Introduction

Patient-reported outcome measures (PROMs) are instruments, often validated questionnaires, that capture a range of outcomes including symptoms, functioning, quality of life, psychological well-being, and treatment-related side effects [1, 2]. PROMs have become essential in cancer care because they offer insights into aspects of patients’ health that may not be observed through clinical examination alone [3]. Research in oncology and quality of life shows that the use of PROMs can improve symptom management [4], enhance patient-clinician communication [5], and support more responsive and person-centered care [6]. At the organizational level, PROMs data can be used to inform quality improvement and monitor outcomes across care processes [7, 8]. Beyond their measurement function, PROMs are also communicative tools that elicit patients’ perspectives and bring these perspectives into clinical encounters [9].

Despite these benefits, integrating PROMs meaningfully into routine oncology practice remains challenging. Implementation across hospitals has shown wide variation in completion rates, patient satisfaction, and the extent to which PROMs are discussed in clinical encounters [10–12]. Some studies report that patients do not always receive feedback about their responses, and that clinicians differ in whether they incorporate it into consultations or how they interpret the data [13, 14]. These inconsistencies indicate that, although PROMs bring added value to routine cancer care, their full potential is yet to be realized.

Earlier research has pointed to barriers such as system integration, inadequate digital infrastructure, and logistical challenges [15–17]. However, a solely barrier-oriented perspective might overlook how PROMs’ value depends on a sequence of interconnected communication processes, from inviting patients to complete PROMs and interpreting results, to discussing them during consultations and informing care decisions [18, 19]. In oncology, where care pathways are complex and patients often experience high symptom burdens, these processes are especially important. When they are fragmented, or insufficiently connected with one other, PROMs risk becoming a burden to patients and clinicians rather than supporting meaningful communication [20]. Therefore, this study asks: where do challenges in PROMs implementation emerge across the implementation process, and how do these challenges shape the communicative use of PROMs in oncology care?

Recent conceptual research has emphasized this communicative and procedural dimension. De Ligt and colleagues [19] proposed a framework that conceptualizes PROMs use as a multi-stage communication process involving the exchange of meaning between patients, clinicians, and support staff. The framework proposes several key stages, such as how the purpose of PROMs is introduced, how results are made accessible and understandable, and how they are brought into conversations about care. Importantly, these stages are sequential and interdependent. For instance, prior research suggests that the value of PROMs depends not only on their completion but on how results are fed back and used in clinical encounters [21, 22]. Without such feedback, response rates may decline over time, further limiting the data available for clinical use [12]. Together, these stages form a workflow for PROMs implementation, highlighting specific process points where PROMs can enable or hinder meaningful dialogue.

While this framework offers a valuable theoretical lens, it remains largely conceptual, and empirical examinations of how these communication processes unfold in real-life oncology care remain limited. In particular, we lack insight into which steps are involved in PROMs implementation, where challenges tend to emerge along this process, and why the anticipated communicative and patient-centered benefits are difficult to achieve. Drawing on the framework proposed by De Ligt et al. [19], this study aims to (1) use a communication-centered analytical lens to examine how PROMs are implemented across sequential stages in everyday oncology care, and (2) contribute to the framework’s refinement by providing empirical validation and identifying steps that extend beyond its current scope. While our perspective is communication-centered, it also encompasses systemic and organizational factors insofar as they impact how PROMs-related communication unfolds. Building on theoretical insights, this study aims to examine what it takes to use PROMs to facilitate meaningful communication between patients and healthcare professionals within the complexity of cancer care.