Barriers and facilitators to implementing patient-reported outcome and experience measures (PROMs/PREMs) in health systems: a comprehensive overview of systematic reviews

OBJECTIVES: Patient-reported outcome measures and experience measures (PROMs/PREMs) are central to person-centred, value-based healthcare. We synthesized barriers and facilitators influencing the implementation of PROMs and PREMs to identify priorities for health system action and research. METHODS: We conducted an overview of systematic reviews adhering to JBI and PRIOR guidelines. Databases were searched in June 2023, with hand-searching to March 2026. Two reviewers performed screening, quality appraisal, and factor coding using the Consolidated Framework for Implementation Research (CFIR). Data synthesis included thematic analysis by CFIR construct. RESULTS: Thirty-two reviews contributed 1,326 factor mentions across 44 of 48 CFIR constructs and spanned diverse clinical populations and settings. The five most salient barriers (40.2% of mentions) were patients' difficulty completing measures because of literacy, language, illness, disability, or limited digital access; poor integration into clinical workflows and information systems; lengthy, inaccessible, or difficult-to-use measures and platforms; complex administration, interpretation, and response processes; and clinicians' limited motivation to collect or use results. The five leading facilitators (34.7% of mentions) were user-centred measure and platform design; visible clinical benefits over usual care; reliable and interoperable IT infrastructure; workflows embedding completion, timely review, and follow-up; and patients' belief that measures addressed meaningful needs and improved communication. Evidence was concentrated in oncology and high-income settings, with limited PREM-specific coverage. CONCLUSIONS: PROM and PREM programmes should prioritize workflow and IT integration, inclusive design of measures and platforms, clear ownership, and support for patients and clinicians. This review can guide implementation investment, local pre-implementation work, and evaluations.

• ✓The five leading facilitators (34.7% of mentions) were user-centred measure and platform design; visible clinical benefits over usual care; reliable and interoperable IT infrastructure; workflows embedding completion, timely review, and follow-up; and patients' belief that measures addressed meaningful needs and improved communication.
• ✓Evidence was concentrated in oncology and high-income settings, with limited PREM-specific coverage.
• ✓CONCLUSIONS: PROM and PREM programmes should prioritize workflow and IT integration, inclusive design of measures and platforms, clear ownership, and support for patients and clinicians.
• ✓This review can guide implementation investment, local pre-implementation work, and evaluations.