How digital patient-reported outcomes questionnaires support nursing consultations in a cardiology outpatient clinic: a qualitative evaluation in cardiac rehabilitation and heart failure care

Patient-Reported Outcomes are increasingly used as a tool to improve patient engagement and support clinical decision-making. As part of the national implementation of Patient-Reported Outcome (PRO), the Cardiology department implemented digital PRO questionnaires in both cardiac rehabilitation and follow-up for patients with heart failure.

This study aimed to explore patient and healthcare professional experiences with digital PRO questionnaires and to identify factors that facilitate or hinder their use in clinical practice.

A qualitative study was conducted based on ten semi-structured interviews with patients, nurses, and administrative staff. Data were analyzed thematically with a focus on participants’ experiences, usability, integration into clinical workflows, communication, and patient involvement.

Nurses perceived the digital PRO questionnaires as meaningful and relevant, particularly when actively integrated into clinical consultations. The questionnaires facilitated discussion of difficult issues including sexuality, structured dialogue, and in some cases resulted in better prepared patients. However, implementation was hindered by several barriers, including limited preparation time and time pressure, which led to reduced prioritization of PRO questionnaires. Challenges related to result interpretation and the need for additional training also emerged. From the patients’ perspective, findings suggest that increased involvement and engagement supported greater reflection on their own health status. Furthermore, patients perceived the digital PRO questionnaires as technically accessible and user-friendly, adding relevance and value to consultations.

Drawing on interview data, patients reported high levels of involvement in nursing consultations and perceived that PRO responses were actively used in the dialogue. Digital PRO questionnaires supported patient engagement and showed potential as decision support tools in clinical practice. However, nurses reported implementation challenges related to time constraints, the need for standardized workflows for questionnaire distribution, and further development of support tools to facilitate interpretation of PRO data.