The quality of patient-centred care: haematological cancer survivors' perceptions

Development and testing of a patient-reported experience measure for cancer: A cross-sectional survey

AIM

To develop and psychometrically test the Patient-reported Experience Measure-Cancer (PREM-C), reflecting patients' perceptions of cancer care experiences according to the Institute of Medicine domains.

DESIGN

A three-phase cross-sectional survey was conducted.

METHODS

Development, reliability and validity testing of the PREM-C measure was undertaken. Data collection included three phases: firstly (development) between October and November, 2015; secondly (psychometric testing), May 2016-June, 2017, and finally, (revision and psychometric testing) May 2019-March 2020.

RESULTS

The final PREM-C structure, created using the Institute of Medicine domains, was psychometrically sound with five factors identified in the Exploratory Factor Analysis, demonstrating internal reliability ranging from 0.8 to 0.9. Confirmatory Factor Analysis indicated the hypothesized model fitted well (Root mean square error of approximation = 0.076). External convergent and divergent validity was established with the PREM-C found to be moderately correlated with the Picker Patient Experience Questionnaire but weakly correlated with the WHOQoL-BREF.

CONCLUSION

The development and testing of the PREM-C demonstrated good fit as a clinically relevant measure of ambulatory cancer patients' experiences of care. To make meaningful changes to nursing practice and health services, patient experience measures such as the PREM-C might support staff to identify areas for service improvement.

IMPACT

Few reliable measures and less validated measures collect patients' perceptions of the quality of their healthcare provision. Rigorous psychometric testing of the newly developed PREM-C demonstrated good internal consistency, test-retest reliability, and external convergent and divergent validity. The PREM-C is a potentially relevant measure of cancer patients' experiences of care. It might be used to assess patient-centred care and guide safety and quality improvements in clinical settings. PREM-C use might inform service providers of experiences of care in their institution and inform policy and practice development. This measure is sufficiently generic, allowing potential use in other chronic disease populations.

PATIENT OR PUBLIC CONTRIBUTION

This conduct of this study was supported by the participating patients of the hospital Cancer Outpatients Service.

Identification of an oncological clinical pathway through questionnaires to health professionals

BACKGROUND

Clinical Pathways in Oncology can benefit patients using organized interventions to standardize and increase care efficiency. Healthcare systems should have tools to identify their oncological clinical pathways for a better institutional organization to reduce mortality rates and contain costs without compromising quality. Our objective is to determine the regional Oncology Clinical Pathway from a first basic hypothesis using questionnaires directed to healthcare professionals considered key deciders within the Pathway.

METHODS

Study design consisted of data analysis of two structured region-wide questionnaires; built using available literature on Oncology Clinical Pathways, in a Portuguese Healthcare context and pre-tested in a focus group of key deciders (Physicians and nurses with management functions) from which a design was created. Queries analyzed the patients: tumor staging at service arrival; time intervals on tumor suspicion/diagnosis confirmation and diagnosis/first treatment; referral pathway; diagnostic networks and patient Follow-up. One questionnaire was sent to key deciders directly involved with Oncology patients at a Regional Hospital. 15 physicians and 18 nurses of this sample answered the questionnaire (approx. response rate = 67%). Another questionnaire sent to healthcare professionals in Primary Healthcare Centers yielded response rate 19.2%, N = 29 physicians and 46 nurses. Finally, we performed a descriptive analysis and a Cronbach Alpha reliability analysis.

RESULTS

Our findings reveal: different appreciations of tumor staging at arrival in Primary Healthcare Centers and Regional Hospitals (the latter receiving more metastatic cases); approximately 4 weeks between tumor suspicion-diagnostic and divided opinions regarding diagnostic-treatment time intervals. Primary Healthcare Centers depend on private laboratories for diagnostics confirmation, while the Hospitals resolve this locally. Referral pathways indicate almost half of the patients being sent from primary healthcare centers to National Reference Hospitals instead of a Regional Hospital. Patient follow-up is developed throughout the institutions, however, is more established at Regional Hospitals. As patients advance through the Oncology Clinical Pathway and toward treatment stages the number of healthcare professionals involved reduce.

CONCLUSION

Our questionnaires enable us to understand the real pathway between the different institutions involved and the main entry points of the patients into the Oncology Clinical Pathway.

The impact of psychological distress on quality of care and access to mental health services in cancer survivors

Introduction

Psychological distress is highly prevalent among cancer survivors and significantly impacts their health outcomes. Our study aim is to examine the impact of psychological distress on the quality of care in cancer survivors.

Methods

We utilized longitudinal panels from the Medical Expenditure Panel Survey data spanning from 2016 to 2019 to estimate the impact of psychological distress on quality of care. We compared a sample of cancer survivors with psychological distress (N = 176) to a matched sample of cancer survivors without psychological distress (N = 2,814). We employed multivariable logistic regression models and Poisson regression models. In all models, we adjusted for age at the survey, sex, race/ethnicity, education, income, insurance, exercise, chronic conditions, body mass index, and smoking status. Descriptive statistics and regression models were performed using STATA software.

Results

Our findings revealed a higher prevalence of psychological distress among younger survivors, females, individuals with lower incomes, and those with public insurance. Cancer survivors with psychological distress reported more adverse patient experiences compared to those without distress. Specifically, survivors with distress had lower odds of receiving clear explanations of their care (OR: 0.40; 95% CI: 0.17-0.99) and lower odds of feeling respected in expressing their concerns (OR: 0.42; 95% CI: 0.18-0.99) by their healthcare providers. Furthermore, psychological distress was associated with increased healthcare utilization, as evidenced by a higher number of visits (p = 0.02). It also correlated with a decrease in healthcare service ratings (p = 0.01) and the affordability of mental health services (p < 0.01) for cancer survivors.

Discussion

These findings indicate that psychological distress can significantly impact the delivery of healthcare and the patient experience among cancer survivors. Our study underscores the importance of recognizing and addressing the mental health needs of cancer survivors. It provides insights for healthcare professionals and policymakers to better understand and cater to the mental health needs of this population.

Patients' cancer care perceptions conceptualized through the Cancer Experience Measurement Framework

BACKGROUND

Research on patients' perceptions of cancer care often documents sub-optimal experiences. Cancer care quality issues include restricted service access, lack of care coordination, gaps in follow-up and "generic" rather than person-centered care. Recent reports underscore that proactively and periodically seeking user feedback is crucial for timely care quality improvement. The present study aimed to analyze and thematically organize a large amount of feedback from patients who had been treated for cancer within the last 6 months.

METHODS

Randomly selected participants (N = 3,278) from 3 University-affiliated cancer centres in Montreal, Quebec, Canada completed the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) and an open-ended question on their perceptions of the care they received. 692 participants responded to the latter. Guided by the Cancer Experience Measurement Framework (CEMF), their feedback was analyzed using a qualitative thematic approach.

RESULTS

Cancer care perceptions included sub-themes of care access and coordination, continuity/transition, and perceived appropriateness/personalisation of care. The most salient theme was captured by care access and coordination with 284 comments (44%) directly addressing these issues. The ways in which health care services were structured including setting, schedule, and location were often raised as cause for concerns. Issues surrounding cancer information/education, emotional support, and physical comfort were frequently reported as unmet needs. In addition, limited access to cancer services led patients to seek alternatives such as going to emergency departments and/or private care.

CONCLUSIONS

These findings are timely as they show that most patients are well aware of quality issues in cancer care and are willing to report candidly on these. Patient feedback also underscore the importance for cancer care institutions to periodically gather patient-reported data so that systems can re-calibrate their service offerings according to these data. Ultimately, patient reports will translate into enhanced quality, personalization, and safer cancer care provision.

Cultural adaptation and validation of the Survivor Unmet Needs Survey Short-Form among cancer patients in China

AIM

Cancer patients have long been found to have multiple types of unmet needs during their survivorship. Composite psychological instruments are essential for measuring the unmet needs of cancer patients. The objective of this study was to evaluate the psychometric properties of the Short-Form Survivor Unmet Needs Survey (SF-SUNS)-Chinese version.

DESIGN

A cross-sectional survey.

METHODS

The Chinese version was developed using the standard Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology and 428 Chinese cancer patients participated in the survey between 2016-2017. Inter-rater reliability, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were calculated.

RESULTS

Confirmatory factor analysis supported the four-factor structure with good model fit. Cronbach's alpha of 0.894 for the overall scale and intra-class correlation coefficients (0.869-0.884) indicated that reliability was satisfactory. The EFA extracted four factors with eigenvalues greater than 1 and these factors explained 50.68% of the total variance. The Chinese version of SF-SUNS was confirmed to have the potential to become a useful and valid instrument. It could contribute to the assessment of unmet needs among Chinese cancer patients with accuracy and with respect to Chinese culture and context. This measurement of unmet needs may help promote cancer management and nursing quality. Clinical nurses and researchers could use the simple assessment tool to target the individual needs of Chinese cancer patients and then provide more personalized care efficiently.

Psychometric validation of a Patient-Centred Quality of Cancer Care Questionnaire in Mexico

OBJECTIVES

To develop and validate a Patient-Centred Quality of Cancer Care Questionnaire in Spanish (PCQCCQ-S) appropriate to the Mexican context.

DESIGN

Psychometric validation of a questionnaire.

SETTING

Two public oncology hospitals in Mexico City.

PARTICIPANTS

1809 patients with cancer aged ≥18 years.

SOURCE OF INFORMATION

Cross-sectional survey.

METHODS

The validation procedures comprised (1) content validity through a group of experts and patients; (2) item reduction and evaluation of the factor structure, through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach's alpha; (4) convergent validity between the PCQCCQ-S and supportive care needs scale; (5) correlation analysis between the PCQCCQ-S and quality of life scale by calculating Spearman's rank-correlation coefficient; and (6) differentiation by 'known groups' through the Wilcoxon rank-sum test.

RESULTS

The PCQCCQ-S has 30 items with the following five factors accounting for 96.5% of the total variance: (1) timely care; (2) clarity of the information; (3) information for treatment decision-making; (4) activities to address biopsychosocial needs; and (5) respectful and coordinated care. Cronbach's alpha values ranged from 0.73 to 0.90 among the factors. PCQCCQ-S has moderate convergent validity with supportive care needs scale, revealing that higher quality is correlated with lower patient needs. PCQCCQ-S has acceptable ability to differentiate by 'known groups', showing that older patients and those with low levels of education perceived lower total quality of care as compared with their counterparts.

CONCLUSION

PCQCCQ-S has acceptable psychometric properties and can be used to measure quality of patient-centred cancer care in Mexico and serve as a reference to develop PCQCCQ-S in other Spanish-speaking countries.

Factors associated with a preference for disclosure of life expectancy information from physicians: a cross-sectional survey of cancer patients undergoing radiation therapy

PURPOSE

This study aimed to investigate experiences and preferences for disclosure of life expectancy, agreement between them, and the factors associated with preferences for disclosure of life expectancy with physicians among cancer patients undergoing radiation therapy.

METHODS

Cancer patients aged 20 years or older were consecutively sampled when they started radiation therapy at two university hospitals. Patients completed self-administered questionnaires concerning their experiences of and preferences for disclosure of life expectancy, treatment decision-making, psychological distress, physical symptoms, sociodemographic and medical factors, physician's communication style, and provision of psychological, physical, and practical support.

RESULTS

Among the 226 respondents (response rate: 58%) who responded, 54% experienced disclosure of life expectancy, and 45% preferred it. The agreement is 65%. Eighty-five percent recognized their aim of radiation therapy as curative. A univariate analysis indicated that having a full/part-time job and wishing to leave treatment decisions to doctors were significantly associated with preference for disclosure of life expectancy, but psychological distress was not. A multiple regression analysis revealed that having a full-time/part-time job was significantly associated with preference of communication about life expectancy.

CONCLUSIONS

Fifty-four percent of the patients experienced and 45% of the patients preferred disclosure of life expectancy. The agreement is moderate. Our results show that there was a significant association between employment status and patient's preference for disclosure of life expectancy with physicians. Communication of prognosis is difficult but whether a patient continues to work or not may be an indicator of preference.

Quality of Patient-Centered Care Provided to Patients Attending Hematological Cancer Treatment Centers

The Institute of Medicine has recommended that improvements are needed in patient-centered care. This study examined hematological cancer patients' perceptions of which aspects of cancer care were being delivered well and areas that required improvement, and whether patient characteristics, or the treatment center they attended, were associated with quality of patient-centered care. Participants were recruited via three Australian hematological cancer treatment centers and completed a paper-and-pen survey assessing sociodemographic, disease, and psychological and treatment characteristics at recruitment. A second survey that contained the Quality of Patient-Centered Cancer Care measure was completed one month after recruitment (n = 215). The most frequently delivered feature of patient-centered cancer care was hospital staff showing respect for patients (91.0%). The area of care reported most commonly as not being delivered was hospital staff helping the patient find other cancer patients to talk to (29.8%). Patients without depression reported higher perceived quality of treatment decision-making, co-ordinated and integrated care, emotional support, follow-up care, respectful communication, and cancer information than patients with depression. The treatment center that was attended was associated only with the quality of cancer information patients received. Privacy issues may hinder staff connecting patients directly but this could be overcome via referrals to cancer organizations that offer peer support services.

Psychological distress, chronic conditions and quality of life in elderly hematologic cancer patients: study protocol of a prospective study

Background

Similar to most solid tumors, the incidence of hematologic malignancies has been rising. Although the median age at diagnosis is about 70 years, little is known about psychosocial aspects and comorbid conditions in elderly patients with hematologic cancers. The main objectives of our study are to assess the prevalence of psychological distress, chronic conditions, functional disabilities, and quality of life in both elderly hematologic cancer patients aged ≥70 years and an age-matched comparison sample of the general population.

Methods

We conduct a prospective study with three measuring points (t_1: ≥5 years after first time hematologic cancer diagnosis / relapse; t_2 and t_3 six months and 1 year after t_1). In addition, we use a cross sectional study design to recruit a comparison sample of the general population matched by age and sex. Both samples, patients and the comparison group complete validated questionnaires measuring psychological distress, chronic conditions, functional disabilities, and quality of life as well as health care needs and health care utilization.

Discussion

Our study will provide both a data set offering detailed information about elderly hematologic cancer patients’ physical, psychological and demographic characteristics, and reference data of the elderly general population. Furthermore, the study will provide important information for the development and implementation of psychooncological support offers and survivorship care plans.

How Does Caregiver Well-Being Relate to Perceived Quality of Care in Patients With Cancer? Exploring Associations and Pathways

Purpose Perceived quality of care (QOC) is an increasingly important metric of care quality and can be affected by such factors among patients with cancer as quality of life and physician trust. This study sought to evaluate whether informal caregiver well-being was also associated with perceived QOC among patients with cancer and assessed potential pathways that link these factors. Methods This study used data from the Cancer Care Outcomes Research and Surveillance (CanCORS) consortium. Patients with lung and colorectal cancer enrolled in CanCORS (N = 689) nominated an informal caregiver to participate in a caregiving survey. Both groups self-reported sociodemographic, psychosocial, and caregiving characteristics; cancer characteristics were obtained from the CanCORS core data set. Multivariable logistic regression was used to assess the association between caregiver psychosocial factors and subsequent patient-perceived QOC, controlling for earlier patient-perceived QOC and covariates. Secondary analysis examined potential pathways that link these factors. Results Patients whose informal caregiver had higher levels of depressive symptoms were significantly more likely to report fair or poor QOC (odds ratio, 1.06; 95% CI, 1.01 to 1.13). When caregivers reported fair or poor self-rated health, patients were more than three times more likely to report fair or poor perceived QOC (odds ratio, 3.76; 95% CI, 1.76 to 9.55). Controlling for patient psychosocial factors and physician communication and coordination of medical care reduced the effect size and/or statistical significance of these relationships. Conclusion Informal caregivers are an important part of the care team and their well-being is associated with patient-perceived QOC. Engaging informal cancer caregivers as part of the care team and conducting ongoing risk stratification screening and intervention to optimize their health may improve patient-reported outcomes and QOC.