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A framework for implementing patient-reported outcomes in clinical care: the PROTEUS-practice guide

Nature Medicine (2024)Cite this article

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Patient-reported outcomes (PROs) are a powerful tool for clinical practice that directly measure patient experiences, enabling providers to tailor care to patients’ needs and priorities. PROs are patients’ own reports of how they feel, function, and live their lives1, collected using standardized, validated questionnaires. Compelling evidence demonstrates the value of using PROs in clinical practice, whereby a healthcare provider and a patient together use the patient’s PROs to inform care. Implementing PROs as part of routine care can facilitate patient–provider communication, help to identify and address healthcare problems, increase efficiency, and improve patient outcomes, such as symptom burden, functioning, quality of life, and even survival2. Measurement of PROs is an integral part of innovative payment models, including the Centers for Medicare and Medicaid Services ‘Enhancing Oncology Model’ and ‘Comprehensive Primary Care Plus’ (CPC+) model3, and contributes to quality metrics such as Newsweek’s 2023 ranking of the world’s best specialized hospitals4.

Despite being enthusiastic to use PROs to inform care, many healthcare systems lack understanding of the considerations involved in designing, implementing, and managing PRO systems. Furthermore, there is no one-size-fits-all approach to integrating PROs into clinical practice, and PRO systems can (and should) vary according to factors such as healthcare setting, PRO system goals, and patient characteristics. Established resources provide data-driven and consensus-based guidance on specific aspects of using PROs in clinical practice. However, a unified framework with updated and comprehensive guidance is needed to support the use of PROs in clinical practice.

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Acknowledgements

We thank members of the PROTEUS Consortium and the original developers of the foundational resources synthesized in the PROTEUS-Practice Guide for their contributions.

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Authors and Affiliations

  1. Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    Norah L. Crossnohere

  2. Centre for Patient Reported Outcomes Research, NIHR Birmingham Biomedical Research Centre and NIHR Applied Research Collaboration West Midlands, Institute of Applied Health Research, University of Birmingham, Birmingham, UK

    Nicola Anderson, Melanie Calvert & Ameeta Retzer

  3. Department of Orthopedics and Physical Performance, University of Rochester Medical Center, Rochester, NY, USA

    Judith Baumhauer

  4. Patient Advocate, National Coalition for Cancer Survivorship, Silver Spring, MD, USA

    Rebecca Esparza

  5. University of Utah Health, Salt Lake City, UT, USA

    Sandi Gulbransen

  6. Psychosocial Department, Emma Children’s Hospital Academic Medical Center, Amsterdam, The Netherlands

    Lotte Haverman

  7. Princess Margaret Cancer Center, Toronto, Ontario, Canada

    Yuchen Li

  8. Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA

    Carolyn Petersen

  9. MD Anderson Center for INSPiRED Cancer Care, University of Texas, Houston, TX, USA

    Christopher Sidey-Gibbons

  10. University of North Carolina, Department of Health Policy and Management, and Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA

    Angela M. Stover

  11. Patient Advocate, The PROTEUS Consortium, Baltimore, MD, USA

    Elissa Thorner

  12. Epic Systems, Verona, WI, USA

    Garrett Ursin

  13. University of Leeds, Leeds, UK

    Galina Velikova

  14. Strategic Communications & Planning, Philadelphia, PA, USA

    Elliott Sparkman Walker

  15. Queen’s University Cancer Research Institute, Cancer Care and Epidemiology, Kingston, ON, Canada

    Michael Brundage

  16. Johns Hopkins Schools of Medicine and Public Health, Baltimore, MD, USA

    Claire Snyder

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  1. Norah L. Crossnohere
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  15. Galina Velikova
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  17. Michael Brundage
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  18. Claire Snyder
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Corresponding author

Correspondence to Norah L. Crossnohere.

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Competing interests

The PROTEUS Consortium is funded by unrestricted support from Pfizer Inc., who had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. M.C. receives funding from the National Institute for Health and Care Research (NIHR), UKRI, NIHR Biomedical Research Centre, NIHR Applied Research Collaboration West Midlands, NIHR Birmingham–Oxford Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, GSK and Merck, and has received personal fees from Aparito, CIS Oncology, Halfloop, Merck, Pfizer, Vertex and Gilead outside the submitted work. A.M.S. has, in the past two years, received related funding from Pfizer Global and unrelated funding from UroGen Pharma Ltd, Sivan Innovation, Hematology/Oncology Pharmacy Foundation, Cancer and Aging Research Group (CARG) Infrastructure grants (R21AG059206 and R33AG059206), and the American Society of Clinical Oncology, and was a paid consultant with Navigating Cancer in 2021. C.S. has consulting funding from Shionogi. N.C. has unrelated consulting support from Boehringer Ingelheim.

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Crossnohere, N.L., Anderson, N., Baumhauer, J. et al. A framework for implementing patient-reported outcomes in clinical care: the PROTEUS-practice guide. Nat Med (2024). https://doi.org/10.1038/s41591-024-02909-8

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