How Can the Use of Patient-Reported Outcomes Data by Orthopaedic Surgeons Be Improved? A National Qualitative Study.

Background: Routine collection of patient-reported outcome measures (PROMs) is increasing within orthopaedic settings. Although PROMs have the potential to aid orthopaedic surgeons in clinical decision-making, surgeon engagement with and use of these data is limited. Identifying and addressing the facilitators and barriers to the use of PROMs data by orthopaedic surgeons may increase their usage in routine clinical practice.

Questions/purposes: In a qualitative study, we asked: (1) What are the barriers to the use of PROMs data by orthopaedic surgeons? (2) What are the facilitators to the use of PROMs data by orthopaedic surgeons? (3) How can orthopaedic surgeons' uptake of and engagement with PROMs data in clinical practice be enhanced?

Methods: A descriptive qualitative study design was undertaken by enrolling 20 orthopaedic surgeon participants (18 of whom were men). The surgeons were purposively sampled from a carefully curated matrix developed from the research team's professional contacts. This sampling database comprised surgeons performing arthroplasty and endeavored to span a range of demographic and professional characteristics including practice setting (metropolitan and regional Australia, private and public hospitals), clinical experience (< 10 years to 30+ years), and surgeon age (30 to 39 years to 70 to 79 years). In total, 28 orthopaedic surgeons were invited to participate, of which 25 were determined to be eligible. Following established qualitative methods, surgeon recruitment, data collection, and data analysis occurred concurrently. Specifically, invitations to participate were sent to potentially eligible surgeons in successive batches, with ongoing consideration of diversity in sample characteristics. The interviewer determined that thematic saturation had occurred after analyzing the final four interviews, which revealed repetitive themes and no new insights, leading to the cessation of recruitment after 20 interviews. Individual semistructured interviews explored participants' perceptions of factors that support and hinder the use of orthopaedic PROMs data in clinical practice. Surgeons' views on enhancing the utilization of PROMS data were also sought, including opportunities for improving electronic PROMs reporting systems, using a national registry platform as an exemplar. To enhance methodological rigor and reduce researcher bias, five randomly selected, deidentified interview transcripts were independently reviewed by two researchers to ensure consistency in coding and theme development. A combined deductive and inductive approach was then used for data analysis, enabling the categorization of themes into barriers, enablers, and opportunities for improving PROMs use by orthopaedic surgeons.

Results: Key barrier themes impacting orthopaedic surgeons' use of PROMs data included time constraints and a lack of awareness or understanding of PROMs and how these data could be used. Key facilitator themes included better availability of PROMs-specific reports, including reporting within hospital-level audits and providing opportunities for surgeon participation in PROMs research activities to improve familiarization with PROMs data. To increase the use of PROMs data in clinical practice, participants suggested the development and delivery of multiple PROMs education options (for example, seminars and written materials such as email communications with practical examples of PROMs use in clinical practice) for orthopaedic surgeons, continuing education incentives for using PROMs data (for continuing professional development points for reviewing individual PROMs reports), and modern technology solutions (including portable options of PROMs systems) to improve ease of access.

Conclusion: Despite the widespread availability of PROMs data, an incomplete understanding of how to interpret and utilize the data effectively could be addressed if surgeons are provided with supportive educational tools. We will conduct further research to facilitate the development of these tools through codesign methods with surgeons, with careful consideration of the time limitations that impact surgeons' abilities to access and utilize PROMs data.

Clinical Relevance: Targeted educational tools, codeveloped with orthopaedic surgeons, could help realize the potential of PROMs data to support shared decision-making and patient care.