scholarly journals Toward Patient-Centered Cancer Care: Patient Perceptions of Problematic Events, Impact, and Response

2012 ◽  
Vol 30 (15) ◽  
pp. 1784-1790 ◽  
Author(s):  
Kathleen M. Mazor ◽  
Douglas W. Roblin ◽  
Sarah M. Greene ◽  
Celeste A. Lemay ◽  
Cassandra L. Firneno ◽  
...  

Purpose Cancer treatments are complex, involving multiple clinicians, toxic therapies, and uncertain outcomes. Consequently, patients are vulnerable when breakdowns in care occur. This study explored cancer patients' perceptions of preventable, harmful events; the impact of these events; and interactions with clinicians after such events. Patients and Methods In-depth telephone interviews were conducted with cancer patients from three clinical sites. Patients were eligible if they believed: something “went wrong” during their cancer care; the event could have been prevented; and the event caused, or could have caused, significant harm. Interviews focused on patients' perceptions of the event, its impact, and clinicians' responses to the event. Results Ninety-three of 416 patients queried believed something had gone wrong in their care that was preventable and caused or could have caused harm. Seventy-eight patients completed interviews. Of those interviewed, 28% described a problem with medical care, such as a delay in diagnosis or treatment; 47% described a communication problem, including problems with information exchange or manner; and 24% described problems with both medical care and communication. Perceived harms included physical and emotional harm, disruption of life, effect on family members, damaged physician-patient relationship, and financial expense. Few clinicians initiated discussion of the problematic events. Most patients did not formally report their concerns. Conclusion Cancer patients who believe they experienced a preventable, harmful event during their cancer diagnosis or care often do not formally report their concerns. Systems are needed to encourage patients to report such events and to help physicians and health care systems respond effectively.

2015 ◽  
Vol 22 (3) ◽  
pp. 305-310
Author(s):  
Elena-Daniela Grigorescu ◽  
Cristina Mihaela Lăcătuşu ◽  
Gina Eosefina Botnariu ◽  
Raluca Maria Popescu ◽  
Alina Delia Popa ◽  
...  

Abstract The physician-patient communication has an essential role in establishing and supporting the relationship between these two partners. Moreover, modern medicine highlights the patient-centered approach. Publications assessing the impact of an efficient physicianpatient communication on medical care results in diseases such as diabetes and hypertension have revealed a positive correlation between patient’s satisfaction about the communication with the physician and values of blood pressure, glycated hemoglobin and pain intensity. Interventions needed in both doctors and patients for developing communication abilities were paid special attention in order to achieve an appropriate improvement in their communicative interaction during periodical appointments. In the field of diabetes mellitus, the medical challenge is to improve patients’ knowledge about medical care; this aim is achieved only by therapeutic education, using high-quality communication techniques.


2002 ◽  
Vol 20 (4) ◽  
pp. 1008-1016 ◽  
Author(s):  
Wenchi Liang ◽  
Caroline B. Burnett ◽  
Julia H. Rowland ◽  
Neal J. Meropol ◽  
Lynne Eggert ◽  
...  

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.


2020 ◽  
Vol 29 (11) ◽  
pp. 1723-1733
Author(s):  
Kerri‐Anne R. Mitchell ◽  
Kelly J. Brassil ◽  
Serena A. Rodriguez ◽  
Edward Tsai ◽  
Kayo Fujimoto ◽  
...  

Author(s):  
Fay J. Hlubocky ◽  
Anthony L. Back ◽  
Tait D. Shanafelt

Despite their benevolent care of others, today, more than ever, the cancer care professional who experiences overwhelming feelings of exhaustion, cynicism, and inefficacy is in grave jeopardy of developing burnout. Clinicians are repeatedly physically and emotionally exposed to exceedingly long hours in direct care with seriously ill patients/families, limited autonomy over daily responsibilities, endless electronic documentation, and a shifting medical landscape. The physical and emotional well-being of the cancer care clinician is critical to the impact on quality care, patient satisfaction, and overall success of their organizations. The prevention of burnout as well as targeting established burnout need to be proactively addressed at the individual level and organizational level. In fact, confronting burnout and promoting wellness are the shared responsibility of both oncology clinicians and their organizations. From an individual perspective, oncology clinicians must be empowered to play a crucial role in enhancing their own wellness by identification of burnout symptoms in both themselves and their colleagues, learning resilience strategies (e.g., mindful self-compassion), and cultivating positive relationships with fellow clinician colleagues. At the organizational level, leadership must recognize the importance of oncology clinician well-being; engage leaders and physicians in collaborative action planning, improve overall practice environment, and provide institutional wellness resources to physicians. These effective individual and organizational interventions are crucial for the prevention and improvement of overall clinician wellness and must be widely and systematically integrated into oncology care.


2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 166-166
Author(s):  
Catherine R. Fedorenko ◽  
Laura Elizabeth Panattoni ◽  
Qin Sun ◽  
Li Li ◽  
Karma L. Kreizenbeck ◽  
...  

166 Background: Rural residents are diagnosed at later stages of cancer compared to urban residents, have poorer survival, and face distinct barriers to receiving quality cancer care. ASCO has developed policy initiatives to address rural cancer care; however, little is known about quality of cancer care among patients residing in rural areas. This study examined the impact of rurality on performance metrics, controlling for socioeconomic status and insurance type. Methods: We linked Washington state cancer registry records from 2015-2017 with claims records for two large commercial insurers, Medicare, and Medicaid. Using claims from this database, we generated eight nationally recognized quality measures. Rurality was measured by the Rural-Urban Commuting Area Codes (RUCAs) categorized into 4 levels (Metro, Metro with commute, Micropolitan, Small Town/Rural). Process and outcome measures were adjusted for age, sex, race, comorbidity score, stage, cancer type, marital status, the Area Deprivation Index, and treatment factors where appropriate. Results were stratified by payer type. Results: The table below lists the effect of a patient’s rurality on the quality metric where significant (p<0.05). Where rurality did not impact the performance measure, results are left blank. Conclusions: After controlling for socioeconomic status and payer type, quality of cancer care for rural cancer patients was not consistently poorer compared to urban patients. These results suggest that lower survival among rural patients may be due to factors beyond quality of care.[Table: see text]


2021 ◽  
pp. 2-2
Author(s):  
Mariia Pavlushenko ◽  
Roman Liubota ◽  
Roman Vereshchako ◽  
Nikolay Anikusko ◽  
Irina Liubota

The biggest challenge for the World Health Organization today is the fight against the COVID-19 pandemic. The current situation prompted major adjustments in the system of cancer care. In this review, we investigate the aspects of cancer treatment and care during the pandemic, since in this setting oncological services face challenges in determining the feasibility of anticancer treatments while minimizing the risk of infection. Cancer patients are at a higher risk from COVID-19 disease. Therefore, oncological community is discussing on the priorities for providing cancer therapies and care and at the same time minimizing the risk of infection.


Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 6011-6011
Author(s):  
Leslie J Padrnos ◽  
Qing Wu ◽  
Robyn M Scherber ◽  
Donald W. Northfelt ◽  
Joseph R. Mikhael ◽  
...  

Abstract Background: Patients diagnosed with cancer experience a significant influx of health care information while continuing to demonstrate understanding deficit regarding their disease and health. This knowledge deficit can negatively impact a patient’s acute and long term health care experience. By identifying patient information deficits and needs, health care providers may be better able to provide targeted education to patients and families. Aims: The aim of this study is to evaluate the impact of a patient centered cancer symposium on knowledge level, reported symptom burden, and desired information from a broad population of cancer patients. Methods: Surveys were distributed to the attendees of the third annual Mayo Clinic “Living with Cancer” patient symposium in January 2014. While 700 individuals registered for the event, only individuals with a past or present cancer diagnosis were asked to participate. Surveys included demographic data in addition to a questionnaire evaluating disease comprehension, symptom burden, desired information and desired role in the health care decision making process. Results: 75 patients completed the pre-intervention and post-intervention survey. There were slightly more female participants (60.2%). Disease types included 40% hematologic malignancies, 27% breast cancer, 20% prostate cancer and 13% other. The majority of patients were greater than 3 years from cancer diagnosis (62%). Baseline Patient Understanding: Most respondents reported understanding their disease quite a bit (54%) or very much (30%). Respondents reported the majority of their knowledge regarding their disease came from their oncologist (56%), oncology nurse (24%), previous symposiums (22%), or the internet (15%). Most respondents reported “quite a bit” or greater comprehension of screening tests (75%), monitoring disease response to treatment (70%), monitoring disease recurrence (70%), treatment options (67%) and treatment side effects (73%). There was no consensus among participants regarding understanding or limiting risk factors, symptoms associated with disease relapse, fatigue and pain management, navigating the health care system, financial considerations, or confidence in their primary care physician’s involvement in their cancer or post-cancer care. A large proportion of attendees reported “quite a bit” or greater desire for increased information/understanding regarding their disease (83%), risk factors (83%), nutrition (80%), screening tests (69%), and management of fatigue (69%) and stress (68%). Knowledge Improvement Durable at 3 months: There was improvement in 18 of 20 areas of self-reported knowledge. This was noted in increased percentage of respondents reporting “quite a bit” or greater comprehension, especially in areas of disease risk factors(55%pre vs 63%post), disease side effects(55%pre vs 63%post), and health care navigation(53%pre vs 69%post). The reported desire for “quite a bit” or more increased understanding on various topics did decrease post symposium regarding their disease(87.9% pre vs 68.9%post), disease risk factors(86.3%pre vs 64.0%post), screening tests(74.7%pre vs 63.3%post), and nutrition(78.4%pre vs 64.9%post)(all p<0.05). There was no significant decrease in the desire for increased understanding managing stress and fatigue. Summary: Demonstrated in this study, individuals choosing to attend a patient-centered cancer symposium, seek to improve an already solid knowledge base. Study participants indicate a significant desire for increased information on all topics, even those with sufficient level of knowledge reported. This indicates that some cancer patients’ thirst for knowledge is difficult to quench, and may benefit from recurrent education opportunities. The improvement in almost all topics assessed indicates a patient centered symposium is an effective method to provide information to patients regarding the spectrum of cancer health management. Disclosures No relevant conflicts of interest to declare.


2019 ◽  
Vol 23 (1) ◽  
pp. 104-114 ◽  
Author(s):  
R. A. Khalfin ◽  
V. V. Madyanova ◽  
O. E. Kachkova ◽  
I. D. Demina ◽  
T. I. Krishtaleva ◽  
...  

Purpose of the study. To analyze the concept of creating patient-oriented medicine, the prerequisites for its emergence, the difficulties of introducing it into existing health systems based on foreign experience. Materials and methods. The main materials of the study were used sources of foreign literature, which presents the concept of patient-oriented medicine, analyzed the prerequisites for changing models of health care in the European Union, USA and Asia in accordance with the principles of patient-oriented medicine, as well as data on the components and levels of patient-oriented medicine in foreign countries Results. The analyzed literature quite fully describes the difficulties of introducing patient-oriented medicine into existing health care systems. Particular attention should be paid to a multidisciplinary approach, continuity at different levels of medical care and effective communication between the physician and the patient towards the integration of this model into clinical practice. The analysis of the availability of medical care in developed countries and its dependence on social status, ethnicity and disease of the patient. Conclusion. Patient-oriented medicine is a new model for planning, implementing and evaluating medical services, which is based on mutually beneficial partnerships between medical workers, patients and their families. Taking into account the current problems of domestic health care, the introduction of the patient-oriented model will significantly improve the quality of medical care provided to the population of our country. Globally, the implementation of the principles of this model is far from complete. In the Russian Federation, targeted work in this direction requires additional scientific research, systematization of available data, and development of new legal documents


2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 130-130
Author(s):  
Mary Anne Fenton

130 Background: Patient navigator programs (PNP) aid in evaluation and treatment of cancer in underserved populations. Along a patient’s journey obstacles to medical care can include cultural, financial, language, physical and transportation barriers, fear and anxiety, comprehension and retention of critical information and coordination of visits. PNP research has focused on addressing ethnic and racial barriers, with scant attention paid to the impact of PNP in the disabled. The Americans with Disabilities Amendments Act of 2008 defines as a “physical or mental impairment that substantially impairs one or more of major life activities." Methods: A retrospective analysis was performed of patients with stage I-III breast cancer under age 70 with disabilities enrolled in the PNP at Rhode Island Hospital or the Miriam Hospital (RIH/MH) from 2006-2012. Charts were reviewed and assessed for quality measures as defined by the National Comprehensive Cancer Center (NCCN) guidelines and American Society of Medical Oncology Quality Practice Initiative (QOPI) benchmarks, for demographics, stage at diagnosis, treatment recommended and received, and patient outcomes. Results: 44 patients were identified. All patients were recommended treatment in accordance with NCCN guidelines. Compliance with radiation and endocrine therapy guidelines was excellent. In the smaller cohort of patients for whom adjuvant chemotherapy was indicated, there was a higher rate of nonconcordance (25%) compared to 13% in the NCCN database. All nonconcordance was attributed to patient refusal (6) or delay due to comorbid conditions (3). Conclusions: Our analysis suggests PNP may enhance compliance with recommended treatment and thus quality care in breast cancer patients with disabilities. Integration of PNP in cancer care serves as a valuable adjunct in removing obstacles to cancer care for the disabled. [Table: see text]


Author(s):  
V.V. Chuksina ◽  
◽  
K.A. Mirvoda ◽  

The subject of this article is Law of the Russian Federation on Amendments to the Constitution of the Russian Federation (14.03.2020 No. 1-Federal Constitutional Law) «On improving the regulation of certain issues of the public power organization and functioning», namely, aspects of «coordination of health care» and «protection of the family, motherhood and childhood». The authors analyzed the issues of the medical care provision centralization, the impact of these amendments on the legal capacity of citizens. For a more in-depth analysis, the experience of foreign countries (Canada and Germany) was used. Despite the fact that the health care systems of the countries cited as an example differ in their essence and organization, nevertheless, they influence the formation of the availability of medicine for the population. As a result of the study of this experience, it was concluded that the delegation of freedom in the provision of medical care to lower levels of government allows to provide to the population affordable and high-quality medical care. It is noted that at present it is necessary to review the degree of participation of local governments in ensuring the availability of medical care in accordance with the federal law.


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