Implementation Challenges of Remote Cancer Symptom Management With Electronic Patient‑Reported Outcomes in China’s Primary Health Care Settings: Qualitative Study Article Swipe
Min Li
,
Jingyu Zhang
,
Jundi Zheng
,
Changjin Wu
,
Zezhong Shao
,
Lei Cheng
,
Hongfan Yu
,
Lu Xu
,
Yu Zhang
,
Xu Wang
,
Jin Bai
,
Qiuling Shi
,
Xiaojun Dai
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.2196/78333
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.2196/78333
Background Electronic patient-reported outcomes (ePROs)–based cancer symptom management presents an opportunity to improve patient outcomes by optimizing symptom detection and prompting clinician interventions in tertiary hospitals. However, real-world evidence is limited, especially in primary health care (PHC) settings, which are accompanied by more complex and unknown influencing factors. Objective We conducted a qualitative study to identify facilitators and barriers associated with the implementation of ePRO-based symptom management in China’s PHC settings under the implementation science (IS) framework. We further developed strategies and recommendations for real-world practices and health policies. Methods This qualitative study was conducted from October to December 2023 in 9 purposively selected PHC institutions (5 urban and 4 rural) across 5 administrative districts of Yangzhou, Jiangsu Province, China. Community-dwelling patients with cancer, PHC providers, and medical supervisors participated in semistructured interviews and focus group discussions. We used 2 subframeworks under the IS framework—the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change—to conduct data analysis and generate strategies. Results A total of 72 individuals were invited to participate in this study, including 35 community-dwelling patients with cancer (median 66, IQR 60-71.5 years; n=21, 60% men) and 23 PHC personnel (median 45, IQR 27-51 years; n=12, 52.17% men) who participated in semistructured interviews, and 14 medical supervisors (median 47.5, IQR 36.5-54 years; n=10, 71.43% men) who participated in focus group discussions. This study identified 29 barriers and 21 facilitators, and then developed 13 strategies. Crucial challenges include PHC providers’ low self-efficacy and unclear role identification, coupled with community-dwelling patients’ mistrust of primary care, cancer stigma, and fatalistic beliefs, which further reduce motivation; poor integration of ePRO with existing workflows and the absence of performance incentive mechanisms; a lack of nationwide standardized implementation guidelines and quality evaluation criteria; and outdated medical equipment and a limited range of medications. Common challenges included weak collaborative relationships and insufficient funding. Conclusions Grounded in the IS framework, our study identifies 3 critical priorities for implementing ePRO-based cancer symptom management in PHC settings, including addressing individual-level motivational deficiencies among community-dwelling patients with cancer and PHC providers by resolving misconceptions, bridging knowledge gaps, and establishing supportive incentives; developing supportive medical partnerships and advancing tiered management systems to empower PHC settings; and creating standardized operational guidelines with clear workflows and implementing real-world data-driven regulatory feedback mechanisms to ensure quality control.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.2196/78333
- OA Status
- gold
- References
- 59
- OpenAlex ID
- https://openalex.org/W4415695869
All OpenAlex metadata
Raw OpenAlex JSON
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https://openalex.org/W4415695869Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.2196/78333Digital Object Identifier
- Title
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Implementation Challenges of Remote Cancer Symptom Management With Electronic Patient‑Reported Outcomes in China’s Primary Health Care Settings: Qualitative StudyWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
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2025Year of publication
- Publication date
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2025-09-15Full publication date if available
- Authors
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Min Li, Jingyu Zhang, Jundi Zheng, Changjin Wu, Zezhong Shao, Lei Cheng, Hongfan Yu, Lu Xu, Yu Zhang, Xu Wang, Jin Bai, Qiuling Shi, Xiaojun DaiList of authors in order
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https://doi.org/10.2196/78333Publisher landing page
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://doi.org/10.2196/78333Direct OA link when available
- Cited by
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0Total citation count in OpenAlex
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59Number of works referenced by this work
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| abstract_inverted_index.fatalistic | 259 |
| abstract_inverted_index.framework, | 314 |
| abstract_inverted_index.framework. | 76 |
| abstract_inverted_index.guidelines | 285, 370 |
| abstract_inverted_index.hospitals. | 25 |
| abstract_inverted_index.identified | 226 |
| abstract_inverted_index.identifies | 317 |
| abstract_inverted_index.interviews | 132 |
| abstract_inverted_index.management | 7, 66, 326, 360 |
| abstract_inverted_index.mechanisms | 380 |
| abstract_inverted_index.nationwide | 282 |
| abstract_inverted_index.optimizing | 16 |
| abstract_inverted_index.priorities | 320 |
| abstract_inverted_index.providers, | 125 |
| abstract_inverted_index.real-world | 27, 84, 376 |
| abstract_inverted_index.regulatory | 378 |
| abstract_inverted_index.strategies | 80 |
| abstract_inverted_index.supportive | 351, 354 |
| abstract_inverted_index.Change—to | 155 |
| abstract_inverted_index.Conclusions | 309 |
| abstract_inverted_index.accompanied | 40 |
| abstract_inverted_index.data-driven | 377 |
| abstract_inverted_index.incentives; | 352 |
| abstract_inverted_index.individuals | 167 |
| abstract_inverted_index.influencing | 46 |
| abstract_inverted_index.integration | 266 |
| abstract_inverted_index.interviews, | 205 |
| abstract_inverted_index.mechanisms; | 278 |
| abstract_inverted_index.motivation; | 264 |
| abstract_inverted_index.operational | 369 |
| abstract_inverted_index.opportunity | 10 |
| abstract_inverted_index.participate | 171 |
| abstract_inverted_index.patients’ | 251 |
| abstract_inverted_index.performance | 276 |
| abstract_inverted_index.purposively | 102 |
| abstract_inverted_index.qualitative | 52, 91 |
| abstract_inverted_index.strategies. | 161, 236 |
| abstract_inverted_index.supervisors | 128, 209 |
| abstract_inverted_index.Consolidated | 145 |
| abstract_inverted_index.Implementing | 154 |
| abstract_inverted_index.deficiencies | 334 |
| abstract_inverted_index.discussions. | 136, 223 |
| abstract_inverted_index.establishing | 350 |
| abstract_inverted_index.facilitators | 56 |
| abstract_inverted_index.implementing | 322, 375 |
| abstract_inverted_index.institutions | 105 |
| abstract_inverted_index.insufficient | 307 |
| abstract_inverted_index.medications. | 299 |
| abstract_inverted_index.motivational | 333 |
| abstract_inverted_index.participated | 129, 202, 219 |
| abstract_inverted_index.partnerships | 356 |
| abstract_inverted_index.providers’ | 241 |
| abstract_inverted_index.standardized | 283, 368 |
| abstract_inverted_index.collaborative | 304 |
| abstract_inverted_index.facilitators, | 231 |
| abstract_inverted_index.interventions | 22 |
| abstract_inverted_index.relationships | 305 |
| abstract_inverted_index.self-efficacy | 243 |
| abstract_inverted_index.subframeworks | 140 |
| abstract_inverted_index.Implementation | 148 |
| abstract_inverted_index.administrative | 113 |
| abstract_inverted_index.implementation | 62, 73, 284 |
| abstract_inverted_index.semistructured | 131, 204 |
| abstract_inverted_index.(ePROs)–based | 4 |
| abstract_inverted_index.Recommendations | 152 |
| abstract_inverted_index.framework—the | 144 |
| abstract_inverted_index.identification, | 247 |
| abstract_inverted_index.misconceptions, | 345 |
| abstract_inverted_index.recommendations | 82 |
| abstract_inverted_index.individual-level | 332 |
| abstract_inverted_index.patient-reported | 2 |
| abstract_inverted_index.Community-dwelling | 120 |
| abstract_inverted_index.community-dwelling | 177, 250, 336 |
| cited_by_percentile_year | |
| countries_distinct_count | 1 |
| institutions_distinct_count | 13 |
| citation_normalized_percentile |