Customizing workflows for electronic patient-reported outcome (ePRO) symptom monitoring using the action, actor, context, target, time (AACTT) framework

TL;DR

This paper shows how to create customized workflows for patient symptom monitoring using the AACTT framework to improve implementation in healthcare settings.

Contribution

A detailed, replicable process for customizing ePRO workflows using the AACTT framework for site-specific implementation.

Findings

A five-step process was developed to create site-specific ePRO workflows using stakeholder input and the AACTT framework.

Provisional and final workflows were generated with input from 27 participants representing various healthcare roles.

The AACTT framework effectively guided co-design workshops to align workflows with stakeholder preferences.

Abstract

Real-time electronic patient-reported outcome (ePRO) symptom monitoring is a complex intervention with few examples of successful implementation at scale. A key challenge is designing a clear ePRO symptom monitoring workflow to support implementation into practice. We aimed to create an empirical and theory-informed site-specific workflow guided by the Action, Actor, Context, Target, Time (AACTT) implementation science framework.

A five-step process was undertaken to customize a generic ePRO symptom monitoring workflow to create a site-specific version: (1) design a generic ePRO symptom monitoring workflow through a qualitative study with key stakeholders; (2) conduct co-design workshops to understand stakeholder preferences regarding a site-specific version; (3) code co-design workshop data using the AACTT framework to produce a provisional site-specific version; (4) conduct a final co-design workshop using the AACTT framework to finalize stakeholder preferences for a site-specific version; and (5) code co-design workshop data using the AACTT framework to produce a final site-specific version.

Participants (n = 27) included nine patients, four caregivers, four oncologists, four nurses, two pharmacists, two clinic administrators, and two Electronic Medical Record (EMR) analysts. Provisional and final site-specific workflows were generated outlining the key AACTT components for each step of ePRO symptom monitoring.

We demonstrated the value in using the AACTT to guide the co-design of a site-specific workflow for ePRO symptom monitoring. By describing this process in detail, we will enable others to replicate this process for creating site-specific workflows not only for ePRO symptom monitoring, but for any complex clinical process.

The online version contains supplementary material available at 10.1007/s11136-025-03995-y.

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