Integrating patient-reported outcomes into routine oncology practice: A hybrid type 3 implementation study of FRAME-PRO-CR.

Abstract

495 Background: Systematic identification of late effects and supportive care needs remains inconsistent in routine oncology. Although patient-reported outcomes (PRO) offer a potential solution, their sustained integration into clinical workflows is still limited. This study evaluated the implementation of a dialogue-based PRO (FRAME-PRO-CR) in colorectal cancer care. Methods: A real-world, mixed methods hybrid type 3 implementation trial was conducted in a Danish outpatient oncology clinic. Implementation was guided by an Implementation Research Logic Model, the Theoretical Domains Framework and ERIC taxonomy, and evaluated using RE-AIM integrating Proctor’s outcomes (scales 1-5). A multicomponent strategy targeting workflow integration, clinician use of PRO data, and organizational anchoring was applied. Quantitative outcomes included FRAME-PRO-CR completion rates, referral activity, and clinician- and patient-reported implementation indicators. Qualitative interviews explored implementation processes and contextual influences. Results: During the 6-month period, patient reach was high, with 81% (349/429) completing at least one PRO and an assessment-level completion rate of 72% (664/922). As an exploratory indicator of effectiveness, referral rates to supportive care services increased from 24% pre-implementation to 41% during the trial period. Adoption was high, with 85% of clinicians reporting active use after 2 weeks and 83% after 3 months. Implementation outcomes indicated moderate to high acceptability and appropriateness (median 3.2–3.7) and moderate feasibility (median 3.0–3.15). Maintenance was reflected in a sustained high FRAME-PRO-CR completion rate of 87% during a 6-month post-trial phase. Qualitative findings indicated that embedding PRO use within consultation workflows reduced cognitive burden and supported consistent use, while leadership attention and feedback mechanisms were important for sustaining use over time. Conclusions: A theory-informed, multicomponent strategy supported integration of a dialogue-based PRO into routine colorectal cancer care, achieving high reach, adoption, and maintenance. Future studies should examine the impact of PRO-based interventions on clinical outcomes at larger scale and across diverse settings.