Breast cancer patients' perceived quality of care: The importance of trust and communication

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6554-6554
Author(s):  
R. Franco ◽  
K. P. Joseph ◽  
K. Fei ◽  
N. Bickell
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Quality Care ◽  
Perceived Quality ◽  
Care Quality ◽  
Physician Communication ◽  
Breast Cancer Patients ◽  
Perceived Quality Of Care ◽  
Excellent Care

6554 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients’ perceived quality of cancer care matter. We undertook this study to assess predictors of women's ratings of the quality of their breast cancer care. Methods: 210 of 300 eligible women with stage I or II breast cancer at 1 of 8 participating NYC hospitals were enrolled in our survey: 43 (20%) were African-American (AA), 85 (40%) were white, and 63 (30%) were Hispanic and 19 (9%) were other races. All patients were telephone-surveyed to assess care experiences, knowledge, attitudes & beliefs about breast cancer and its treatment. Trust is based on a validated instrument and calibrated to a 100 point scale (Cronbach α = 0.73). A scale of 5 items assessing physician communication was created and calibrated to100 points (Cronbach α = 0.83). Results: Only 55% of women rated their quality of cancer care as excellent. Compared to women who did not rate their care as excellent, those who did had greater trust in their physician (p < 0.0001), better communication with their physician (p < 0.0001), indicated that were treated well by their physicians’ office staff (p = 0.01), and knew which physician to ask when they had questions (p = 0.0001); age, education & income were not significantly related to patient report of excellent care. AA women were least likely to rate their care as excellent (p = 0.004). AA women had lower levels of trust in their physician (p = 0.02). Patients reporting greater levels of communication also had greater trust (r = 0.38; p < 0.0001). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to and how well the staff treated the patient found that being AA (aRR = 0.47; 95% CI: 0.21–0.88), having greater trust (aRR = 1.72; 95% CI:1.49–1.85) and better communication (aRR = 1.38; 95% CI: 1.03–1.65) were significantly associated with patient perception of excellent quality care (p < 0.0001). Conclusions: Greater levels of physician communication about treatment and patient trust of their physician affect women's ratings of excellent cancer care quality. Efforts should be made to improve physician communication about treatment, particularly among AA women, to improve levels of trust and ratings of cancer care quality. No significant financial relationships to disclose.

Breast cancer patients' quality of care: Does racial concordance matter or is it just a matter of trust?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6537-6537
Author(s):  
K. P. Joseph ◽  
R. Franco ◽  
K. Fei ◽  
N. Bickell
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Perceived Quality ◽  
Care Quality ◽  
Breast Cancer Patients ◽  
Office Staff ◽  
Racial Concordance

6537 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients' perceived quality of cancer care matter. Concordance by race in physician-patient relationships has been associated with patient satisfaction and use of health care, however how that is mediated is unclear. Methods: 210 of 300 eligible women stage I or II breast cancer at 1 of 8 participating NYC hospitals responded to our survey (70% response rate): 20% were African-American (AA), 40% were white, and 30% were Hispanic and 9% were other races. Trust is based on a validated scale and calibrated to a 100 point scale (Cronbach α = 0.76). Bivariate analyses and logistic models were used to identify factors associated with patient ratings of quality of care. Results: Only 55% of women rated the quality of their cancer care as excellent. AA women breast cancer patients were less likely to rate their care as excellent (p=0.004). Compared to women who didn't rate their care as excellent, those who rated it excellent had greater trust in their physician (p < 0.0001) and indicated that were treated well by their physicians' office staff (p = 0.01). Of note, AA patients had lower levels of trust (p = 0.004). Women who were of the same race as their physician did not perceive better quality of care as compared to those who were not racially concordant (p = 0.18); nor did they have higher trust in their physician (p = 0.59). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to, how well the staff treated the patient, and racial concordance with physician, found that trust in physician was significantly associated with patient perception of excellent quality care (aRR = 1.38; 95%CI: 1.03–1.65) and being AA was associated with worse perceived quality (aRR = 0.47; 95%CI: 0.21–0.88) (model c = 0.79; p < 0.0001). Conclusions: Racial concordance between physicians and patients does not directly affect patients' perceived quality of care. However, women's trust in their physician and their perceived treatment by office staff are associated with excellent cancer care quality ratings. Efforts should be made to increase effective intercultural communication particularly among AA women in order to improve ratings of cancer care quality. No significant financial relationships to disclose.

scholarly journals Quality of Breast Cancer Care: Perception Versus Practice

2012 ◽  
Vol 30 (15) ◽  
pp. 1791-1795 ◽  
Author(s):  
Nina A. Bickell ◽  
Jennifer Neuman ◽  
Kezhen Fei ◽  
Rebeca Franco ◽  
Kathie-Ann Joseph
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Cancer Care ◽  
Early Stage ◽  
Perceived Quality ◽  
Perceived Racism ◽  
Breast Cancer Care ◽  
Black Race ◽  
Perceived Quality Of Care

Purpose Because insurers use performance and quality metrics to inform reimbursement, identifying remediable causes of poor-quality cancer care is imperative. We undertook this descriptive cohort study to assess key predictors of women's perceived quality of their breast cancer care and actual guideline-concordant quality of care received. Patients and Methods We surveyed inner-city women with newly diagnosed and surgically treated early-stage breast cancer requiring adjuvant treatment who were enrolled onto a randomized controlled trial (RCT) of patient assistance to reduce disparities in care. We assessed women's perceived quality of care and perceived quality of the process of getting care, such as getting referrals, test results, and treatments; we abstracted records to determine the actual quality of care. Results Of the 374 new patients with early-stage breast cancer enrolled onto the RCT, only a slight majority of women (55%) perceived their quality of care as excellent; 88% actually received good-quality, guideline-concordant care. Excellent perceived quality (P < .001) was significantly associated with patients' perception of the quality of the process of getting care (adjusted relative risk [RR], 1.78; 95% CI, 1.65 to 1.87). Also associated with perceived quality—and mediated by race—were trust in one's physician (adjusted RR, 1.43; 95% CI, 1.16 to 1.64) and perceived racism, which affected black women more than women of other races/ethnicities (black race–adjusted RR for perceived racism, 0.33 [95% CI, 0.10 to 0.87]; black race–adjusted RR for trust, 1.61 [95% CI, 0.97 to 1.90]; c = 0.82 for the model; P < .001). Actual quality of care provided did not affect perceived quality of care received. Conclusion Patients' perceived quality of care differs from their receipt of high-quality care. Mutable targets to improve perceived quality of care include the processes of getting care and trusting their physician.

Communication Between Physicians and Older Women With Localized Breast Cancer: Implications for Treatment and Patient Satisfaction

2002 ◽  
Vol 20 (4) ◽  
pp. 1008-1016 ◽  
Author(s):  
Wenchi Liang ◽  
Caroline B. Burnett ◽  
Julia H. Rowland ◽  
Neal J. Meropol ◽  
Lynne Eggert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Care ◽  
Treatment Options ◽  
Treatment Choice ◽  
Satisfaction With Care ◽  
Physician Communication ◽  
Breast Cancer Patients ◽  
Actual Treatment ◽  
The Impact

PURPOSE: To identify factors associated with patient-physician communication and to examine the impact of communication on patients’ perception of having a treatment choice, actual treatment received, and satisfaction with care among older breast cancer patients. MATERIALS AND METHODS: Data were collected from 613 pairs of surgeons and their older (≥ 67 years) patients diagnosed with localized breast cancer. Measures of patients’ self-reported communication included physician- and patient-initiated communication and the number of treatment options discussed. Logistic regression analyses were conducted to examine the relationships between communication and outcomes. RESULTS: Patients who reported that their surgeons mentioned more treatment options were 2.21 times (95% confidence interval [CI], 1.62 to 3.01) more likely to report being given a treatment choice, and 1.33 times (95% CI, 1.02 to 1.73) more likely to get breast-conserving surgery with radiation than other types of treatment. Surgeons who were trained in surgical oncology, or who treated a high volume of breast cancer patients (≥ 75% of practice), were more likely to initiate communication with patients (odds ratio [OR] = 1.62; 95% CI, 1.02 to 2.56; and OR = 1.68; 95% CI, 1.01 to 2.76, respectively). A high degree of physician-initiated communication, in turn, was associated with patients’ perception of having a treatment choice (OR = 2.46; 95% CI, 1.29 to 4.70), and satisfaction with breast cancer care (OR = 2.13; 95% CI, 1.17 to 3.85) in the 3 to 6 months after surgery. CONCLUSION: Greater patient-physician communication was associated with a sense of choice, actual treatment, and satisfaction with care. Technical information and caring components of communication impacted outcomes differently. Thus, the quality of cancer care for older breast cancer patients may be improved through interventions that improve communication within the physician-patient dyad.

Breast cancer: Global quality care

2019 ◽  
Keyword(s):  
Breast Cancer ◽  
Best Practices ◽  
Cancer Care ◽  
Care Pathway ◽  
Health Care Systems ◽  
Quality Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Global Quality ◽  
Care Systems

Caregivers delivering care to breast cancer patients wish to provide the highest quality breast care possible. Due to the complexity of the care pathway, this care should be delivered by a multidisciplinary team working in a breast cancer unit/centre. This book was written by experts from different disciplines and presents ideas for developing a breast unit wherever you live. The authors provide thorough descriptions of high-quality breast cancer care, define targets, methods to assess one’s care, and ideas on how to improve care within one’s resources. A global view of the quality of breast cancer care shows specific best practices applicable to many centres operating in various health care systems with different financial and political situations. Foundation hallmarks of innovation, communication, patient-centred care, multidisciplinary, and budget considerations guide specific recommendations for each component of care. This book discusses global and local considerations so that optimally ‘integrated’ breast cancer care can be organized. Each component of care (e.g. imaging, surgery, etc.) is discussed from both theoretical and practical aspects. The recommendation for each component of care is facilitated by experienced experts laying out rational and practical approaches to each step. This book provides guidance how to integrate the different disciplines into breast cancer care. Beyond treatment, it provides practical considerations regarding accreditation and certification, and it comments on the influence of budget and of treatment. Finally, it demonstrates how best practices may be altered by the emerging involvement of patients, technologies, and transitions of future societal values.

Quality of care for breast cancer patients in Japan: An analysis of the Japanese Breast Cancer Registry

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6547-6547
Author(s):  
H. Mukai ◽  
T. Higashi ◽  
T. Iwase ◽  
T. Sobue
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Registry ◽  
Cancer Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Recommended Care ◽  
Adherence Score ◽  
Breast Cancer Registry

6547 Background: In Japan, growing concern that patients do not receive optimum care led to the enactment of the Cancer Control Act in 2006, which mandates the government to undertake initiatives in ensuring the quality of cancer care. Here, we evaluated the current status of breast cancer care in Japan using process-of-care quality indicators (QIs) for breast cancer care. Methods: Combining clinical evidence and expert opinion, we developed 45 QIs covering the continuum of breast cancer care from initial evaluation to follow-up. Each QI describes standards of a particular aspect of care, and its score is calculated as the percentage of applicable patients who received the recommended care (adherence score). Of the 45 QIs, 7 could be scored using data in the Japanese Breast Cancer Registry, which covers about 40% of all Japanese breast cancer patients and has been continuously maintained since 1975. Results: The study population included 15,227 patients registered by 224 facilities in 2005. On average, patients received 72.1% of recommended care. However, substantial variation in adherence was seen across QIs (21–98%). Adherence score was less than 85% in five of seven QIs. Variation across facilities was observed in six QIs. Conclusions: The quality of breast cancer care in Japan has room for improvement in many aspects of care. Although the amount of data in the cancer registry suitable for quality assessment is limited, it is useful in detecting quality problems. [Table: see text] No significant financial relationships to disclose.

ASSESSMENT OF QUALITY OF LIFE IN BREAST CANCER PATIENTS - USING FACT-G, SF-36 AND QLQ-C30 QUESTIONNAIRES

2011 ◽  
pp. 98-105
Author(s):  
Nguyen Thai Bao Nguyen ◽  
Dinh Tung Nguyen ◽  
Vu Quoc Huy Nguyen
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Patients ◽  
Cancer Staging ◽  
Care Quality ◽  
Breast Cancer Patients ◽  
Cross Sectional ◽  
Sf 36 ◽  
Quality Of Life Index

Background: The assessment and improvement of Quality of life (QoL) of breast cancer and other diseases patients have been of great concern for a long time. This research is to assessing the QoL of breast cancer patients using the popular and recommended instruments, the FACT-G, SF-36 and QLQ-C30 (including QLQ-BR23). Methods and Materials: A cross-sectional descriptive study on breast cancer patients receiving surgical, chemotherapy and radiotherapy, using FACT-G, SF-36 and QLQ-C30 to evaluate their quality of life. The assessment is mainly based on the patients’ own feelings. Results: Average age: 48.4±13.1. Most patients in the sample are from stage IIA to stage IIIB (TNM Cancer Staging, by AJCC 2010). Quality of life index using FACT-G is 60.6±5.1, using SF-36 is 46.5±11.0 in physical health and 53.1±14.8 in mental health, using QLQ-C30 is 53.1±21.0. Conclusion: The QoL assessment by using these instruments shows results mostly in average on many aspects. The screening needs to be improved for better early-detection and treatment, especially in mental care. Quality of life of breast cancer patients reasearches should be paid more attention and widely expanded.

Patient Navigation and the Quality of Breast Cancer Care: An Analysis of the Breast Cancer Care Quality Indicators

2012 ◽  
Vol 19 (10) ◽  
pp. 3251-3256 ◽  
Author(s):  
Joseph J. Weber ◽  
Debra C. Mascarenhas ◽  
Lisa S. Bellin ◽  
Rachel E. Raab ◽  
Jan H. Wong
Keyword(s):  
Breast Cancer ◽  
Quality Indicators ◽  
Cancer Care ◽  
Patient Navigation ◽  
Care Quality ◽  
Breast Cancer Care

Quality of care outcomes among breast cancer patients treated with cancer care pathway regimens.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e18827-e18827
Author(s):  
Santosh Gautam ◽  
Michael Jordan Fisch ◽  
Gosia Sylwestrzak ◽  
Michael Eleff ◽  
David Joseph Debono ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Cancer Patients ◽  
Cancer Care ◽  
Care Pathway ◽  
Breast Cancer Patients ◽  
Care Outcomes

scholarly journals Breast Cancer Care Quality Indicators in Spain: A Systematic Review

2021 ◽  
Vol 18 (12) ◽  
pp. 6411
Author(s):  
Marta Maes-Carballo ◽  
Yolanda Gómez-Fandiño ◽  
Carlos Roberto Estrada-López ◽  
Ayla Reinoso-Hermida ◽  
Khalid Saeed Khan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Indicators ◽  
Cancer Care ◽  
Clinical Pathways ◽  
Primary Care Patient ◽  
Data Extraction ◽  
Quality Care ◽  
Care Patient ◽  
Care Quality ◽  
Breast Cancer Care

Breast cancer (BC) management care requires an increment in quality. An initiative to improve the BC quality care is registered, and quality indicators (QIs) are studied. We appraised the appearance of QIs and their standards systematically in Spain. A prospective systematic search (Prospero no: CRD42021228867) for clinical pathways and integrated breast cancer care processes was conducted through databases and the World Wide Web in February 2021. Duplicate data extraction was performed with 98% reviewer agreement. Seventy-four QIs (QI per document mean: 11; standard deviation: 10.59) were found in 15 documents. The Catalonian document had the highest number of QIs (n = 30). No QI appeared in all the documents. There were 9/74 QIs covering structure (12.16%), 53/74 covering process (71.62%), and 12/74 covering outcome (16.22%). A total of 22/66 (33.33%) process and outcome QIs did not set a minimum standard of care. QIs related to primary care, patient satisfaction, and shared decision making were deficient. Most of the documents established a BC QI standard for compliance, but the high variability hinders the comparison of outcomes. Establishing a consensus-based set of QIs needs urgent attention.

Examples of National Programmes on Quality Management

2019 ◽  
pp. 50-63
Author(s):  
Sabine Siesling ◽  
Jumana Mensah ◽  
Sara Y. Brucker ◽  
Simone Wesselmann ◽  
Marie-Jeanne Vrancken Peeters ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Multidisciplinary Treatment ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Optimal Care ◽  
Medical Specialties ◽  
National Programmes ◽  
Verification Process

Abstract: In several countries throughout the world, national accreditation programmes aim to standardize and improve the quality of care for breast cancer patients. All these national programmes stimulate the development of clinical practice guidelines, foster the implementation of these guidelines in multidisciplinary breast cancer units, and monitor aid implementation through guideline-derived quality indicators (QIs). This requires a well-defined set of quality requirements and indicators to which breast cancer centres adhere as well as a transparent auditing and data verification process. Breast cancer care should be delivered within the scope of a multidisciplinary treatment network and include all medical specialties and professions essential to providing optimal care. National programmes for quality assurance vary in their strategies for obtaining ideal quality of breast cancer care, and these range from auditing, certification, to accreditation. All hospitals should monitor their performance on a regular basis, and QI results as declared by the centres must be reliable and validated in the framework of on-site audits.

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