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Micro-Meso-Macro Practice Tensions in Using Patient-Reported Outcome and Experience Measures in Hospital Palliative Care.

Journal article
Authors Marian Krawczyk
Kara Schick-Makaroff
Kelli Stajduhar
Joakim Öhlen
Sheryl Reimer-Kirkham
Esther Mercedes Laforest
Robin Cohen
Published in Qualitative Health Research
Volume 29
Issue 4
Pages 510-521
ISSN 1049-7323
Publication year 2019
Published at University of Gothenburg Centre for person-centred care (GPCC)
Institute of Health and Care Sciences
Pages 510-521
Language en
Subject categories Nursing, Palliative medicine


This article applies a micro-meso-macro analytical framework to understand clinicians' experiences and perspectives of using patient-reported outcome and experience measures (PROMs and PREMs) in routine hospital-based palliative care. We structure our discussion through qualitative analysis of a design and implementation project for using an electronic tablet-based tool among hospital-based palliative clinicians to assess patients' and their family caregivers' quality of life concerns and experiences of care. Our analysis identified three categories of practice tensions shaping clinicians' use of PROMs and PREMs in routine care: tensions surrounding implementation, tensions in standardization and quantification, and tensions that arose from scope of practice concerns. Our findings highlight that clinicians necessarily work within the confluence of multiple system priorities, that navigating these priorities can result in irreducible practice tensions, and that awareness of these tensions is a critical consideration when integrating PROMs and PREMs into routine practice.

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