Barriers and Facilitators to Implementing Patient-Reported Outcome Monitoring in Gastrointestinal Surgery

Cassandra B. Iroz, Julie K. Johnson, Meagan S. Ager, Rachel Hae Soo Joung, Brian C. Brajcich, David Cella, Patricia D. Franklin, Jane Louise Holl, Karl Y Bilimoria, Ryan Patrick Merkow*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction: More than 30% of patients experience complications after major gastrointestinal (GI) surgery, many of which occur after discharge when patients and families must assume responsibility for monitoring. Patient-reported outcomes (PROs) have been proposed as a tool for remote monitoring to identify deviations in recovery, and recognize and manage complications earlier. This study's objective was to characterize barriers and facilitators to the use of PROs as a patient monitoring tool following GI surgery. Methods: We conducted semistructured interviews with GI surgery patients and clinicians (surgeons, nurses, and advanced practitioners). Patients and clinicians were asked to describe their experience using a PRO monitoring system in three surgical oncology clinics. Using a phenomenological approach, research team dyads independently coded the transcripts using an inductively developed codebook and the constant comparative approach with differences reconciled by consensus. Results: Ten patients and five clinicians participated in the interviews. We identified four overarching themes related to functionality, workflow, meaningfulness, and actionability. Functionality refers to barriers faced by clinicians and patients in using the PRO technology. Workflow represents problematic integration of PROs into the clinical workflow and need for setting expectations with patients. Meaningfulness refers to lack of patient and clinician understanding of the impact of PROs on patient care. Finally, actionability reflects barriers to follow-up and practical use of PRO data. Conclusions: While use of PRO systems for postoperative patient monitoring have expanded, significant barriers persist for both patients and clinicians. Implementation enhancements are needed to optimize functionality, workflow, meaningfulness, and actionability.

Original languageEnglish (US)
Pages (from-to)341-349
Number of pages9
JournalJournal of Surgical Research
StatePublished - Aug 2023


  • Gastrointestinal surgery
  • Patient-reported outcomes
  • Postdischarge monitoring
  • Qualitative research
  • Surgical oncology

ASJC Scopus subject areas

  • Surgery


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