1
|
Jolidon V, Eicher M, Peytremann-Bridevaux I, Arditi C. Inequalities in patients' experiences with cancer care: the role of economic and health literacy determinants. BMC Health Serv Res 2024; 24:733. [PMID: 38877526 PMCID: PMC11179203 DOI: 10.1186/s12913-024-11174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Patients with fewer socioeconomic and health literacy resources are disadvantaged in their access and use of healthcare, which may give rise to worse experiences with care and thus inequalities in patient experiences. However, only a limited number of studies have examined how socioeconomic and health literacy factors shape inequalities in patients' experiences with cancer care. OBJECTIVE To examine whether patients' experiences with cancer care differ according to their economic status and health literacy. METHODS Secondary analysis of data on 2789 adult patients diagnosed with cancer from the Swiss Cancer Patient Experiences-2 (SCAPE-2) study, a cross-sectional survey conducted in eight hospitals across Switzerland from September 2021 to February 2022. Regression analysis was applied to examine the independent effect of patients' economic status and health literacy on various outcomes of experiences with cancer care, covering eight different dimensions of patient-centred care, controlling for confounding factors. RESULTS Adjusted regression analysis showed that patients with lower economic status reported significantly worse experiences with cancer care in 12 out of 29 specific care experiences, especially in the dimensions of 'respect for patients' preferences' and 'physical comfort' where all items of experiences were associated with economic status. Additionally, lower health literacy was associated with worse patient experiences in 23 specific care experiences. All items in the dimensions of 'respect for patients' preferences', 'physical comfort' and 'emotional support' were associated with health literacy. DISCUSSION This study revealed significant inequalities in experiences with cancer care shaped by the economic status and health literacy of patients across different dimensions of patient-centred care. It is essential to address the needs of more disadvantaged patients who face obstacles in their access and use of the healthcare system, not only to mitigate inequalities in cancer care but also to avoid inequalities in health outcomes.
Collapse
Affiliation(s)
- Vladimir Jolidon
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Chantal Arditi
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland.
| |
Collapse
|
2
|
Weaver SJ, Breslau ES, Russell LE, Zhang A, Sharma R, Bass EB, Marsteller JA, Snyder C. Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation. J Natl Cancer Inst 2024; 116:800-811. [PMID: 38419574 DOI: 10.1093/jnci/djae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.
Collapse
Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Erica S Breslau
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren E Russell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| |
Collapse
|
3
|
Strohschein FJ, Qi S, Davidson S, Link C, Watson L. A Retrospective Age Analysis of the Ambulatory Oncology Patient Satisfaction Survey: Differences in Satisfaction across Dimensions of Person-Centred Care and Unmet Needs among Older Adults Receiving Cancer Treatment. Curr Oncol 2024; 31:1483-1503. [PMID: 38534946 PMCID: PMC10969488 DOI: 10.3390/curroncol31030113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 05/26/2024] Open
Abstract
Over half of all new cancer cases in Alberta are diagnosed among people aged 65+ years, a group that encompasses vast variation. Patient-reported experience measures are routinely collected within Cancer Care Alberta; however, the specific consideration of the needs and concerns of older Albertans with cancer is lacking. In 2021, 2204 adults who had received treatment at a cancer centre in Alberta completed the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). In this study, we explored the age differences in satisfaction across six dimensions of person-centred care and in the proportions of unmet needs across eight types of issues, with specific attention to older adults. Using three age groups (18-39, 40-64, 65+), only the physical comfort dimension showed significantly lower satisfaction among those aged 65+ years. Using five age groups (18-39, 40-64, 65-74, 75-84, 85+), significantly lower levels of satisfaction were found related to 'physical comfort' for those aged 65-74 and 75-84, 'coordination and continuity of care' for those aged 75-84 and 85+, and 'information, communication, and education' for those aged 85+. Therefore, grouping together all older adults aged 65+ years obscured lower levels of satisfaction with some dimensions of person-centred care among those aged 75-84 and 85+ years. Unmet needs generally increased with age for all types of issues, with significant differences across age groups for emotional, financial, social/family, and sexual health issues. The lower levels of satisfaction and higher proportions of unmet needs call for tailored interventions to promote optimal care experiences and outcomes among older adults receiving cancer care in Alberta and their families.
Collapse
Affiliation(s)
- Fay J. Strohschein
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4, Canada
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Siwei Qi
- Applied Research & Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada
| | - Sandra Davidson
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Claire Link
- Applied Research & Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada
| | - Linda Watson
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4, Canada
- Applied Research & Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada
| |
Collapse
|
4
|
Bergers JH, Wessels-Wynia H, Seute T, Janssens A, van Delden JJ. Getting to Know Your Patient: Content Analysis of Patients' Answers to a Questionnaire for Promoting Person-Centered Care. J Particip Med 2024; 16:e48573. [PMID: 38437017 PMCID: PMC10949129 DOI: 10.2196/48573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/08/2023] [Accepted: 01/03/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Person-centered care (PCC) encourages patients to actively participate in health care, thus facilitating care that fits the life of the patient. Therefore, health care professionals (HCPs) need to know the patient. As part of a broad policy for improving PCC, a digital questionnaire ("We would like to know you") consisting of 5 questions has previously been developed to help HCPs to get to know the patient with the help of patient and staff involvement. OBJECTIVE The purpose of this study was to provide insight into the content and aims of the questionnaire to understand its potential and usability. METHODS We conducted a qualitative, retrospective content analysis of patients' answers using NVivo Pro (QSR International). The questionnaire was used in the outpatient neuro-oncology department of a Dutch academic hospital. RESULTS Of 374 invited patients, 78 (20.9%) completed the questionnaire. We selected a sample of 42 (54%) of the 78 patients. Patients used a median of 16 (IQR 7-27) words per question, and most answers were easily interpretable. When asked about important activities, social activities, sports, or maintaining a normal life were most frequently mentioned. Patients wrote about fear of the disease, its possible influence on life, or fear of the future in general. Patients wanted HCPs to know about their care and communication preferences or shared personal information. They formulated expectations about effective treatment, communication, and the care process. CONCLUSIONS The questionnaire seems usable because patients provide interpretable answers that take little time to read, which HCPs can use to personalize care. Our study shows the potential of the questionnaire to help deliver PCC.
Collapse
Affiliation(s)
- Juno Hk Bergers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hester Wessels-Wynia
- Marketing and Communication, Concern Staff, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tatjana Seute
- Department of Neuro-oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Astrid Janssens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Johannes Jm van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
5
|
Virgilsen LF, Jensen H, Falborg AZ, Prior A, Pedersen AF, Vedsted P. Psychiatric disorders and the cancer diagnostic process in general practice: a combined questionnaire and register study exploring the patients' experiences in Denmark. Scand J Prim Health Care 2024; 42:156-169. [PMID: 38149909 PMCID: PMC10851816 DOI: 10.1080/02813432.2023.2296944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. DESIGN Cross-sectional study using questionnaire and register data. SETTING General practice in Denmark. SUBJECTS Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients' experiences. MAIN OUTCOME MEASURES Patients' experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation.[Box: see text]. RESULTS A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP's abilities, and the patients' knowledge of the process following the GP referral. CONCLUSION The patients' experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders.
Collapse
Affiliation(s)
| | - Henry Jensen
- Research Unit for General Practice, Aarhus C, Denmark
| | | | - Anders Prior
- Research Unit for General Practice, Aarhus C, Denmark
| | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| |
Collapse
|
6
|
Pickwell-Smith B, Greenley S, Lind M, Macleod U. Where are the inequalities in ovarian cancer care in a country with universal healthcare? A systematic review and narrative synthesis. J Cancer Policy 2024; 39:100458. [PMID: 38013132 DOI: 10.1016/j.jcpo.2023.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Patients diagnosed with ovarian cancer from more deprived areas may face barriers to accessing timely, quality healthcare. We evaluated the literature for any association between socioeconomic group, treatments received and hospital delay among patients diagnosed with ovarian cancer in the United Kingdom, a country with universal healthcare. METHODS We searched MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED, PsycINFO and HMIC from inception to January 2023. Forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts, and full-text articles. UK-based studies were included if they reported socioeconomic measures and an association with either treatments received or hospital delay. The inclusion of studies from one country ensured greater comparability. Risk of bias was assessed using the QUIPS tool, and a narrative synthesis was conducted. The review is reported to PRISMA 2020 and registered with PROSPERO [CRD42022332071]. RESULTS Out of 2876 references screened, ten were included. Eight studies evaluated treatments received, and two evaluated hospital delays. We consistently observed socioeconomic inequalities in the likelihood of surgery (range of odds ratios 0.24-0.99) and chemotherapy (range of odds ratios 0.70-0.99) among patients from the most, compared with the least, deprived areas. There were no associations between socioeconomic groups and hospital delay. POLICY SUMMARY Ovarian cancer treatments differed between socioeconomic groups despite the availability of universal healthcare. Further research is needed to understand why, though suggested reasons include patient choice, health literacy, and financial and employment factors. Qualitative research would provide a rich understanding of the complex factors that drive these inequalities.
Collapse
Affiliation(s)
- Benjamin Pickwell-Smith
- Hull York Medical School, University of Hull, Hull, United Kingdom; Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals, Hull, United Kingdom.
| | - Sarah Greenley
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Michael Lind
- Hull York Medical School, University of Hull, Hull, United Kingdom; Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, United Kingdom
| |
Collapse
|
7
|
Somayaji D, Mohedat H, Li CS. Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care. Cancer Nurs 2024:00002820-990000000-00215. [PMID: 38416076 DOI: 10.1097/ncc.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Social determinants of health posit that negative outcomes are influenced by individuals living in underserved and underresourced neighborhoods. OBJECTIVE This study examines a cancer diagnosis, race/ethnicity, age, geographic location (residence), education, and social economic status factors at disease onset and treatment. METHODS A multivariable PO regression analysis was run for quality of care at testing or diagnosis, and quality of care at treatment and the quality of received care compared with another person. RESULTS Participants are representative of the Southern Community Cohort Study (SCCS) of adults diagnosed with breast (n = 263), prostate (n = 195), lung (n = 46), colorectal (n = 105), or other cancers (n = 526). This study includes cancer survivors who completed the SCCS Baseline and Cancer Navigation Surveys in urban (73.13%) and rural (26.87%) areas. White participants reported a higher quality of received care for testing or diagnosis and care for treatment compared with Black participants. Participants with high school or equivalent education (odds ratio, 1.662; 95% confidence interval, 1.172-2.356; P = .0044) or some college or junior college education (odds ratio, 1.970; 95% confidence interval, 1.348-2.879; P = .0005) were more likely to report a better level of quality of received care for treatment. CONCLUSIONS The SCCS represents individuals who are historically underrepresented in cancer research. The results of this study will have broad implications across diverse communities to reduce disparities and inform models of care. IMPLICATIONS FOR PRACTICE Nurses are positioned to evaluate the quality of population health and design and lead interventions that will benefit underserved and underresourced communities.
Collapse
Affiliation(s)
- Darryl Somayaji
- Author Affiliation: School of Nursing, University at Buffalo (Dr Somayaji and Mrs Mohedat), New York; and Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center (Dr Li), Rochester, New York
| | | | | |
Collapse
|
8
|
Checklin M, O'Halloran R, Foster AM, Hutchison A, Wilson T, Bowen A, Vat L, Lawson N, Lenne P, Packer RL. The health care experiences of people with head and neck cancer: A scoping review. Head Neck 2024; 46:74-85. [PMID: 37882242 DOI: 10.1002/hed.27558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/12/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Understanding health care experience in head and neck cancer (HNC) is becoming increasingly important due to changes in the disease profile, survivorship, and a greater appreciation of patient health care experience as an important outcome measure. People with HNC encounter many different types of health care professionals and health care touchpoints. METHOD Through systematic database searching, this scoping review of qualitative English-language studies describes the self-reported care experiences of those with HNC across the health care continuum, and describes the current state of the literature. RESULTS Overall, the 95 studies identified were heterogeneous and investigated a broad range of topics. Trends across studies showed research centered on hospital-based care, conducted in developed countries, with more studies on feeding than other aspects of care. Generic qualitative research frameworks, with individual interviews, were the preferred method of data collection. CONCLUSION Despite identifying many studies, there are significant gaps in our understanding of the HNC patient experience.
Collapse
Affiliation(s)
- Martin Checklin
- Epworth Healthcare, Richmond, Victoria, Australia
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Abby M Foster
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
- Centre for Research Excellence in Aphasia Recovery & Rehabilitation, Melbourne, Victoria, Australia
| | - Alana Hutchison
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Alanna Bowen
- Alanna Bowen Speech Pathology, Melbourne, Victoria, Australia
| | - Laura Vat
- Epworth Healthcare, Richmond, Victoria, Australia
| | | | | | - Rebecca L Packer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Bach Y, Panov E, Espin‐Garcia O, Chen E, Krzyzanowska M, O'Kane G, Moore M, Prince RM, Knox J, Grant R, Ma LX, Allen MJ, Eng L, Kosyachkova E, Megid TBC, Barron C, Wang X, Saltiel M, Farooq ARR, Jang RW, Elimova E. First impressions: A prospective evaluation of patient-physician concordance and satisfaction following the initial medical oncology consultation. Cancer Med 2023; 12:22293-22303. [PMID: 38063318 PMCID: PMC10757128 DOI: 10.1002/cam4.6758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND An especially significant event in the patient-oncologist relationship is the initial consultation, where many complex topics-diagnosis, treatment intent, and often, prognosis-are discussed in a relatively short period of time. This study aimed to measure patients' understanding of the information discussed during their first medical oncology visit and their satisfaction with the communication from medical oncologists. METHODS Between January and August 2021, patients without prior systemic treatment of their gastrointestinal malignancy (GI) attending the Princess Margaret Cancer Centre (PMCC) were approached within 24 h of their initial consultation to complete a paper-based questionnaire assessing understanding of their disease (diagnosis, treatment plan/intent, and prognosis) and satisfaction with the consultation. Medical oncology physicians simultaneously completed a similar questionnaire about the information discussed at the initial visit. Matched patient-physician responses were compared to assess the degree of concordance. RESULTS A total of 184 matched patient-physician surveys were completed. The concordance rates for understanding of diagnosis, treatment plan, treatment intent, and prognosis were 92.9%, 59.2%, 66.8%, and 59.8%, respectively. After adjusting for patient and physician variables, patients who reported treatment intent to be unclear at the time of the consultation were independently associated with lower satisfaction scores (global p = 0.014). There was no statistically significant association between patient satisfaction and whether prognosis was disclosed (p = 0.08). CONCLUSION An in-depth conversation as to what treatment intent and prognosis means is reasonable during the initial medical oncology consultation to ensure patients and caregivers have a better understanding about their cancer.
Collapse
Affiliation(s)
- Yvonne Bach
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Elan Panov
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | - Eric Chen
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | | | | | | | | | - Robert Grant
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Lucy X. Ma
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | - Lawson Eng
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | | | - Carly Barron
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Xin Wang
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | | | | | | |
Collapse
|
10
|
Conroy S, Catto JWF, Bex A, Brown JE, Cartledge J, Fielding A, Jones RJ, Khoo V, Nicol D, Stewart GD, Sullivan M, Tran MGB, Woodward R, Cumberbatch MG. Diagnosis, treatment, and survival from kidney cancer: real-world National Health Service England data between 2013 and 2019. BJU Int 2023; 132:541-553. [PMID: 37436368 DOI: 10.1111/bju.16128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVES To report the NHS Digital (NHSD) data for patients diagnosed with kidney cancer (KC) in England. We explore the incidence, route to diagnosis (RTD), treatment, and survival patterns from 2013 to 2019. MATERIALS AND METHODS Data was extracted from the Cancer Data NHSD portal for International Classification of Diseases, 10th edition coded KC; this included Cancer Registry data, Hospital Episode Statistics, and cancer waiting times data. RESULTS Registrations included 66 696 individuals with KC. Incidence of new KC diagnoses increased (8998 in 2013, to 10 232 in 2019), but the age-standardised rates were stable (18.7-19.4/100 000 population). Almost half of patients (30 340 [45.5%]) were aged 0-70 years and the cohort were most frequently diagnosed with Stage 1-2 KC (n = 26 297 [39.4%]). Most patients were diagnosed through non-urgent general practitioner referrals (n = 16 814 [30.4%]), followed by 2-week-wait (n = 15 472 [28.0%]) and emergency routes (n = 11 796 [21.3%]), with older patients (aged ≥70 years), Stage 4 KCs, and patients with non-specified renal cell carcinoma being significantly more likely to present through the emergency route (all P < 0.001). Invasive treatment (surgery or ablation), radiotherapy, or systemic anti-cancer therapy use varied with disease stage, patient factors, and treatment network (Cancer Alliance). Survival outcomes differed by Stage, histological subtype, and social deprivation class (P < 0.001). Age-standardised mortality rates did not change over the study duration, although immunotherapy usage is likely not captured in this study timeline. CONCLUSION The NHSD resource provides useful insight about the incidence, diagnostic pathways, treatment, and survival of patients with KC in England and a useful benchmark for the upcoming commissioned National Kidney Cancer Audit. The RTD data may be limited by incidental diagnoses, which could confound the high proportion of 'emergency' diagnoses. Importantly, survival outcomes remained relatively unchanged.
Collapse
Affiliation(s)
- Samantha Conroy
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - James W F Catto
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Axel Bex
- Royal Free NHS Foundation Trust, Specialist Centre for Kidney Cancer, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Janet E Brown
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Alison Fielding
- Bladder and Renal Cancer Clinical Studies Group, National Cancer Research Institute, London, UK
| | - Rob J Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Vincent Khoo
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - David Nicol
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Mark Sullivan
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Oxford, UK
| | - Maxine G B Tran
- Royal Free NHS Foundation Trust, Specialist Centre for Kidney Cancer, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rose Woodward
- Action Kidney Cancer, Manchester, UK
- International Kidney Cancer Coalition, UK
| | - Marcus G Cumberbatch
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| |
Collapse
|
11
|
Arditi C, Eicher M, Junod J, Peytremann-Bridevaux I. Socio-demographic and health-related determinants of patients' overall rating and experiences of cancer care. BMC Cancer 2023; 23:918. [PMID: 37773108 PMCID: PMC10540394 DOI: 10.1186/s12885-023-11445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/25/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Understanding how patient-reported experiences of care and overall rating of care vary among patients with different characteristics is useful to help interpret results from patient experience surveys and design targeted improvement interventions. The primary objective of this paper was to identify the socio-demographic and health-related characteristics independently associated with overall rating of cancer care. The secondary objective was to explore if and how these characteristics were associated with specific experiences of cancer care. METHODS This cross-sectional multicenter study analyzed self-reported data collected from 2696 patients diagnosed with breast, prostate, lung, colorectal, skin, or hematological cancer from four large hospitals in French-speaking Switzerland. Multivariate logistic regressions with purposeful stepwise selection of independent variables were used to identify the socio-demographic and health-related characteristics independently associated with overall rating of cancer care in the primary analyses. In the secondary analyses, we ran the multivariate model from the primary analyses with specific experiences of care as outcomes to estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI) of the selected characteristics. RESULTS Respondents' mean rating of overall cancer care was 8.5 on a scale from 0 to 10, with 17% categorized as reporting a low rating (0-7 rating). Being a woman (OR 1.43, 95% CI 1.12-1.83), not being Swiss (OR 1.47, 95% CI 1.12-1.94), reporting lower health literacy (OR 1.95, 95% CI 1.54-2.47), preferring making medical decisions alone (OR 1.92, 95% CI 1.38-2.67), having forgone care due to cost (OR 1.72, 95% CI 1.29-2.29), having used complementary medicine (OR 1.55, 95% CI 1.22-1.97), and reporting poorer health (OR 3.12, 95% CI 2.17-4.50) were all independently associated with a low rating of overall cancer care. Poorer health, lower health literacy, and having forgone care were the three characteristics most often associated with problematic experiences of care. CONCLUSIONS Our results identified several patient characteristics consistently associated with lower overall rating of care and specific experiences of cancer care. Among these determinants, health literacy and financial hardship emerged as key recurring factors shaping poor patient experiences that should be prioritized for attention by cancer care services.
Collapse
Affiliation(s)
- Chantal Arditi
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Julien Junod
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
12
|
Abdelhadi O. The impact of psychological distress on quality of care and access to mental health services in cancer survivors. FRONTIERS IN HEALTH SERVICES 2023; 3:1111677. [PMID: 37405330 PMCID: PMC10316283 DOI: 10.3389/frhs.2023.1111677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/29/2023] [Indexed: 07/06/2023]
Abstract
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.
Collapse
|
13
|
Davies EA, Wang YH. Could improving mental health disorders help increase cancer survival? Lancet Haematol 2023:S2352-3026(23)00156-4. [PMID: 37271157 DOI: 10.1016/s2352-3026(23)00156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Elizabeth A Davies
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer, Society and Public Health, King's College London, London, UK.
| | - Yueh-Hsin Wang
- Cancer Epidemiology and Cancer Services Research, Centre for Cancer, Society and Public Health, King's College London, London, UK
| |
Collapse
|
14
|
Quality of care and quality of life as experienced by patients with advanced cancer of a rare tumour type: results of the multicentre observational eQuiPe study. J Cancer Surviv 2023:10.1007/s11764-022-01323-8. [PMID: 36595186 DOI: 10.1007/s11764-022-01323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/15/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Patients with a rare cancer face difficulties during their disease trajectory, such as delayed diagnosis and lack of expert care. However, little is known about their perceived quality of care (QoC) and quality of life (QoL) in the advanced disease stage. We aimed to assess the QoC and QoL as experienced by patients with advanced rare cancers compared to patients with advanced common cancers. METHODS In this cross-sectional study, baseline data of patients with advanced cancer from the multicentre, longitudinal, observational eQuipe study were analysed. Multivariable linear regression analyses were conducted to assess differences in experienced QoC (continuity of care, continuity of information, and satisfaction with care) and QoL (functioning, symptoms, overall QoL, and social wellbeing) between advanced rare and common cancer patients. RESULTS Of the 1087 included patients, 106 (9.8%) had a rare cancer type. In comparison to patients with advanced common cancers, patients with advanced rare cancers experienced significantly lower continuity of care (77.8 vs. 71.1 respectively, p = 0.011) and social functioning (78.8 vs. 72.6 respectively, p = 0.012). No differences were found regarding continuity of information, satisfaction with care, overall QoL, and social wellbeing. CONCLUSIONS Patients with advanced rare cancers experience less continuity of care, and the impact of the disease on social and family life seems higher compared to patients with advanced common cancers. IMPLICATIONS FOR CANCER SURVIVORS To enhance the QoC and QoL of patients with advanced rare cancers, supportive care should mainly focus on improving continuity of care and patients' social functioning.
Collapse
|
15
|
Samaroo K, Hosein A, Ali J. Perception of Survivorship Needs Among Breast Cancer Patients in Trinidad and Tobago. Cureus 2023; 15:e34394. [PMID: 36874708 PMCID: PMC9977196 DOI: 10.7759/cureus.34394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/02/2023] Open
Abstract
The perception of survivorship among the cancer communities of the Caribbean is largely unknown. This study focused on determining the perception and interest in cancer survivorship among breast cancer (BC) patients in Trinidad and Tobago, as a preliminary, to introducing a pilot survivorship program and evaluating its impact on this patient population. Participants were given a questionnaire to determine needs, expectations and interest in survivorship care. Baseline measurable outcomes reported in this article include the following: 1. Participants' satisfaction with their medical care follow-up plan (if any), 2. Participants' satisfaction with the amount of information provided by healthcare providers, and 3. Participants' satisfaction with their physician's overall concern about their well-being, ranked on a 5-point Likert scale. Participants also reported on the advice/ guidelines provided by their physicians, after surgery and/or on completion of treatment, what they did to cope with BC, and their expectations of what could have been done to improve the quality of care received. A second questionnaire was then used to measure the level of interest in participating in a Cancer Survivorship Program (CSP) with components such as: nutrition, psychosocial development, spiritual well-being, and yoga and mindfulness. The level of interest was ranked by participants on a 5-point Likert scale. Fifteen themes emerged from participants' responses to the first questionnaire. Nutrition stood out as the module of highest interest, followed by psychosocial development among BC patients.
Collapse
Affiliation(s)
- Kristy Samaroo
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Amalia Hosein
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Jameel Ali
- Surgery, University of Toronto, Toronto, CAN.,Breast Surgical Oncology, St. James Medical Complex, Port of Spain, TTO
| |
Collapse
|
16
|
Factors influencing cancer survivors' experiences with follow-up cancer care: results from the pan-Canadian Experiences of Cancer Patients in Transition Study survey. Support Care Cancer 2022; 30:9559-9575. [PMID: 36123549 DOI: 10.1007/s00520-022-07357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care. METHODS In 2016, the Canadian Partnership Against Cancer collected survey responses from cancer survivors about their experiences with follow-up cancer care. We included respondents from this survey if they were diagnosed with non-metastatic breast, hematologic, colon, melanoma, and prostate cancer. Our primary outcome was cancer survivors' self-reported overall experience with follow-up cancer care. We used multivariable logistic regression to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care. RESULTS Of the 8402 cancer survivors included in our study, 81.8% (n = 6,875) reported a positive experience with their follow-up cancer care. The individual factors associated with positive overall experiences were more commonly those associated with self-perceptions of respondents' personal health and well-being rather than baseline sociodemographic factors, such as sex, income, or education. For example, respondents were more likely to report a positive experience if they perceived their quality of life as good (OR 1.9, 95% CI 1.0-3.5, p < 0.01) or reported not having an unmet practical concern (OR 1.3, 95% CI 1.1-1.6, p < 0.01). The structural factors most strongly associated with positive overall experiences included respondents perceiving their oncology specialist was in charge of their follow-up cancer care (OR 5.2, 95% CI 3.6-7.5, p < 0.01) and reporting the coordination of their follow-up cancer care among healthcare providers was good or very good (OR 8.4, 95% CI 6.7-10.6, p < 0.01). CONCLUSION While real-world experiences with follow-up cancer care in Canada are reported to be positive by most cancer survivors included in this study, we found differences exist based on individual and structural factors. A better understanding of the reasons for these differences is required to guide the provision of high-quality follow-up care that is adapted to the needs and resources of individuals and contexts.
Collapse
|
17
|
Riopel E, Cubilla I, Romero-Romero E, Diaz S F. Inpatient Experience Surveys and Overall Hospital Rating: A Correlation Analysis for a Private Hospital in Central America. J Patient Exp 2022; 9:23743735221138242. [PMID: 36407717 PMCID: PMC9669674 DOI: 10.1177/23743735221138242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To validate the use of a patient experience survey
composed of the Spanish version of the Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS) survey and of questions locally
created in our institution, a private hospital in Panama. To identify which
domains of our patient experience survey have the strongest association with the
overall inpatient hospital experience rating. Methods: A
retrospective analysis of 1619 electronic survey results of adult inpatient
experience data was performed using exploratory factor and Pearson correlation
analyses. The data was collected between March 2018 and December 2019 from a
web-survey application, accessible through a link sent by email after hospital
discharge. Results: Results from analyses showed that questions
grouping occurred under the same domains as the HCAHPS English version (factor
loading 0.456 to 0.918) and that a new domain named administrative processes
(0.818 to 0.846) arose for the newly created questions. Cronbach's alpha values
ranged from 0.32 to 0.85, with an α of0.65 for the new local questions.
Correlation analyses were higher for the domains of communication from nurses
(0.670) and administrative processes (0.618). Conclusions: Our
investigation validates the use of our patient experience survey, composed of
questions from the Spanish version of the HCAHPS survey and locally created
ones. In our institution, communication from nurses is most correlated with the
inpatient hospital experience rating. Hospital administrative processes were
also strongly associated with the overall inpatient hospital rating, and we
argue that these later aspects should be addressed to improve the patient
experience.
Collapse
Affiliation(s)
- Eve Riopel
- Pacífica Salud: Hospital Punta Pacífica, Ciudad de Panamá, Panamá
| | - Idalina Cubilla
- Hospital Rafael Estévez, Caja de Seguro Social, Aguadulce, Panamá
- Centro de Investigación Médica, Pacífica Salud, Ciudad de Panamá, Panamá
| | | | - Fernando Diaz S
- Pacífica Salud: Hospital Punta Pacífica, Ciudad de Panamá, Panamá
| |
Collapse
|