Medical Oncology Care Plan: a tool for improving the provision of clinical information to patients

Patient experiences and needs in cancer care- results from a nationwide cross-sectional study in Germany

BACKGROUND

Patient-centredness has become a central quality indicator for oncology care. Elements include shared decision-making, patient navigation and integration of psychosocial care, which impact patient-reported and clinical outcomes. Despite efforts to promote patient-centred care in Germany in recent decades, implementation remains fragmented. Further, research on patient experiences with cancer care and its determinants is limited. Therefore, this study examines which patient- and facility-specific factors are associated with patient-centred quality care delivery.

METHODS

A cross-sectional study was conducted among 1,121 cancer patients in acute treatment, rehabilitation, and aftercare for different cancer entities across Germany. A participatory developed questionnaire was used. Outcome measures were the quality of physician-patient interaction and provision of psychosocial care during acute care. Predictors comprised patient-specific characteristics and treatment facility-specific factors. Multiple linear regression and multivariate binary logistic regression analyses were performed. In addition, a content analysis of open-ended comments on the patients' overall cancer care needs was applied.

RESULTS

Multiple linear regression analysis showed recent diagnosis (β=-0.12, p = < 0.001), being male (β=-0.11, p = 0.003), and having a preference for passive decision-making (β=-0.10, p = 0.001) to be significantly associated with higher interaction quality, but not age, education and health insurance type. An overall low impact of patient characteristics on interaction quality was revealed (adj. R2 = 0.03). Binary logistic regression analysis demonstrated the availability of central contact persons (OR = 3.10, p < 0.001) followed by recent diagnosis (p < 0.001), having breast cancer (p < 0.001) and being female (OR = 1.68, p < 0.05) to significantly predict offering psycho-oncological counselling to patients in acute care facilities. The availability of peer support visiting services (OR = 7.17, p < 0.001) and central contact persons (OR = 1.87, p < 0.001) in the care facility, breast cancer diagnosis (p < 0.001) and a higher level of education (p < 0.05) significantly increased the odds of patients receiving information about peer support in the treatment facility. Despite relatively satisfactory quality of physician-patient interactions in cancer care (M = 3.5 (± 1.1)), many patients expressed that better patient-centred communication and coordinated, comprehensive cancer care are needed.

CONCLUSION

The findings reflect effective developments and improvements in cancer care and suggest that patients' social characteristics are less decisive for delivering patient-centred quality care than systemic factors surrounding the care facilities. They can serve to inform oncology care in Germany.

Accessibility of care plan information from previous treatment setting in palliative care unit: A qualitative study

AIM

To describe accessibility of care plan information from patients' previous treatment setting in palliative care.

DESIGN

A qualitative descriptive study.

METHODS

A total of 33 nurses, social workers and physicians were interviewed. Data were analysed by deductive and inductive content analysis. The Fit between Individuals, Task and Technology (FITT) framework was used as a deductive analysis framework.

RESULTS

Individual-task Fit was described in relation to professional-specific care plan information in palliative care and use of time to obtain care plan information. Individual-technology Fit was described in relation to health informatics competencies and HIS usability. Task-technology Fit was described in relation to interoperability between care settings and healthcare providers and lack of interoperability between care settings and healthcare providers.

RELEVANCE TO CLINICAL PRACTICE

The study confirms the need to review the HIS as a whole from a holistic and patient-oriented perspective to ensure the continuity of palliative care.