians’ experiences and perspectives of using patient-reported outcome and experience measures (PROMs and PREMs) in routine hospital-based palliative care. We structure our discussion through qualitative analysis of a design and implementation project for using an electronic tablet-based tool among hospital-based palliative clinicians to assess patients’ and their family caregivers’ quality of life concerns and experiences of care. Our analysis identified three categories of practice tensions shaping clinicians’ use of PROMs and PREMs in routine care: tensions surrounding implementation, tensions in standardization and quantification, and tensions that arose from scope of practice concerns. Our findings highlight that clinicians necessarily work within the confluence of multiple system priorities, that navigating these priorities can result in irreducible practice tensions, and that awareness of these tensions is a critical consideration when integrating PROMs and PREMs into routine practice.

• Item Type: Articles
• Additional Information: The research was made possible due to support from the Canadian Frailty Network (Grant No. CAT2013-51) and the Canada Research Chairs program in funding Sawatzky’s chair in patient-reported outcomes.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Krawczyk, Dr Marian
• Authors: Krawczyk, M., Sawatzky, R., Schick-Makaroff, K., Stajduhar, K., Öhlen, J., Reimer-Kirkham, S., Mercedes Laforest, E., and Cohen, R.
• College/School: College of Social Sciences > School of Social & Environmental Sustainability
• Journal Name: Qualitative Health Research
• Publisher: SAGE Publications
• ISSN: 1049-7323
• ISSN (Online): 1552-7557
• Published Online: 15 March 2018
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in Qualitative Health Research 29(4): 510-521
• Publisher Policy: Reproduced in accordance with the publisher copyright policy