Physiotherapist and nurse perspectives on the acceptability and timing of patient-reported outcome measures in clinical practice: Balancing standardisation and flexibility.

Abstract

Patient-reported outcome measures (PROMs), when used at the point-of-care, provide a mechanism to systematically integrate patients' voices into shared decision-making. We examined clinicians' perspectives on the acceptability and preferred timing of PROM completion in routine clinical care for respiratory, musculoskeletal, cardiac, kidney and diabetic condition management. Semi-structured interviews were conducted over videoconference between October 2024 and May 2025. Participants worked at various New South Wales Health clinics, providing care for patients with chronic conditions, and were eligible to collect and review PROMs digitally using the Health Outcomes Patient Experience platform (NSW PRMs-HOPE program). Reflexive thematic analysis was undertaken. Twenty-two physiotherapists and nurses were interviewed. Acceptability themes included: (1) purpose of PROMs; (2) broader ethical considerations for PROMs collection and use; (3) practical aspects of PROM administration. Findings highlighted the elusiveness of an "ideal" timing for PROMs. Timing themes included: (1) (mis)alignment in timing of PROM administration; (2) preferences for fixed or customised timing and frequency of administration; (3) temporal fit and workflow alignment. PROMs were reported as most acceptable when their selection, content, and timing aligned with clinical purpose, scope of practice, and existing workflows. Flexibility in PROM administration was perceived to enhance relevance at the point-of-care and support timely, condition-specific clinical conversations and interventions. However, clinicians also recognised that increased flexibility may reduce the comparability of aggregated PROM data across cohorts, highlighting an inherent acceptability trade-off between meeting individual clinical needs and supporting system-level performance monitoring and benchmarking. People with long‑term health conditions can fill out health surveys called patient‑reported outcome measures (PROMs). These health surveys help patients share how they are coping day to day and how their health condition or treatment is affecting their quality of life. PROMs are used more in healthcare now, but we do not know enough about how clinicians feel about using them or when they should be given to patients to improve their care.In this study, we spoke with physiotherapists and nurses who use PROMs. They told us what they think about PROMs and when these should be completed by patients.Physiotherapists and nurses said PROMs can help them better understand their patients, find changes in their patients' health, and support conversations about care. But they also said they needed extra time to help patients fill in PROMs, some of the questions were unclear for patients, there were language and cultural barriers for some patients, and they did not always know how to use the results.Overall, physiotherapists and nurses wanted more choice in which PROMs they use and when patients complete them. They felt this would make PROMs more useful for patient care. But, too much choice could make it harder to compare results across clinics and to see how well services are looking after people.