Abstract：
Details of the development and implementation of integrated care pathways (ICPs) in the context of electronic collection of patient reported outcomes (ePROs) for cancer patients are largely lacking in the literature. This study describes what, why and how decisions were made to adapt and implement an ePROs ICP for patients with lung cancer.
A consensus process was utilized, with the implementation advisory group including multidisciplinary representation from three participating hospitals, to identify local champions and adapt and incorporate the ePRO ICP into the local contexts. Engagement meetings were documented via meeting transcripts, and detailed notes from October 2019 to November 2020 were content-analysed to identify decision-making themes based on the Consolidated Framework for Implementation Research; workflows and process maps were reviewed and modified to integrate ePROs.
In total, 55 engagement activities were held (24 meetings, 20 workshops 11 educational sessions), with n = 96 staff from multiple disciplines participating in the ePROs implementation through advisory meetings, process mapping, change management and staff education. Decisions were made regarding eligible patient cohorts to include, the process for onboarding patients onto the ePRO system, and follow-up and referral pathways. Rationales for decisions included alignment with existing workflows, utilizing available staff, minimizing staff and patient burden and maximizing patient engagement.
Existing resources, staff input and technical and logistical reasons often guided the ICP decisions, highlighting the need for in-depth engagement across all stakeholders for optimal implementation of ePRO ICPs. The ePRO implementation required substantial dialogue and systematic resolution to reach agreement on the final processes. Adapting the local ICP through rigorous engagement facilitated the successful implementation of ePROs as business-as-usual at all three cancer centres. Involving all relevant stakeholders is critical to the successful adaptation of ICPs before their introduction into routine care.
A consensus process was utilized, with the implementation advisory group including multidisciplinary representation from three participating hospitals, to identify local champions and adapt and incorporate the ePRO ICP into the local contexts. Engagement meetings were documented via meeting transcripts, and detailed notes from October 2019 to November 2020 were content-analysed to identify decision-making themes based on the Consolidated Framework for Implementation Research; workflows and process maps were reviewed and modified to integrate ePROs.
In total, 55 engagement activities were held (24 meetings, 20 workshops 11 educational sessions), with n = 96 staff from multiple disciplines participating in the ePROs implementation through advisory meetings, process mapping, change management and staff education. Decisions were made regarding eligible patient cohorts to include, the process for onboarding patients onto the ePRO system, and follow-up and referral pathways. Rationales for decisions included alignment with existing workflows, utilizing available staff, minimizing staff and patient burden and maximizing patient engagement.
Existing resources, staff input and technical and logistical reasons often guided the ICP decisions, highlighting the need for in-depth engagement across all stakeholders for optimal implementation of ePRO ICPs. The ePRO implementation required substantial dialogue and systematic resolution to reach agreement on the final processes. Adapting the local ICP through rigorous engagement facilitated the successful implementation of ePROs as business-as-usual at all three cancer centres. Involving all relevant stakeholders is critical to the successful adaptation of ICPs before their introduction into routine care.
摘要：
在癌症患者的患者报告结果的电子收集（epro）的背景下，综合护理路径（ICPs）的开发和实施的细节在文献中很大程度上缺乏。这项研究描述了什么，为什么以及如何为肺癌患者调整和实施ePROsICP做出决定。
采用了共识过程，实施咨询小组包括三家参与医院的多学科代表，确定本地冠军，并适应并将EPROICP纳入本地环境。参与会议通过会议记录记录，2019年10月至2020年11月的详细说明进行了内容分析，以根据实施研究综合框架确定决策主题；审查和修改了工作流程和流程图，以集成ePro。
总共，举行了55次接触活动(24次会议，20个讲习班11个教育会议)，来自多个学科的n=96名员工通过咨询会议参与ePro的实施，进程映射,变革管理和员工教育。关于符合条件的患者队列的决定包括，将患者送入ePRO系统的过程，以及随访和转诊途径。决策的基本原理包括与现有工作流保持一致，利用可用的工作人员，最大限度地减少员工和患者的负担，最大限度地提高患者的参与度。
现有资源，工作人员的投入以及技术和后勤原因往往指导了国际比较方案的决定，强调需要在所有利益相关者之间进行深入参与，以最佳实施ePROICP。ePRO的实施需要进行实质性的对话和系统的解决方案，以就最终程序达成协议。通过严格的参与适应当地的ICP，促进了所有三个癌症中心照常成功实施ePro。在将ICPs引入常规护理之前，让所有相关利益相关者参与对于成功适应ICPs至关重要。
采用了共识过程，实施咨询小组包括三家参与医院的多学科代表，确定本地冠军，并适应并将EPROICP纳入本地环境。参与会议通过会议记录记录，2019年10月至2020年11月的详细说明进行了内容分析，以根据实施研究综合框架确定决策主题；审查和修改了工作流程和流程图，以集成ePro。
总共，举行了55次接触活动(24次会议，20个讲习班11个教育会议)，来自多个学科的n=96名员工通过咨询会议参与ePro的实施，进程映射,变革管理和员工教育。关于符合条件的患者队列的决定包括，将患者送入ePRO系统的过程，以及随访和转诊途径。决策的基本原理包括与现有工作流保持一致，利用可用的工作人员，最大限度地减少员工和患者的负担，最大限度地提高患者的参与度。
现有资源，工作人员的投入以及技术和后勤原因往往指导了国际比较方案的决定，强调需要在所有利益相关者之间进行深入参与，以最佳实施ePROICP。ePRO的实施需要进行实质性的对话和系统的解决方案，以就最终程序达成协议。通过严格的参与适应当地的ICP，促进了所有三个癌症中心照常成功实施ePro。在将ICPs引入常规护理之前，让所有相关利益相关者参与对于成功适应ICPs至关重要。
