OBJECTIVES: To explore existing evidence on the impact of incorporating patient-reported outcomes (PRO) into routine oncology clinical care on patient outcomes and work flow using a systematic literature review (SLR).

METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was developed and used to guide the SLR conducted in Medline and Embase databases for studies published from 2006 to 2017. An additional search was completed following the initial search to include references of identified articles and prior SLRs. A theoretical framework based on ISOQOL PRO Implementation Guidelines was used to guide data synthesis.

RESULTS: After screening 4,417 abstracts, 36 studies met the eligibility criteria (44% from US). The majority of studies reported PRO intervention trial evaluations (n=22, 61%) or feasibility assessments (n=13, 36%); only three studies reported real-world PRO implementation. Of the 22 studies with an intervention component, three reported no intervention effects on study outcomes. PRO intervention effect was documented for patient centered communication (n=8), changes in PRO score (n=8), chart documentation (n=3), and satisfaction with treatment (n=3). The EORTC QLQ-C30 was most commonly-used across studies (n=10, 28%) with an additional 38 measures also reported. Most elements of the ISOQOL PRO Implementation Guidelines were followed, with a notable gap in providing interpretation guidelines. Fewer than 20% of studies reported information on interpretation of PRO scores and 25% discussed strategies for addressing issues identified by PROs.

CONCLUSIONS: Existing evidence is mixed, but suggests that the use of PROs in clinical care may be effective for symptom monitoring, improving quality of care, and/or increasing patient-centered communication. Yet, reports of real world PRO implementation are scarce. Factors that can facilitate implementation include: 1) increased focus on interpretation guidelines for PROs; 2) addressing existing implementation barriers; 3) early engagement of diverse stakeholders and 4) systematic implementation approach.