146 Chapter 7 clinical practice.13,26 The underestimated value of the OQUA may be explained by the lack of received information and feedback about the outcomes, completion of training before PROMs were part of the curriculum (average of 13.2 years of work experience) and, in addition, general resistance to change in an established workflow.3,12 In the literature, the overwhelming amount of patient information provided by a PROM is considered a potential barrier to its use in clinical practice.12,21,23 This barrier was not identified in our study, which may be explained by the intensive development process of the OQUA with involvement and feedback from ENT professionals, and by the reported belief that the OQUA covers all relevant ear complaints. However, this (potential) barrier should be included in the careful consideration of allowing patients to explain their answers in the questionnaire. Enablers have been shown to be more variable across health care settings than barriers.3 The variation observed in the literature may be explained by differences in the implementation stage (pre-, during or post), the local needs of clinics, specific healthcare settings and different patient populations. These enablers included the convenience of tracking and monitoring patient changes, allowing analysis among patients, colleagues and organization; validating a professional’s clinical perception of patient outcomes; facilitating the extraction of patient information that may not be discussed during the consultation; and strengthening the patientclinician relationship.6,12 The above factors can be explained by their consistency with the objectives of the OQUA and in general by the potential benefits of PROMs on providing patient-centred care.1,2 This concordance may underscore the importance of educating professionals about the objectives of the OQUA, demonstrating the beneficial outcomes of the OQUA as a PROM by training, and evaluating the results of the OQUA with individuals, departments or organizations for incentivisation. Looking from the patients perspective, often the majority of patients are not familiar with the content, purpose and benefits of PROMs in general.12,27 This observation can be supported with the findings of our study. One explanation for this barrier may be that most patients (compared to healthcare providers) do not encounter PROMs in their daily lives, and in case of the OQUA, patients did not receive insufficient information from the professional or organization. Several studies have suggested that providing educational resources (e.g., brochures, videos) or offering support from staff can be helpful in increasing patients’ general knowledge about PROMs.12,28 In the literature, the perceived burden of completing PROMs is described as one of the biggest barriers for the patient. This implies that a PROM should be short
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