Patient-Reported Outcome Use: Sense-Making and Interactional Alignment in Heart Failure Consultations

• In Event: AI, Novel Technologies, and Health Equity

Abstract

Patient reported outcome measures (PROs) assess health and functioning directly from patients themselves. They have gained traction within healthcare organizations as tools for symptom monitoring, clinical decision making, and data-driven quality improvement. Yet PRO use in clinical practice and shared decision making remains understudied. As a strategic case study, this paper leverages PRO use in the care of patients with heart failure (HF)–a population who commonly experiences illness uncertainty, frequent changes in symptoms and health status, and fragmented healthcare. Drawing on video-recorded consultations and interviews with HF patients (n=61) and nurse practitioners (n=6), we examine how PROs shape HF patient-clinician interactions. Our findings suggest that: (1) PROs operate as a sense-making mechanism by which patients and clinicians co-construct a shared definition of the situation; (2) PROs facilitate interactional alignment between patients and clinicians when results reflect patients’ perceived health status and efforts to engage in self-care management; and (3) PROs contribute to interactional misalignment when results reveal but cannot resolve patients’ and clinicians’ structural constraints and disparities in health literacy.

Authors

• David Russell, Appalachian State University

• Jon Samuel Gordon, Appalachian State University

• Karsten Rogerson, Appalachian State University

• Sophie Davis, Appalachian State University

• Katie Johanningsmeier, Appalachian State University

• So Hyeon Bang, Columbia University School of Nursing

• Mary Beth Happ, The Ohio State University

• Ruth Marie Masterson Creber, Columbia University School of Nursing