Barriers and facilitators of implementing patient-reported outcome measures in clinical care using the CFIR-ERIC framework

Listening to Patients, Not Just Their Tests

When you see a doctor, blood tests and scans tell only part of the story. How you actually feel—your pain, fatigue, mood, and ability to live your daily life—often stays locked inside your head. Patient-Reported Outcome Measures, or PROMs, are short questionnaires that ask you directly about your health and quality of life. This study from Singapore asks a simple but important question: what helps, and what gets in the way, when hospitals try to use these tools routinely in real-world Asian clinics?

What These Questionnaires Are Meant to Do

PROMs turn personal experiences into structured information that doctors can use alongside lab results and scans. They can highlight symptoms that are invisible on tests, such as anxiety, poor sleep, or struggling to climb stairs. For patients, filling them in can prompt reflection—"how have I really been doing lately?"—and give a clearer agenda for the clinic visit. For health systems moving toward "value-based care," where success is measured by how well people live rather than just how many procedures are done, PROMs promise a more complete picture of treatment benefits and harms.

How the Study Was Done

The researchers interviewed 33 patients and 27 healthcare workers—including doctors, nurses, and administrators—at Singapore’s two largest academic hospitals. Conversations took place in English or Mandarin, in person or over video calls. The team used a well-known framework from implementation science, which is the study of how to turn good ideas into everyday practice. This framework helped them sort comments into categories such as features of the tool itself, the hospital environment, individual attitudes, and the steps needed to roll out new practices. They also used a companion tool that links common obstacles to expert-recommended strategies for overcoming them.

What Helps PROMs Succeed

Patients and clinicians agreed that PROMs can strengthen communication. Some patients said the forms helped them remember problems they might otherwise forget to mention, and helped doctors "understand where I am." Clinicians reported that, in some conditions, PROM scores already guide major treatment decisions, such as whether to increase or reduce powerful medications. Patients also described feeling more informed and in control when they could see their own answers laid out, saying the questionnaires helped them "assess my own condition." Finally, many participants felt that when trusted doctors endorse PROMs and explain why they matter, patients are far more willing to complete them and to take them seriously.

What Gets in the Way

The study also uncovered several barriers, many with a distinctly Asian flavor. Some PROMs were written overseas, with examples like skiing or British slang that felt irrelevant or confusing in Singapore. Older patients and people who speak mainly dialects worried about language and wording. Many were wary of digital links because of frequent phone and text scams, and feared their data and even photos could be misused. On the hospital side, staff described a lack of coordinated systems: PROMs sometimes sat in separate software that did not talk to the main medical record. Nurses and doctors said they had little formal training on when to give questionnaires, how to interpret scores, or how to answer patients’ questions. Already tight clinic schedules and performance targets focused on seeing large numbers of patients made some clinicians feel that PROMs were extra work without clear reward.

Practical Ways Forward

Using the strategy-matching tool, the researchers mapped these obstacles to a menu of 48 practical steps. Top suggestions included running focused education sessions, creating simple teaching materials, and building local "champions"—frontline clinicians who believe in PROMs and help colleagues use them. Other ideas were to adapt questionnaires to local cultures and languages, weave them into existing trusted hospital IT systems and pre-visit messages, and involve families who often support older or less digitally confident patients. The authors argue that change must happen at many levels at once: individual clinics, hospital leadership, and national health systems.

Why This Matters for Everyday Care

In plain terms, the study concludes that PROMs can make care more human and more precise—but only if they are thoughtfully tailored and supported. For patients, that means forms written in familiar language, sent through trusted channels, and clearly linked to how doctors will act on the answers. For healthcare professionals, it means training, time, and tools that integrate smoothly into their daily workflow. From an Asian perspective, it also means recognizing cultural norms: many people still expect doctors to lead decisions, and families to play a central role. If health systems address these realities instead of ignoring them, PROMs can evolve from extra paperwork into a routine, powerful way of making sure the patient’s voice truly shapes their care.

Citation: Kwan, Y.H., Cheung, Y.S., Chew, X.R. et al. Barriers and facilitators of implementing patient-reported outcome measures in clinical care using the CFIR-ERIC framework. Sci Rep 16, 5494 (2026). https://doi.org/10.1038/s41598-026-35154-9

Keywords: patient-reported outcomes, patient-centred care, implementation science, value-based healthcare, digital health