Prioritizing implementation strategies of electronic patient-reported outcome in cancer management in primary health care: A best–worst scaling study among stakeholders

Background Electronic patient-reported outcomes (ePRO) are valuable for cancer symptom monitoring, but implementation in resource-limited primary health care remains challenging. Identifying stakeholder preferences regarding implementation strategies is crucial for facilitating the adoption and effectiveness of ePRO-based cancer symptom management. Objective This study aimed to prioritize optimal implementation strategies for ePRO-based cancer symptom management in Chinese primary health care, considering stakeholder preferences. Methods A best–worst scaling was conducted among stakeholders. Thirteen implementation strategies, derived through qualitative research and implementation science frameworks, were assessed. Preferences were analyzed using count analysis, conditional logit model (CLM), mixed logit model (MLM), and latent class analysis (LCA). Results A total of 169 respondents were included in the final analysis. Count analysis identified the top three preferred strategies as developing tiered cancer management through ePRO (standardized BW = 0.32), providing evidence-based practice (EBP) incentives (standardized BW = 0.20), and engaging stakeholders (standardized BW = 0.14). Least preferred were disseminating paper/web-based ePRO-related materials (standardized BW = –0.28) and developing ePRO toolkits (standardized BW = –0.25). CLM and MLM results aligned with count analysis, with tiered cancer management through ePRO having the highest odds ratios (OR = 3.20 for CLM, 4.37 for MLM), followed by EBP incentives (OR = 2.55 for CLM, 3.12 for MLM) and stakeholder engagement (OR = 2.25 for CLM, 3.13 for MLM). LCA identified five stakeholder subgroups with distinct preference patterns based on professional roles and settings, including: favorability towards tiered cancer management through ePRO (class 1), preferences for disseminating paper/web-based ePRO-related materials (class 2), financial incentives among younger practitioners and healthcare administrators (classes 3 and 4), and prioritization of stakeholder engagement (class 5). However, tiered cancer management through ePRO were relatively highly preferred across all groups. Conclusions Tailoring ePRO implementation to stakeholder preferences is crucial. Tiered cancer management was universally preferred, while other strategies varied by professional role. Future research should focus on longitudinal evaluations and economic assessments.