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McConnell KM, Zaleta AK, Saracino R, Miller M. Interdisciplinary provider visits attenuate relationship between patient concerns and distress in older adults with cancer. Qual Life Res 2024:10.1007/s11136-024-03760-7. [PMID: 39162969 DOI: 10.1007/s11136-024-03760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE This study examined the relationship between multidimensional patient concerns and anxiety and depression in a national sample of older adults with cancer (OACs ≥ 65 years) and the buffering effect of visiting providers across disciplines (e.g., oncology, allied health, primary care, mental health) on these relationships. METHODS Participants completed a cross-sectional survey through the Cancer Support Community's Cancer Experience Registry (CER), an online community-based research initiative. Eligible participants were 65 years and older and diagnosed with cancer in the past five years. Participants completed self-report measures of (1) the severity of their concerns across multiple domains, (2) anxiety and depression, and (3) whether they received care for "symptoms and side effects" from various providers. RESULTS The sample consisted of 277 OACs; 45% endorsed elevated anxiety and 31% endorsed elevated depression. The most severe concerns were in the domains of body image and healthy lifestyle and symptom burden and impact. More severe concerns were associated with higher levels of anxiety and depression. The relationship between concern severity and distress was weaker in OACs who saw a palliative care, mental health, physical or occupational therapy provider, pharmacist, or primary care provider relative to OACs who did not. A visit with an oncology provider did not moderate most relationships between concerns and distress. CONCLUSIONS The relationship between OACs' concerns and distress was attenuated by treatment with a specialty provider. Interdisciplinary team care may be a vital component of comprehensive patient-centered care for OACs.
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Affiliation(s)
- Kelly M McConnell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Rebecca Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Miller
- Cancer Support Community, Research and Training Institute, Washington, DC, USA.
- Inova Life With Cancer, Inova Schar Cancer Institute, 8081 Innovation Park Drive, Fairfax, VA, 22031, USA.
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Ochoa-Dominguez CY, Pickering TA, Navarro S, Rodriguez C, Farias AJ. Healthcare Experiences Are Associated with Colorectal Cancer Mortality but only for Specific Racial Groups: a SEER-CAHPS Study. J Racial Ethn Health Disparities 2024; 11:2224-2235. [PMID: 37369914 PMCID: PMC11236924 DOI: 10.1007/s40615-023-01690-7] [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: 03/22/2023] [Revised: 06/01/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The objective of this study was to determine whether racial/ethnic disparities exist in patient-reported experiences with care after colorectal cancer diagnosis and whether they are associated with mortality. METHODS We conducted a retrospective cohort study of colorectal cancer patients diagnosed from 1997 to 2011, ≥ 65 years, and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey at least 6 months after a cancer diagnosis. We leverage the National Cancer Institute's SEER-CAHPS dataset of Medicare beneficiaries. CAHPS survey responses were used to generate four composite measures of patient experiences with 1) getting needed care, 2) getting needed prescription drugs, 3) getting care quickly, and 4) physician communication. We used multivariable linear regression models to examine racial differences in patient experiences with aspects of their care and multivariable Cox proportional hazards models to identify the risk of mortality associated with each composite score by racial group. RESULTS Of the 5135 patients, 76.86% were non-Hispanic White, 7.58% non-Hispanic Black, 8.30% Hispanic, and 7.26% non-Hispanic Asian. Overall, patients reported the highest scores for composite measures regarding "getting all needed prescriptions" and the lowest score for "getting care quickly." In our adjusted models, we found that Hispanics, non-Hispanic Black, and non-Hispanic Asian patients reported significantly lower scores for getting needed prescription drugs (B = - 4.34, B = - 4.32, B = - 5.66; all p < 0.001) compared to non-Hispanic Whites. Moreover, non-Hispanic Black patients also reported lower scores for getting care quickly (B = - 3.44, p < 0.05). We only found one statistically significant association between composite scores of patient experience and mortality. For non-Hispanic Black patients, a 3-unit increase in getting needed care was associated with 0.97 times the hazard of mortality (p = 0.003). CONCLUSION Our research underscores that CAHPS patient experiences with care are an important patient-centered quality-of-care metric that may be associated with cancer outcomes and that there may be differences in these relationships by race and ethnicity. Thus, highlighting how patients' perceptions of their healthcare experiences can contribute to disparities in colorectal cancer outcomes.
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Affiliation(s)
- Carol Y Ochoa-Dominguez
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Trevor A Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Stephanie Navarro
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Claudia Rodriguez
- Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
- Gehr Family Center for Health System Science, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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Navarro S, Tsui J, Barzi A, Stern MC, Pickering T, Farias AJ. Associations Between Patient Experience With Care, Race and Ethnicity, and Receipt of CRC Treatment Among SEER-CAHPS Patients With Multiple Comorbidities. J Natl Compr Canc Netw 2023; 22:e237074. [PMID: 38150827 PMCID: PMC10872498 DOI: 10.6004/jnccn.2023.7074] [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: 04/24/2023] [Accepted: 08/17/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Patients with colorectal cancer (CRC) and multiple comorbidities are less likely to receive guideline-concordant treatment (GCT), a disparity exacerbated by racial and ethnic disparities in GCT. Yet, positive patient experiences with care are associated with more appropriate care use. We investigated associations between patient experiences with care, race and ethnicity, and receipt of GCT for CRC among older adults with multiple comorbidities. METHODS We used SEER-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to identify participants diagnosed with CRC from 2001 to 2017 at age ≥67 years with additional chronic conditions. Stage-specific GCT was identified following recommendations in the NCCN Guidelines for Colon and Rectal Cancer. Patient experiences with care were identified from CAHPS surveys. Multivariable log-binomial regression estimated associations between race and ethnicity and receipt of GCT by experiences with care. RESULTS A total of 2,612 patients were included. Those reporting excellent experience with getting care quickly were 5% more likely to receive GCT than those reporting less-than-excellent experience (relative risk [RR], 1.05; 95% CI, 1.04-1.05). When reporting less-than-excellent experience with getting care quickly, non-Hispanic Black (NHB) patients were less likely than non-Hispanic White (NHW) patients to receive GCT (RR, 0.80; 99.38% CI, 0.78-0.82), yet NHB patients were more likely to receive GCT than NHW patients when reporting excellent experience (RR, 1.05; 99.38% CI, 1.02-1.09). When reporting less-than-excellent experience with getting needed care, Hispanic patients were less likely than NHW patients to receive GCT (RR, 0.91; 99.38% CI, 0.88-0.94), yet Hispanic patients were more likely to receive GCT than NHW patients when reporting excellent experience (RR, 1.06; 99.38% CI, 1.03-1.08). CONCLUSIONS Although excellent patient experience among those with multiple comorbidities may not be strongly associated with receipt of GCT for CRC overall, improvements in experiences of accessing care among NHB and Hispanic patients with CRC and additional comorbidities may aid in mitigating racial and ethnic disparities in receipt of GCT.
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Affiliation(s)
- Stephanie Navarro
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
| | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
- USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Afsaneh Barzi
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Mariana C. Stern
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
- USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Trevor Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
| | - Albert J. Farias
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California
- USC Norris Comprehensive Cancer Center, Los Angeles, California
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Dibble KE, Deng Z, Jin M, Connor AE. Associations between race/ethnicity and SEER-CAHPS patient care experiences among female Medicare beneficiaries with breast cancer. J Geriatr Oncol 2023; 14:101633. [PMID: 37741036 PMCID: PMC10843501 DOI: 10.1016/j.jgo.2023.101633] [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: 06/26/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION We aimed to determine if racial/ethnic disparities exist in survivorship care patient experiences among older breast cancer survivors. MATERIALS AND METHODS Nineteen thousand seventeen female breast cancer survivors aged ≥65 at post-diagnosis survey contributed data via the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) and Centers for Medicare and Medicaid Services Consumer Assessment of Healthcare Providers & Systems (CAHPS) data linkage (2000-2019). Multivariable linear regression models were used to estimate adjusted beta (β) coefficients and standard error (SE) estimates for associations between race/ethnicity and survivorship care patient experiences. RESULTS Most women were non-Hispanic (NH)-White (78.1%; NH-Black [8.1%], NH-Asian [6.5%], Hispanic [6.2%]). On average, women reported 76.3 years (standard deviation [SD] = 7.14) at CAHPS survey and 6.10 years since primary diagnosis (SD = 3.51). Compared with NH-White survivors, NH-Black survivors reported lower mean scores for Getting Care Quickly (β = -5.17, SE = 0.69, p ≤0.001), Getting Needed Care (β = -1.72, SE = 0.63, p = 0.006), and Overall Care Ratings (β = -2.72, SE = 0.48, p ≤0.001), mirroring the results for NH-Asian survivors (Getting Care Quickly [β = -7.06, SE = 0.77, p ≤0.001], Getting Needed Care [β = -4.43, SE = 0.70, p ≤0.001], Physician Communication [β = -1.15, SE = 0.54, p = 0.03], Overall Care Rating [β = -2.32, SE = 0.53, p ≤0.001]). Findings among Hispanic survivors varied, where mean scores were lower for Getting Care Quickly (β = -2.83, SE = 0.79, p ≤0.001), Getting Needed Care (β = -2.43, SE = 0.70, p = 0.001), and Getting Needed Prescription Drug(s) (β = -1.47, SE = 0.64, p = 0.02), but were higher for Health Plan Rating (β = 2.66, SE = 0.55, p ≤0.001). Education, Medicare plan, and multimorbidity significantly modified various associations among NH-Black survivors, and education was a significant modifier among NH-Asian and Hispanic survivors. DISCUSSION We observed racial/ethnic disparities in the associations with survivorship care patient experience among NH-Black, Hispanic, and NH-Asian breast cancer survivors. Future research should examine the impact of education, Medicare plans, and multimorbidity on these associations.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA.
| | - Zhengyi Deng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Mu Jin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA; Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21205, USA
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Pandit AA, Gressler LE, Halpern MT, Kamel M, Payakachat N, Li C. Differences in racial/ethnic disparities in patient care experiences between prostate cancer survivors and males without cancer: A SEER-CAHPS study. J Geriatr Oncol 2023; 14:101554. [PMID: 37320932 PMCID: PMC10335318 DOI: 10.1016/j.jgo.2023.101554] [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: 11/07/2022] [Revised: 04/14/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Our purpose was to evaluate whether racial/ethnic disparities in patient care experiences (PCEs) differ between males with prostate cancer ("PCa group") and males without cancer ("non-cancer group"). MATERIALS AND METHODS This retrospective study used 2007-2015 National Cancer Institute's Surveillance, Epidemiology and End Results registry data linked to Consumer Assessment of Healthcare Providers and Systems surveys. PCa and non-cancer groups were propensity score matched 1:5 on demographic and clinical characteristics. Differences in racial/ethnic disparities (DRD) (non-Hispanic Black [NHB], Hispanic, non-Hispanic Asian [NHA], and Other Races compared to non-Hispanic White [NHW]) in PCEs (getting needed care, getting care quickly, doctor communication, customer service, and getting needed prescription drugs) were compared between matched PCa and non-cancer groups. Per prior literature, DRD in PCE scores were categorized as small (<3), medium (≥3 but <5) or large (≥5). RESULTS There were 7312 males in the PCa group and 36,559 matched males in the non-cancer group. Within each group, all racial/ethnic minority categories reported worse scores compared to NHW individuals (p < 0.05) for ≥3 PCE composite measures. Compared to PCa group, a larger NHA-NHW difference was observed in non-cancer group for getting needed care (-4.65 in PCa vs. -7.77 in non-cancer; DRD = 3.11, p = 0.029) and doctor communication (-2.46 in PCa vs. -4.85 in non-cancer; DRD = 2.38, p = 0.023). DISCUSSION In both PCa and non-cancer groups, racial/ethnic minorities reported worse experiences compared to NHW individuals for several PCE measures. However, the difference in getting needed care and doctor communication between NHA and NHW individuals were more pronounced in non-cancer group than PCa group.
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Affiliation(s)
- Ambrish A Pandit
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| | - Laura E Gressler
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| | - Michael T Halpern
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America.
| | - Mohamed Kamel
- Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America; Department of Urology, Ain Shams University, Cairo 11566, Egypt.
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States of America.
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Mitchell KAR, Boyle JR, Juricekova L, Brown RF. Adjuvant chemotherapy non-adherence, patient-centered communication, and patient-level factors in elderly breast and colon cancer patients. Cancer Med 2023. [PMID: 37148551 DOI: 10.1002/cam4.5884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/15/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND We examined patient-level factors (patient characteristics, disease and treatment factors, and patient experience), patient-centered communication (PCCM), and non-adherence to adjuvant chemotherapy (AC) guidelines among breast and colon cancer patients to inform AC adherence promotion and improve clinical outcomes. METHODS Descriptive statistics for patient-level factors, PCCM, and AC non-adherence (primary non-adherence, non-persistence at 3 and 6 months) were obtained. Multiple logistic regression models were used to estimate AC non-adherence after accounting for the identified patient-level factors. RESULTS The majority of the sample (n = 577) were White (87%), breast cancer patients (87%), and reported PCCM (provider communication score ≥ 90%, 73%, provider communication score = 100%, 58%). All three levels of AC nonadherence were significantly higher in breast cancer patients (69%, 81%, and 89% for primary non-adherence, and non-persistence at 3 and 6 months, respectively) than colon cancer patients (43%, 46%, and 62%, respectively). Male sex, survey assistance, and low/average ratings of a personal doctor, specialist, and healthcare were associated with lower PCCM. Older age, breast cancer diagnosis, and diagnosis group following 2007-2009 increased the likelihood of all three levels of AC non-adherence. Comorbidities and PCCM-90 were exclusively associated with non-persistence at 3 months. CONCLUSIONS Adjuvant chemotherapy non-adherence varied by cancer diagnosis and treatment factors. The relationship between PCCM and AC non-adherence differed by level of PCCM, time period, and the presence of comorbidities. AC guideline adherence, communication, and value-concordant treatment should be assessed and compared simultaneously to improve our understanding of their interrelationships.
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Affiliation(s)
| | - Joseph R Boyle
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Lenka Juricekova
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Pandit AA, Patil NN, Mostafa M, Kamel M, Halpern MT, Li C. Rural–Urban Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study. Cancers (Basel) 2023; 15:cancers15071939. [PMID: 37046601 PMCID: PMC10093298 DOI: 10.3390/cancers15071939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Background: We sought to evaluate rural–urban disparities in patient care experiences (PCEs) among localized prostate cancer (PCa) survivors at intermediate-to-high risk of disease progression. Methods: Using 2007–2015 Surveillance Epidemiology and End Results (SEER) data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, we analyzed survivors’ first survey ≥6 months post-diagnosis. Covariate adjusted linear regressions were used to estimate associations of treatment status (definitive treatment vs. none) and residence (large metro vs. metro vs. rural) with PCE composite and rating measures. Results: Among 3779 PCa survivors, 1798 (53.2%) and 370 (10.9%) resided in large metro and rural areas, respectively; more rural (vs. large metro) residents were untreated (21.9% vs. 16.7%; p = 0.017). Untreated (vs. treated) PCa survivors reported lower scores for doctor communication (ß = −2.0; p = 0.022), specialist rating (ß = −2.5; p = 0.008), and overall care rating (ß = −2.4; p = 0.006). While treated rural survivors gave higher (ß = 3.6; p = 0.022) scores for obtaining needed care, untreated rural survivors gave lower scores for obtaining needed care (ß = −7.0; p = 0.017) and a lower health plan rating (ß = −7.9; p = 0.003) compared to their respective counterparts in large metro areas. Conclusions: Rural PCa survivors are less likely to receive treatment. Rural–urban differences in PCEs varied by treatment status.
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Liu M, Hu L, Xu Y, Wang Y, Liu Y. Patient healthcare experiences of cancer hospitals in China: A multilevel modeling analysis based on a national survey. Front Public Health 2023; 11:1059878. [PMID: 36908411 PMCID: PMC9992183 DOI: 10.3389/fpubh.2023.1059878] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
Importance Patient satisfaction is a crucial indicator for assessing quality of care in healthcare settings. However, patient satisfaction benchmark for cancer hospitals in China is not established. Objective To examine patient satisfaction levels in tertiary cancer hospitals in China, and inter-hospital variations after case-mix adjustment. Design A nationwide cross-sectional hospital performance survey conducted from January to March 2021. Settings At 30 tertiary cancer hospitals in China. Participants A total of 4,847 adult inpatients consecutively recruited at 30 tertiary cancer hospitals were included. Exposures Patient characteristics included demographic characteristics (sex, age, education, and annual family income), clinical characteristics (cancer type, cancer stage, self-reported health status, and length of stay), and actual respondents of questionnaire. Main outcomes and measures Patient satisfaction was measured using 23 items covering five aspects, administrative process, hospital environment, medical care, symptom management, and overall satisfaction. Responses to each item were recorded using a 5-point Likert scale. Patient satisfaction level for each aspect was described at individual and hospital levels. Using multilevel logistic regression, patient characteristics associated with patient satisfaction were examined as case-mix adjusters and inter-hospital variation were determined. Results The satisfaction rates for symptom management, administrative process, hospital environment, overall satisfaction, and medical care aspects were 74.56, 81.70, 84.18, 84.26, and 90.86% with a cut-off value of 4, respectively. Significant predictors of patient satisfaction included sex, age, cancer type, cancer stage, self-reported health status, and actual respondent (representative or patient) (all P < 0.05). The ranking of the hospitals' performance in satisfaction was altered after the case-mix adjustment was made. But even after the adjustment, significant variation in satisfaction among hospitals remained. Conclusions and relevance This study pointed to symptom management as a special area, to which a keen attention should be paid by policymakers and hospital administrators. Significant variation in satisfaction among hospitals remained, implying that future studies should examine major factors affecting the variation. In review, target interventions are needed in low-performing hospitals.
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Affiliation(s)
| | - Linlin Hu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Pandit AA, Gressler LE, Halpern MT, Kamel M, Payakachat N, Li C. Racial/Ethnic Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study. Curr Oncol 2022; 29:8357-8373. [PMID: 36354719 PMCID: PMC9689524 DOI: 10.3390/curroncol29110659] [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: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate racial/ethnic disparities in patient care experiences (PCEs) among prostate cancer (PCa) survivors. METHODS This retrospective study used 2007-2015 National Cancer Institute Surveillance, Epidemiology and End Results registry data linked to Consumer Assessment of Healthcare Providers and Systems surveys. First survey ≥ 6 months post-PCa diagnosis was analyzed. We performed multivariable linear regression, adjusting for demographic and clinical covariates, to evaluate the association of race/ethnicity (non-Hispanic Whites (NHWs), non-Hispanic Black (NHBs), Hispanic, non-Hispanic Asian (NHAs), and other races) with PCE composite measures: getting needed care, doctor communication, getting care quickly, getting needed prescription drugs (Rx), and customer service. RESULTS Among 7319 PCa survivors, compared to NHWs, Hispanics, NHBs and NHAs reported lower scores for getting care quickly (ß = -3.69; p = 0.002, ß = -2.44; p = 0.021, and ß = -6.44; p < 0.001, respectively); Hispanics scored worse on getting needed care (ß = -2.16; p = 0.042) and getting needed Rx (ß = -2.93; p = 0.009), and NHAs scored worse on customer service (ß = -7.60; p = 0.003), and getting needed Rx (ß = -3.08; p = 0.020). However, NHBs scored better than NHWs on doctor communication (ß = 1.95, p = 0.006). No statistically significant differences were found between other races and NHWs. CONCLUSIONS Comparing to NHWs, Hispanics and NHAs reported worse experiences on several PCE composite measures, while NHBs reported worse scores on one but better scores on another PCE composite measure. Further research is needed to understand the reasons behind these disparities and their influence on healthcare utilization and health outcomes among PCa survivors.
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Affiliation(s)
- Ambrish A. Pandit
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
| | - Laura E. Gressler
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
| | - Michael T. Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Mohamed Kamel
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
- Department of Urology, Ain Shams University, Cairo 11566, Egypt
| | - Nalin Payakachat
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
| | - Chenghui Li
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA
- Correspondence: ; Tel.: +1-(501)-686-6298
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Wollersheim BM, van der Poel HG, van Asselt KM, Pos FJ, Tillier CN, Akdemir E, Vis AN, Lampe MI, van den Bergh R, Somford DM, Knipscheer B, Cauberg ECC, Noordzij A, Aaronson NK, Boekhout AH, van de Poll-Franse LV. Quality of early prostate cancer follow-up care from the patients’ perspective. Support Care Cancer 2022; 30:10077-10087. [DOI: 10.1007/s00520-022-07396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022]
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Arevalo M, Pickering TA, Vernon SW, Fujimoto K, Peskin MF, Farias AJ. Do breast cancer survivors with a recent history of clinical depression report worse experiences with care? A retrospective cohort study using SEER-CAHPS data. Cancer Med 2022; 12:1949-1960. [PMID: 35929584 PMCID: PMC9883547 DOI: 10.1002/cam4.5031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE We examined whether breast cancer survivors' experiences with care differed by a recent history of clinical depression, and whether associations differed by race/ethnicity. METHODS Using the Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset, we analyzed records of breast cancer survivors who completed a survey at least 12 months after their cancer diagnosis. We assessed clinical depression 12 months prior to survey completion using Medicare claims. We used separate multivariable logistic regressions to examine the associations between depression and excellent (vs. less than excellent) ratings of experiences with care (i.e., doctor communication, getting needed care, getting care quickly, getting prescription drugs, specialist and overall care). We also assessed interactions of depression by race/ethnicity. All models were adjusted for demographics and cancer prognostic and treatment factors. RESULTS Of the 2271 survivors, 7.6% were clinically depressed. After adjusting for covariates, survivors with clinical depression had lower odds of reporting excellent ratings of their ability to get needed care, care by their specialist, and overall care, compared to those without depression (AOR = 0.58, 95% CI: 0.40-0.84; AOR = 0.40, CI: 0.31-0.76; and AOR = 0.61, CI: 0.42-0.89, respectively). Among Hispanics, having depression was associated with higher odds of excellent ratings of one's ability to get needed care (AOR: 5.42, 95% CI: 1.02-28.81). No other statistically significant associations by race/ethnicity were found. CONCLUSIONS Breast cancer survivors with depression report poorer patient experiences with care. Further research is needed to understand complexities of ratings of experiences with care among survivors of diverse backgrounds. IMPLICATIONS Survivors with a recent history of clinical depression may benefit from additional supportive care services.
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Affiliation(s)
- Mariana Arevalo
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Trevor A. Pickering
- Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sally W. Vernon
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Melissa F. Peskin
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Albert J. Farias
- Department of Preventive MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA,Gehr Family Center for Health System ScienceKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA,Cancer Control Research ProgramUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesCaliforniaUSA
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12
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Racial and ethnic differences in patient ratings of colorectal and non-small-cell lung cancer care: A SEER-CAHPS study. Cancer Causes Control 2022; 33:1125-1133. [PMID: 35864368 DOI: 10.1007/s10552-022-01606-6] [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: 11/23/2021] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Although significant racial and ethnic disparities exist in colorectal and lung cancer treatment and survival, racial differences in patient-reported experience of care are not well understood. The purpose of this study was to examine differences in patient-reported ratings of colorectal and non-small-cell lung cancer care by race/ethnicity. METHODS Medicare beneficiaries with AJCC stage I-IV colorectal and non-small-cell lung cancer (2003-2013) who completed a Medicare Consumer Assessment of Healthcare Providers (CAHPS) survey within 5 years of cancer diagnosis were identified in the linked SEER-CAHPS dataset. Scores were compared by race/ethnicity, defined as White, Black, or any other race/ethnicity. RESULTS Of the 2,621 identified patients, 161 (6.1%) were Black, 2,279 (87.0%) White, and 181 (6.9%) any other race/ethnicity. Compared to White patients, Black patients were younger, had lower educational level, and had higher census tract poverty indicator (p < 0.001). Black patients rated their ability to get care quickly significantly lower than White patients (63.5 (SE 3.38) vs. 71.4 (SE 2.12), p < 0.01), as did patients of any other race/ethnicity (LS mean 66.2 (SE 2.89), p = 0.02). Patients of any other race/ethnicity reported their ability to get needed care significantly lower than White patients (LS mean 81.9 (SE 2.46) vs. 86.7 (SE 1.75), p = 0.02); however, there was no difference in ability to get needed care between Black and White patients. CONCLUSION Patient ratings for getting care quickly were lower in non-White patients, indicating racial disparities in perceived timeliness of care.
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13
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Lung Cancer Mortality Racial/Ethnic Disparities in Patient Experiences with Care: a SEER-CAHPS Study. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01358-8. [PMID: 35767217 DOI: 10.1007/s40615-022-01358-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND To determine whether there are racial/ethnic disparities in patient experiences with care among lung cancer survivors, whether they are associated with mortality. METHODS A retrospective cohort study of lung cancer survivors > 65 years old who completed a CAHPS survey > 6 months after the date of diagnosis. We used data from the SEER-Consumer Assessment of Healthcare Providers Systems (SEER-CAHPS®) database from 2000 to 2013 to assess racial/ethnic differences in patient experiences with care multivariable Cox proportional hazards models to assess the association between patient experience with care scores mortality in each racial/ethnic group. RESULTS Within our cohort of 2603 lung cancer patients, Hispanic patients reported lower adjusted mean score with their ability to get needed care compared to white patients (B: - 5.21, 95% CI: - 9.03, - 1.39). Asian patients reported lower adjusted mean scores with their ability to get care quickly (- 4.25 (- 8.19, - 0.31)), get needed care (- 7.06 (- 10.51, - 3.61)), get needed drugs (- 9.06 (- 13.04, - 5.08)). For Hispanic patients, a 1-unit score increase in their ability to get all needed care (HR: 1.02, 1.00-1.03) care coordination (1.06, 1.02-1.09) was associated with higher risk of mortality. Among black patients, a 1-unit score increase in their ability to get needed care (HR: 0.99, 95% CI 0.98-0.99) care coordination (0.97, 0.94-0.99) was associated with lower risk mortality. CONCLUSIONS There are racial/ethnic disparities in lung cancer patient experiences with care that may impact mortality. Patient experiences with care are important risk factors of mortality for certain racial/ethnic groups.
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14
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Lines LM, Cohen J, Kirschner J, Barch DH, Halpern MT, Kent EE, Mollica MA, Smith AW. Associations between illness burden and care experiences among Medicare beneficiaries before or after a cancer diagnosis. J Geriatr Oncol 2022; 13:731-737. [PMID: 35272981 PMCID: PMC9233114 DOI: 10.1016/j.jgo.2022.02.017] [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: 06/14/2021] [Revised: 12/20/2021] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION To understand associations between a new measure of illness burden and care experiences in a large, national sample of Medicare beneficiaries surveyed before or after a cancer diagnosis. MATERIALS AND METHODS The SEER-CAHPS Illness Burden Index (SCIBI) was previously developed using Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) linked data. The SCIBI provides a standardized morbidity score based on self- and other-reported information from 8 domains and proxies relative risk of 12-month, all-cause mortality among people surveyed before or after a cancer diagnosis. We analyzed a population of Medicare beneficiaries (n = 116,735; 49% fee-for-service and 51% Medicare Advantage [MA]; 73% post-cancer diagnosis) surveyed 2007-2013 to understand how their SCIBI scores were associated with 12 different care experience measures. Frequentist and Bayesian multivariable regression models adjusted for standard case-mix adjustors, enrollment type, timing of cancer diagnoses relative to survey, and survey year. RESULTS AND DISCUSSION SCIBl scores were associated (P < .001) in frequentist models with better ratings of Health Plan (coefficient ± standard error: 0.33 ± 0.08) and better Getting Care Quickly scores (0.51 ± 0.09). In Bayesian models, individuals with higher illness burden had similar results on the same two measures and also reported reliably worse Overall Care experiences (coefficient ± posterior SD: -0.17 ± 0.06). Illness burden may influence how people experience care or report those experiences. Individuals with greater illness burdens may need intensive care coordination and multilevel interventions before and after a cancer diagnosis.
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Affiliation(s)
- Lisa M Lines
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America; University of Massachusetts Chan Medical School, 55 Lake Ave., North Worcester, MA 01655, United States of America.
| | - Julia Cohen
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America
| | - Justin Kirschner
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America
| | - Daniel H Barch
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America; Psychology Department, Tufts University, Medford, MA, United States of America
| | - Michael T Halpern
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States of America
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America; University of North Carolina Lineberger Comprehensive Cancer Center, United States of America
| | - Michelle A Mollica
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States of America
| | - Ashley Wilder Smith
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States of America
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15
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Lines LM, Barch DH, Zabala D, Halpern MT, Jacobsen PB, Mollica MA. Associations between Mental Health and Care Experiences among Older Adults with Cancer. Psychooncology 2022; 31:1491-1501. [DOI: 10.1002/pon.5966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/02/2022] [Accepted: 05/08/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Lisa M. Lines
- RTI International 3040 E. Cornwallis Rd Research Triangle Park NC27709 United States
- University of Massachusetts Medical School 55 Lake Ave. North Worcester MA01655 United States
| | - Daniel H. Barch
- RTI International 3040 E. Cornwallis Rd Research Triangle Park NC27709 United States
- Tufts University Psychology Department Medford MA United States
| | - Diana Zabala
- RTI International 3040 E. Cornwallis Rd Research Triangle Park NC27709 United States
| | - Michael T. Halpern
- National Cancer Institute Division of Cancer Control and Population Sciences Healthcare Delivery Research Program Bethesda United States
| | - Paul B. Jacobsen
- National Cancer Institute Division of Cancer Control and Population Sciences Healthcare Delivery Research Program Bethesda United States
| | - Michelle A. Mollica
- National Cancer Institute Division of Cancer Control and Population Sciences Healthcare Delivery Research Program Bethesda United States
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16
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Alessy SA, Alhajji M, Rawlinson J, Baker M, Davies EA. Factors influencing cancer patients' experiences of care in the USA, United Kingdom, and Canada: A systematic review. EClinicalMedicine 2022; 47:101405. [PMID: 35497061 PMCID: PMC9046116 DOI: 10.1016/j.eclinm.2022.101405] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 11/01/2022] Open
Abstract
The extent to which individual and structural factors influence cancer patients' reports of their experiences are not yet well understood. We sought to identify which groups of patients consistently report poorer experiences and whether structural care factors might also be associated with better or worse reports. We conducted a systematic review of literature in PubMed and Web of Science with the date of last search as 27th of February 2022 following PRISMA guidelines. We focused on studies from three established population-based surveys datasets and instruments. After screening 303 references, 54 studies met the inclusion criteria. Overall, being from an ethnic minority group, having a more deprived socioeconomic status, poorer general or mental health status, being diagnosed with poor prognosis cancers, presenting to care through an emergency route, and having delayed treatment were consistently associated with poorer cancer care experiences. Conversely being diagnosed with earlier stage disease, perceiving communication as effective, positive patient-provider relationships, and receiving treatment with respect were overall associated with better reports of cancer care experiences. Improvement efforts aimed at delivering better experiences of patient-centred care need to take account much more explicitly patients' differing characteristics, prognoses, and trajectories they take through their care journeys.
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Affiliation(s)
- Saleh A. Alessy
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
- Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King’s College London, London, SE1 9RT, UK
| | - Mohammed Alhajji
- Behavioural Insights Unit (Nudge), Ministry of Health, Riyadh, Saudi Arabia
| | - Janette Rawlinson
- Patient representative, National Cancer Research Institute (NCRI), Consumer forum, NCRI CSG (Lung) Subgroup, BTOG Steering Committee, NHSE CEG, UK
| | - Matthew Baker
- Patient representative, National Cancer Research Institute (NCRI), Consumer Involvement Advisory Group, Consumer Forum, UK
| | - Elizabeth A. Davies
- Centre for Cancer, Society & Public Health, Comprehensive Cancer Centre, King’s College London, London, SE1 9RT, UK
- Corresponding author.
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17
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Fitch MI, Nicoll I, Newton L, Strohschein FJ. Challenges of Survivorship for Older Adults Diagnosed with Cancer. Curr Oncol Rep 2022; 24:763-773. [PMID: 35286555 PMCID: PMC8918886 DOI: 10.1007/s11912-022-01255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review The purpose of this brief review is to highlight significant recent developments in survivorship research and care of older adults following cancer treatment. The aim is to provide insight into care and support needs of older adults during cancer survivorship as well as directions for future research. Recent Findings The numbers of older adult cancer survivors are increasing globally. Increased attention to the interaction between age-related and cancer-related concerns before, during, and after cancer treatment is needed to optimize outcomes and quality of life among older adult survivors. Issues of concern to older survivors, and ones associated with quality of life, include physical and cognitive functioning and emotional well-being. Maintaining activities of daily living, given limitations imposed by cancer treatment and other comorbidities, is of primary importance to older survivors. Evidence concerning the influence of income and rurality, experiences in care coordination and accessing services, and effectiveness of interventions remains scant for older adults during survivorship. Summary There is a clear need for further research relating to tailored intervention and health care provider knowledge and education. Emerging issues, such as the use of medical assistance in dying, must be considered in this population.
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Affiliation(s)
- Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, 207 Chisholm Ave, Toronto, ON M4C 4V9 Canada
| | | | - Lorelei Newton
- School of Nursing, STN CSC, University of Victoria, PO Box 1700, Victoria, BC V8W 2Y2 Canada
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18
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Nartey Y, Tata LJ, Khakwani A, Beattie V, Beckett P, Hubbard RB, Stewart I. Using patient experiences to evaluate care and expectations in lung cancer: analysis of the English Cancer Patient Experience Survey linked with the national cancer registry. Support Care Cancer 2022; 30:4417-4428. [PMID: 35106657 PMCID: PMC8942895 DOI: 10.1007/s00520-022-06863-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/24/2022] [Indexed: 01/15/2023]
Abstract
Purpose Identification of unmet needs in person centred and supportive care could be limited by differences in experience across specific cancer populations. Using the experiences of people with lung cancer, we assess distinctions according to demographic and clinical characteristics. Methods The English Cancer Patient Experience Survey was linked to the national cancer registry. The primary outcome was experience of the lung cancer pathway when assessed in multi-question models developed with item response theory. Secondary outcomes were experience by treatment received and in separate dimensions of the care pathway: up to diagnosis, treatment information, and staff support. Results Responses from 15,967 adults with a lung cancer diagnosis between 2009 and 2015 were included. Positive experiences were more likely to be reported by people aged between 65 and 80 (adjusted coefficient 0.08, 95%CI 0.05;0.11), those living in the most deprived areas (adjusted coefficient 0.10, 95%CI 0.05;0.14), diagnosed at lung cancer stage IIA–B (adjusted coefficient 0.09, 95%CI 0.04;0.14), and those diagnosed through inpatient elective admissions (adjusted coefficient 0.17, 95%CI 0.07;0.28). Specific experiences differed across dimensions of care and within lung cancer treatment groups. Conclusions Experiences differed according to gender and ethnicity, supporting previous observations in cancer. In contrast to previous studies, people with lung cancer were more likely to report positive pathway experiences at older ages, living in more deprived areas, or diagnosed after stage I, all frequently associated with worse clinical outcomes. The distinct observations in lung cancer specific analyses suggest potential unmet needs, such as in early stage disease and younger age groups. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-06863-4.
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Affiliation(s)
- Yvonne Nartey
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Laila J Tata
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Aamir Khakwani
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Vanessa Beattie
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Paul Beckett
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Richard B Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Iain Stewart
- Division of Respiratory Medicine, NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK. .,National Heart & Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY, UK.
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19
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Racial/ethnic disparities in patient experiences with care and Gleason score at diagnosis of prostate cancer: a SEER-CAHPS study. Cancer Causes Control 2022; 33:601-612. [PMID: 35032242 DOI: 10.1007/s10552-022-01552-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine whether racial/ethnic differences in patient experiences with care, potentially leading to underutilization of necessary care, are associated with disparities in Gleason score at diagnosis. METHODS We used the SEER-CAHPS linked dataset to identify Medicare beneficiaries who completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey prior to diagnosis of prostate cancer. Independent variables included aspects of patient experiences with care captured by CAHPS surveys. We conducted survey weighted multivariable multinomial logistic regression analyses, stratified by patient race/ethnicity, to estimate associations of CAHPS measures with Gleason score at diagnosis. RESULTS Of the 4,245 patients with prostate cancer, most were non-Hispanic white (NHW) (77.6%), followed by non-Hispanic black (NHB) (8.4%), Hispanic (8.4%), and Asian (5.6%). Excellent experience with getting needed prescription drugs was associated with lower odds of Gleason scores of 7 and 8-10 in NHBs (7: OR = 0.19, 95% CI = 0.05-0.67; 8-10: OR = 0.04, 95% CI = 0.01-0.2) and lower odds of 8-10 in NHWs (OR = 0.61, 95% CI = 0.40-0.93). For NHBs, excellent primary physician ratings were associated with greater odds of a Gleason score of 8-10 (OR = 13.28, 95% CI = 1.53-115.21). CONCLUSION Patient experiences with access to care and physician relationships may influence Gleason score in different ways for patients of different racial/ethnic groups. More research, including large observational studies with greater proportions of racial/ethnic minority patients, is necessary to understand these relationships and target interventions to overcome disparities and improve patient outcomes.
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20
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Watanabe T, Ichinose Y, Matsuki M, Wakita T, Toida T, Masuda M, Higashi T. Experiences of patients with cancer at health care facilities in Japan: results from a nationwide survey. BMC Health Serv Res 2021; 21:1180. [PMID: 34715853 PMCID: PMC8556904 DOI: 10.1186/s12913-021-07184-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To elucidate the experience of patients with cancer from diagnosis to early survivorship in Japan using a nationwide questionnaire survey, and to inform the current progress of the cancer control programs. METHODS The survey was sent to a representative sample of adult patients with cancer identified from the national database of hospital-based cancer registries. The patients' responses were compared across three groups: patients with rare cancers, patients aged < 40 years, and patients with non-rare cancers aged ≥40 years. RESULTS Of 20,488 patients invited to participate in the survey, 8935 (43.6%) responded. Respondents reported an average score of 7.9 out of 10 on global ratings of care. Patients with rare cancers experienced a longer time to diagnosis but the shortest time from diagnosis to first treatment (p < 0.05). Patients aged < 40 years rated worse for the majority of the survey items, especially on items that related to communication with medical staff and items referring to early survivorship. CONCLUSION The care experienced by patients with cancer in Japan varies on the basis of age group and cancer type. Efforts should be directed to ensuring prompt access to diagnostic facilities for patients with rare cancers and providing sufficient support to younger patients.
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Affiliation(s)
- Tomone Watanabe
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan. .,Department of Cancer Health Services Research, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
| | - Yuichi Ichinose
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Mei Matsuki
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.,Department of Respiratory Medicine, the University of Tokyo, Tokyo, Japan
| | - Takafumi Wakita
- Department of Social Psychology, Kansai University, Osaka, Japan
| | - Tsutomu Toida
- Department of Economics, Dokkyo University, Saitama, Japan
| | - Masato Masuda
- University of Ryukyus Hospital Cancer Center, Okinawa, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.,Department of Cancer Health Services Research, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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21
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Yannitsos D, Barbera L, Al-Rashdan A, Grendarova P. Diagnostic timelines and self-reported symptoms of patients with lung and gastrointestinal cancers undergoing radiation therapy. Retrospective case control study. Support Care Cancer 2021; 30:1501-1509. [PMID: 34533629 DOI: 10.1007/s00520-021-06522-0] [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: 03/17/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have found that patients with lung cancer report worse patient experience compared to other tumour groups. Reasons that may negatively impact patient experience include delays in diagnosis as well as inadequate symptom management. The purpose of this study was to compare the diagnostic timelines and symptom reports of patients with lung and gastrointestinal (GI) cancers. METHODS This study included patients diagnosed with lung or GI cancers who attended a radiation oncology (RO) consultation and/or received radiation treatment between May and August 2019 at the Tom Baker Cancer Centre, Calgary, Alberta, Canada. Data collected included demographics, dates of diagnostic time points, and self-reported symptom scores across 3 time points. A descriptive analysis was completed, and the median number of days between time points was compared between tumour groups. RESULTS Patients with lung cancer had longer diagnostic timelines compared to GI patients. The median number of days between the first investigative test and biopsy was 21 days longer for patients with lung cancer (p < 0.05). From RO consultation to the first treatment review appointment, 25% and 4% of lung and GI patients, respectively, reported worsening of symptoms. A greater proportion of lung patients reported worse symptom scores during treatment compared to GI patients. This varied by specific symptom. CONCLUSIONS Patients with lung cancer experienced delays in receiving a diagnosis and worse symptom burden during radiation therapy in this study. We identified potential targets to improve patient experience.
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Affiliation(s)
- Demetra Yannitsos
- Department of Oncology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada. .,Tom Baker Cancer Centre, Calgary, Canada.
| | - Lisa Barbera
- Department of Oncology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,Tom Baker Cancer Centre, Calgary, Canada
| | - Abdulla Al-Rashdan
- Department of Oncology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,Tom Baker Cancer Centre, Calgary, Canada
| | - Petra Grendarova
- Department of Oncology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,Tom Baker Cancer Centre, Calgary, Canada
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22
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Stover AM, Kurtzman R, Walker Bissram J, Jansen J, Carr P, Atkinson T, Ellis CT, Freeman AT, Turner K, Basch EM. Stakeholder Perceptions of Key Aspects of High-Quality Cancer Care to Assess with Patient Reported Outcome Measures: A Systematic Review. Cancers (Basel) 2021; 13:cancers13143628. [PMID: 34298841 PMCID: PMC8306432 DOI: 10.3390/cancers13143628] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary We conducted a review to identify important symptoms reported by patients on questionnaires (e.g., pain) that can be used to compare cancer centers on how well they provide care. For example, cancer centers could be compared on the percentage of patients with controlled pain after adjusting for demographic and clinical characteristics. Standard review methods were used to identify studies through August 2020. Searches generated 1813 articles and 1779 were coded as not relevant. The remaining 34 studies showed that patients, caregivers, clinicians, and healthcare administrators identify psychosocial care (e.g., distress) and symptom management as critical parts of high-quality care. Patients and caregivers also perceive that maintaining physical function and daily activities are important. Clinicians and healthcare administrators perceive control of specific symptoms to be important (e.g., pain, poor sleep, diarrhea). Results were used to inform testing of symptom questionnaires to compare the quality of care provided by six cancer centers. Abstract Performance measurement is the process of collecting, analyzing, and reporting standardized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and conflicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Correspondence:
| | - Rachel Kurtzman
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC 27599, USA;
| | | | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Thomas Atkinson
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - C. Tyler Ellis
- Department of Surgery, University of Louisville Health, Louisville, KY 40202, USA;
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Ethan M. Basch
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
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Mahdavi M, Doshmangir L, Jaafaripooyan E. Rethinking health services operations to embrace patient experience of healthcare journey. Int J Health Plann Manage 2021; 36:2020-2029. [PMID: 34288080 DOI: 10.1002/hpm.3288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
Patient experience is assumed pivotal for improving health services operations. The patient experience of healthcare services in Iran has been mostly assessed through the satisfaction and quality of single services or activities at individual providers, clinical departments, or health facilities. However, given the rise of chronic and multi-morbid conditions, health services for these conditions consist of several activities and interactions through a journey that patients take in the health system. To fill in this gap, we propose focusing on the assessment of patient experience on the patient journey through the health system. We advocate that there is much potential for improving the patient experience by rethinking the operations management of health services to embrace the patient experience of the healthcare journey. Rethinking health operations management may include an exhaustive list of interventions. Concisely, at the strategic level, policy-makers while understanding the need for shifting towards the patient experience, make sure that operational level management is experience oriented. This would be pursued through a strategic approach to patient experience, reconsidering qualifications for operational management, and benchmarking to identify and share best practices. Lessons learnt from previous quality improvement programmes are also considered as a capacity to establish the experience orientation.
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Affiliation(s)
- Mahdi Mahdavi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Leila Doshmangir
- School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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24
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Ochoa CY, Toledo G, Iyawe-Parsons A, Navarro S, Farias AJ. Multilevel Influences on Black Cancer Patient Experiences With Care: A Qualitative Analysis. JCO Oncol Pract 2021; 17:e645-e653. [PMID: 33974829 DOI: 10.1200/op.21.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Black patients with cancer report worse experiences with health care compared with White patients; however, little is known about what influences these ratings. The objective of this study is to explore the multilevel factors that influence global ratings of care for Black cancer survivors. METHODS We conducted semistructured in-depth interviews with 18 Black cancer survivors. We assessed the global ratings of their personal doctor, specialist, health plan, prescription drug plan, and overall health care, and asked patients to elaborate on their rating. We analyzed the interviews with a deductive grounded theory approach using the socioecologic model to identify the individual, interpersonal, organizational, and environmental influences on Black cancer patient experiences with global ratings of care. We used an inductive constant comparison approach to identify additional themes that emerged. Two coauthors separately coded a set of transcripts and met to refine the codebook. RESULTS On average, participants reported the highest mean rating for their specialist (9.39/10) and the lowest mean rating for their personal doctor (7.33/10). Emerging themes that influenced patient ratings were perceptions about their interaction with medical providers, physician communication, the doctor's expertise, and aspects of the physical facilities. Global ratings of care measures were widely influenced by patient interactions with their providers that were empathetic, nondiscriminatory, and where the doctors addressed all concerns. CONCLUSION This grounded theory study identifies multiple aspects of health care that intervention researchers, health care administrators, and providers may target to improve Black cancer patient experiences with care.
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Affiliation(s)
- Carol Y Ochoa
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Gabriela Toledo
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Aisa Iyawe-Parsons
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Stephanie Navarro
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Albert J Farias
- Department of Preventive Medicine, The Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles, CA
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25
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DiMartino LD, Kirschner J, Jackson GL, Mollica MA, Lines LM. Are care experiences associated with survival among cancer patients? An analysis of the SEER-CAHPS data resource. Cancer Causes Control 2021; 32:977-987. [PMID: 34046807 DOI: 10.1007/s10552-021-01451-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer patients' care experiences encompass the range of interactions with the health care system and are an important indicator of care quality, which may influence survival outcomes. This study evaluates relationships between care experiences and survival using a large, nationally representative sample of cancer patients. METHODS We used linked SEER (Surveillance Epidemiology and End Results)-CAHPS (Consumer Assessment of Healthcare Providers and Systems) data to identify people diagnosed 8/2006-12/2013, focusing on 10 solid tumor cancer sites with the highest mortality rates among those > 65. CAHPS measures included 5 global ratings and 3 composite scores. We used survey-weighted Cox proportional hazard models comparing survival time for those who had lower (0-8) vs higher ratings (9-10) and lower (0-89) vs higher (90-100) composite scores, adjusting for case-mix and additional covariates. RESULTS We identified 2,263 eligible people; 26% died by 5-year post-survey completion or end of follow-up (12/31/2017). We found lower Prescription Drug Plan (PDP) ratings were significantly associated with lower mortality (adjusted HR = 0.67, p = 0.03). Lower Getting Needed Care scores were also significantly associated with lower mortality (adjusted HR = 0.79, p = 0.04). For other care experience measures, general health status, cancer stage, and comorbidities were more predictive of survival (p < .05). CONCLUSIONS Except for PDP and Getting Needed Care, survival was similar for those with worse versus better care experiences. Patients with poorer cancer prognoses may perceive better services from their drug plan and more responsive care from clinical providers compared to those with better prognoses. Further research is needed examining processes underlying perceptions of care experiences and survival.
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Affiliation(s)
| | | | - George L Jackson
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Duke University, Durham, NC, USA
| | | | - Lisa M Lines
- RTI International, Research Triangle Park, NC, USA
- University of Massachusetts Medical School, Worcester, MA, USA
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26
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Snyder RA, Wardrop R, McLain AC, Parikh AA, Cass AL. Association of Patient Experience With Guideline-Concordant Colon Cancer Treatment in the Elderly. JCO Oncol Pract 2021; 17:e753-e763. [PMID: 33566681 DOI: 10.1200/op.20.00626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The association between patient-reported experience of care and care quality is not well described. The purpose of this study was to assess the relationship between the patient-reported experience and receipt of guideline-concordant colon cancer (CC) treatment. METHODS Medicare beneficiaries with resected stage I-III CC (2003-2013) were identified in the linked SEER Consumer Assessment of Healthcare Providers and Systems data set. Patient-reported scores were compared by receipt of guideline concordant care (GCC) (resection of ≥ 12 lymph nodes [stage I-III] and adjuvant chemotherapy [stage III]). Linear mixed-effects regression was performed to compare adjusted mean patient experience scores by GCC. RESULTS Of the 1,010 identified patients, 58.4% of stage I (n = 192/329) and 73.4% of stage II (n = 298/406) patients underwent resection of ≥ 12 LN. Among stage III patients, 76.0% (n = 209/275) underwent resection of ≥ 12 lymph node and 52.4% (n = 144/275) received adjuvant chemotherapy. By multivariable analysis, patient-reported scores of healthcare quality, physicians, physician communication, getting needed care, and getting care quickly were similar among patients who received GCC compared with those who did not. However, mean scores of overall healthcare quality (91.3 v 82.4, P = .0004) and getting needed care (92.8 v 86.8, P = .047) were higher among stage III patients who received GCC compared with those who did not. CONCLUSION Patient-reported scores of healthcare quality and ability to get needed care are associated with GCC among elderly patients with stage III CC. Further investigation is needed to determine whether patient-reported experience correlates with other clinical measures of quality of CC care.
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Affiliation(s)
- Rebecca A Snyder
- Department of Surgery, University of South Carolina School of Medicine - Greenville/Prisma Health, Greenville, SC.,Now with the Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC.,Now with the Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Rebecca Wardrop
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Alexander A Parikh
- Department of Surgery, University of South Carolina School of Medicine - Greenville/Prisma Health, Greenville, SC.,Now with the Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Anna L Cass
- Department of Health Sciences, Furman University, Greenville, SC
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27
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The association between patient experience and healthcare outcomes using SEER-CAHPS patient experience and outcomes among cancer survivors. J Geriatr Oncol 2020; 12:623-631. [PMID: 33277226 DOI: 10.1016/j.jgo.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To understand the relationship between patient experience, as measured by scores on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, and clinical and financial outcomes among older cancer survivors. MATERIALS AND METHODS We analyzed the records of all Fee-for-Service (FFS) Medicare beneficiaries 66 years and older who completed one CAHPS survey from 2001 to 2004 or 2007-2013 with one of the five following cancer types: breast, bladder, colorectal, lung, or prostate; and completed a CAHPS survey within 5 years of cancer diagnosis date. We conducted a multivariate analysis, controlling for clinical and demographic variables, to evaluate the association between excellent CAHPS scores and the following clinical and financial outcomes: mortality, emergency department visits, and total healthcare expenditures. RESULTS A total of 7395 individuals were present in our cohort, with 57% being male and 85.7% non-Hispanic White. Breakdown of the cohort by cancer site is as follows: prostate (40.4%), breast (28.6%), colorectal (14.0%), lung (9.4%), and bladder (7.6%). When looking at the relationship between CAHPS scores and clinical outcomes, there was no significant difference between excellent and non-excellent CAHPS score respondents in all three of the clinical outcomes studied. Furthermore, there was no association between ED utilization and patient experience scores when stratifying by cancer site and race/ethnicity among this cohort. CONCLUSION In this cohort, a highly rated patient experience, as measured by responses on the CAHPS survey, is not associated with improved clinical outcomes among older cancer survivors.
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28
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Halpern MT, Cohen J, Lines LM, Mollica MA, Kent EE. Associations between shared care and patient experiences among older cancer survivors. J Cancer Surviv 2020; 15:333-343. [PMID: 32948992 DOI: 10.1007/s11764-020-00934-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Cancer survivors have unique medical care needs. "Shared care," delivered by both oncologists and primary care providers (PCPs), may better address these needs. Little information is available on differences in outcomes among survivors receiving shared care versus oncologist-led or PCP-led care. This study compared experiences of care for survivors receiving shared care, oncologist-led, PCP-led, or other care patterns. METHODS We used SEER-CAHPS data, including NCI's SEER registry data, Medicare claims, and Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses. Medicare Fee-for-Service beneficiaries age ≥ 65 years in SEER-CAHPS with breast, cervical, colorectal, lung, renal, or prostate cancers or hematologic malignancies who responded to a Medicare CAHPS survey ≥ 18 months post-diagnosis were included. CAHPS measures included ratings of overall care, personal doctor, specialist physician, health plan, prescription drug plan, and five composite scores. Survivorship care patterns were identified using proportions of oncologist, PCP, and other physician encounters. Multivariable regressions examined associations between care patterns and CAHPS outcomes. RESULTS Among 10,132 survivors, 15% received shared care, 10% oncologist-led, 33% PCP-led, and 42% other. Compared with shared care, we found no significant differences in experiences of care except for getting needed drugs (lower scores for PCP-led and other care patterns). Sensitivity analyses using different patterns of care definitions similarly showed no associations between survivorship care pattern and experience of care. CONCLUSIONS Within the limitations of the study dataset, survivors age 65+ receiving shared care reported similar experiences of care to those receiving oncologist-led, PCP-led, and other patterns of care. IMPLICATIONS FOR CANCER SURVIVORS Shared care may not provide survivor-perceived benefits compared with other care patterns.
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Affiliation(s)
- Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, 20850, USA.
| | - Julia Cohen
- RTI International, Research Triangle Park, Durham, NC, 27709, USA
| | - Lisa M Lines
- RTI International, Research Triangle Park, Durham, NC, 27709, USA.,University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Michelle A Mollica
- Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, 20850, USA
| | - Erin E Kent
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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29
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Mahal AR, Cramer LD, Wang EH, Wang S, Davidoff AJ, Gross CP, Yu JB. Did quality of life for older cancer survivors improve with the turn of the century in the United States? J Geriatr Oncol 2020; 12:102-105. [PMID: 32535014 DOI: 10.1016/j.jgo.2020.05.010] [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: 12/09/2019] [Revised: 01/28/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Although survival after a cancer diagnosis has improved considerably over the past 20 years, little is known about trends in health-related quality-of-life (HRQOL) for older prostate, breast, and lung cancer survivors. METHODS Using a population-based registry with longitudinal patient reported outcomes (the National Cancer Institute Surveillance, Epidemiology and End Results database linked to Medicare Health Outcomes Survey), we analyzed Medicare Advantage patients diagnosed with cancer during 1998-2011, who completed surveys regarding HRQOL through 2013. 'Early Era' patients were treated during 1998-2003; 'Late Era' patients were treated during 2006-2011. After propensity score matching, post-diagnosis changes in health utility (HU), Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were calculated and compared between the two eras. RESULT We identified 208 older patients with prostate, 276 with breast and 76 with lung cancer who were treated in the 'Early Era' and matched to equal numbers in the 'Late Era'. Mean age of patients in early and late era was 72 and 73 years, respectively. The mean post-diagnosis decline in health utility for patients treated in the 'Late Era' was not significantly different from the 'Early Era' for any cancer (Prostate [early vs. late]: -0.06 vs. -0.03, p = .09; Breast: -0.03 vs. -0.04, p = .65; Lung: -0.07 vs. -0.07, p = .95); nor for Physical Component Summary or Mental Component Summary scores. CONCLUSION Older patients treated for prostate, breast or lung cancer in the later era reported similar outcomes of changes in HRQOL compared to earlier era patients.
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Affiliation(s)
| | - Laura D Cramer
- Yale School of Medicine, 333 Cedar St, New Haven, CT, USA; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, 333 Cedar St, New Haven, CT, USA
| | - Elyn H Wang
- Stanford Department of Radiation Oncology, 875 Blake Wilbur Drive, Stanford, CA, USA
| | - Shiyi Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, 333 Cedar St, New Haven, CT, USA; Yale School of Public Health, 60 College Street, New Haven, CT, USA; Yale Cancer Center, 333 Cedar St, New Haven, CT, USA
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, 333 Cedar St, New Haven, CT, USA; Yale School of Public Health, 60 College Street, New Haven, CT, USA; Yale Cancer Center, 333 Cedar St, New Haven, CT, USA
| | - Cary P Gross
- Yale School of Medicine, 333 Cedar St, New Haven, CT, USA; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, 333 Cedar St, New Haven, CT, USA; Yale Cancer Center, 333 Cedar St, New Haven, CT, USA
| | - James B Yu
- Yale School of Medicine, 333 Cedar St, New Haven, CT, USA; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, 333 Cedar St, New Haven, CT, USA; Yale Cancer Center, 333 Cedar St, New Haven, CT, USA; Department of Therapeutic Radiology at Yale School of Medicine, PO Box 208040, New Haven, CT, USA.
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30
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Geriatric oncology health services research: Cancer and Aging Research Group infrastructure core. J Geriatr Oncol 2019; 11:350-354. [PMID: 31326392 DOI: 10.1016/j.jgo.2019.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023]
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Langford A, Loeb S. Perceived Patient-Provider Communication Quality and Sociodemographic Factors Associated With Watching Health-Related Videos on YouTube: A Cross-Sectional Analysis. J Med Internet Res 2019; 21:e13512. [PMID: 31102372 PMCID: PMC6543799 DOI: 10.2196/13512] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/22/2019] [Accepted: 04/26/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Approximately 73% of US adults use YouTube, making it the most popular social media platform. Misinformation on social media is a growing concern; recent studies show a high proportion of misinformative health-related videos. Several studies on patient-provider communication and general health information seeking have been conducted. However, few studies to date have examined the potential association between patient-provider communication and health information seeking on specific social media platforms such as YouTube. A better understanding of this relationship may inform future health communication interventions. OBJECTIVE The aim was to use nationally representative cross-sectional data to describe the association between perceived patient-provider communication quality and sociodemographic factors on watching YouTube health-related videos. METHODS Data from the 2018 Health Information National Trends Survey were analyzed (N=3504). The primary outcome was whether participants watched a health-related video on YouTube over the past 12 months. A patient-provider communication composite score was created by summing responses about how often providers did the following: (1) gave you the chance to ask all the health-related questions you had, (2) gave attention to your feelings, (3) involved you in health care decisions as much as you wanted, (4) made sure that you understood the things you needed to do to take care of your health, (5) explained things in a way that you could understand, (6) spent enough time with you, and (7) helped you deal with feelings of uncertainty. Sociodemographic factors included age, gender, race/ethnicity, and education. Descriptive statistics and multivariable logistic regression were conducted. RESULTS Approximately 1067 (35% weighted prevalence) participants reported watching a health-related video on YouTube. Higher perceived quality of patient-provider communication on the composite score was significantly associated with lower odds of watching health-related videos on YouTube. Regarding sociodemographic factors, increasing age and being a high school graduate (compared with college graduate) were associated with lower odds of watching health-related videos on YouTube; whereas, Hispanic and non-Hispanic Asians were more likely to have watched a health-related video on YouTube. For individual aspects of patient-physician communication, two of seven patient-provider communication variables were significant. Those who reported that providers "sometimes" spent enough time with them had higher odds of watching a health-related video on YouTube, compared with those who said providers "always" spent enough time with them. Participants reporting that they "never" have a chance to ask all their health-related questions also had higher odds of watching health-related videos on YouTube compared with those who reported "always." CONCLUSIONS Higher perceived quality of patient-provider communication is associated with lower odds of watching health-related videos on YouTube. When providers do not spend enough time or give an opportunity to ask questions, patients are more likely to pursue health information on social media.
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Affiliation(s)
- Aisha Langford
- Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Stacy Loeb
- Department of Urology and Population Health, NYU Langone Health, New York, NY, United States
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32
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Arrieta H, Astrugue C, Regueme S, Durrieu J, Maillard A, Rieger A, Terrebonne E, Laurent C, Maget B, Servent V, Lavau-Denès S, Dauba J, Fonck M, Thiébaut R, Bourdel-Marchasson I. Effects of a physical activity programme to prevent physical performance decline in onco-geriatric patients: a randomized multicentre trial. J Cachexia Sarcopenia Muscle 2019; 10:287-297. [PMID: 30829460 PMCID: PMC6463460 DOI: 10.1002/jcsm.12382] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/20/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Older adults with cancer experience negative long-term functional effects of both cancer and treatments. Exercise may minimize their age-related and cancer-related functional decline. METHODS We conducted a multicentre open-label 12 month randomized clinical trial with two parallel arms including participants aged ≥70 years with lymphoma or carcinoma requiring curative treatment. The study started at the beginning of any phase of cancer treatment (surgery, chemotherapy, or radiotherapy). The usual care group (UCG) received the current national recommendations in physical activity (a guideline without specific counselling). The intervention group (IG) received 1 year phoned physical activity advice individually adapted to physical assessment (twice a month during the first 6 months and then monthly). The primary outcome was the proportion of subjects with a 1 year decreased short physical performance battery (SPPB) score of 1 point or more. Physical, cognitive, and clinical secondary outcomes were also investigated. RESULTS We allocated 301 participants (age 76.7 ± 5.0, female 60.6%) to each group. At baseline, the median SPPB was 10/12 in both groups. Breast was the most frequent tumour site (35.7%). After 1 year, 14.0% of participants in the UCG and 18.7% in the IG had a decrease in SPPB score of 1 point or more (P = 0.772). At 2 years, there was no difference in SPPB, gait speed, International Physical Activity Questionnaire score, and verbal fluency. Subgroup analyses after 2 years showed a decline in SPPB for 29.8% of UCG and 5.0% of IG breast cancer participants (P = 0.006), in 21.7% of UCG and 6.2% of IG female participants (P = 0.019), and in 24.5% of UCG and 11.1% of IG normal nutritional status participants (P = 0.009). Falls, hospitalization, institutionalization, and death rates were similar in both groups. CONCLUSIONS Personalized phoned physical activity advice had not reduced functional decline at 1 year but provided preliminary evidence that may prevent physical performance decline at 2 years in older adults with breast cancer.
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Affiliation(s)
- Haritz Arrieta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain.,CNRS, RMSB, UMR 5536, Bordeaux, France.,University of Bordeaux, RMSB, UMR 5536, Bordeaux, France
| | - Cyril Astrugue
- Pole de Santé Publique, Service d'Information Médicale, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, CHU de Bordeaux, Bordeaux, France
| | - Sophie Regueme
- Pôle de gérontologie clinique, CHU de Bordeaux, Bordeaux, France
| | - Jessica Durrieu
- Pôle de gérontologie clinique, CHU de Bordeaux, Bordeaux, France
| | - Aline Maillard
- Pole de Santé Publique, Service d'Information Médicale, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, CHU de Bordeaux, Bordeaux, France
| | - Alban Rieger
- Pôle de gérontologie clinique, CHU de Bordeaux, Bordeaux, France
| | - Eric Terrebonne
- Pôle appareil digestif, endocrinologie et nutrition, CHU de Bordeaux, Bordeaux, France
| | - Christophe Laurent
- Pôle appareil digestif, endocrinologie et nutrition, CHU de Bordeaux, Bordeaux, France
| | | | | | | | | | | | - Rodolphe Thiébaut
- Pole de Santé Publique, Service d'Information Médicale, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, CHU de Bordeaux, Bordeaux, France
| | - Isabelle Bourdel-Marchasson
- CNRS, RMSB, UMR 5536, Bordeaux, France.,University of Bordeaux, RMSB, UMR 5536, Bordeaux, France.,Pôle de gérontologie clinique, CHU de Bordeaux, Bordeaux, France
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