Oncology team perception and patient experience discordances in triple-negative breast cancer (TNBC) care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19176-e19176
Author(s):  
Sara A. Hurvitz ◽  
Rebecca R Crawford ◽  
Tamar Sapir ◽  
Jeffrey D. Carter
Keyword(s):  
Treatment Options ◽  
Primary Care Providers ◽  
Patient Centered Care ◽  
Influential Factors ◽  
Patient Treatment ◽  
Care Providers ◽  
Patient Centered ◽  
Actual Patient ◽  
Patient Reported ◽  
Centered Care

e19176 Background: In TNBC, ensuring patients understand their treatment options and engaging them in shared decision-making (SDM) is vital to patient centered care; however, system-, team-, and individual-level barriers may challenge optimal SDM. As part of a quality improvement, accredited initiative, we identified areas of discordance between oncology healthcare professionals (HCP) perception and actual patient reported experiences. Methods: From 02/2019 – 10/2019, we administered surveys to assess challenges, barriers, attitudes, and experiences of HCP who care for patients with TNBC (N = 77) and their patients with TNBC (N = 65) at 6 community oncology practices. Results: Despite indications of high levels of SDM – 86% of patients indicated that they are always or mostly involved with treatment decisions – survey responses highlight discordances. For example, when asked to identify the most influential factors to patient treatment choice, HCP most commonly indicated side effects (94%), while patients most commonly indicated quality of life (48%). Additionally, when asked to identify the side effect of greatest concern to patients, 61% of patients indicated alopecia, while 45% of HCP indicated gastrointestinal (GI) distress. While both HCP and their patients indicate that the oncology team is the most useful source of patient education, HCP underestimated the extent to which patients rely on their primary care providers (PCPs). Patients and HCP each identified limited time as a barrier to SDM, but patients indicated not knowing what to ask, while HCP indicated that low health literacy was the top barrier to SDM. 31% of patients and their care team identified that improvements in discussions about realistic prognosis were vital to improved care. Conclusions: These survey findings reveal discordances between oncology HCP’s perceptions and patient reported experiences when receiving treatment for TNBC. These findings may highlight areas for improvement in co-productive patient-centered care. [Table: see text]

scholarly journals Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers

2015 ◽  
Vol 23 (1) ◽  
pp. 137-143 ◽  
Author(s):  
Jing Zhang ◽  
Yunan Chen ◽  
Shazia Ashfaq ◽  
Kristin Bell ◽  
Alan Calvitti ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Patient Centered Care ◽  
Theory Approach ◽  
Care Providers ◽  
Structured Interviews ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Qualitative Interview Study ◽  
Centered Care

Abstract Objective Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish “patient-centeredness” in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. Methods and Materials Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. Results The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR. Discussion and Conclusion This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing “best” practices to improve patient-centered care in today’s highly “wired” health environment. These findings also show that more user-centered EHR design is needed to improve system usability.

Abstract 002: Patient Provider Communication and Patient-centered Outcomes Among Patients With Atherosclerotic Cardiovascular Disease in United States: Medical Expenditure Panel Survey 2010-2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Victor Okunrintemi ◽  
Erica Spatz ◽  
Joseph Salami ◽  
Haider Warraich ◽  
Salim Virani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Atherosclerotic Cardiovascular Disease ◽  
Care Providers ◽  
Patient Centered ◽  
Patient Reported ◽  
Centered Care ◽  
Nationally Representative

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

Patterns of care in ALK+ or ROS1+ non-small cell lung cancer (NSCLC) in community systems.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 232-232
Author(s):  
Benjamin Philip Levy ◽  
Breanne Y Farris ◽  
Rebecca R Crawford ◽  
Jeffrey D. Carter ◽  
Tamar Sapir
Keyword(s):  
Lung Cancer ◽  
Targeted Therapies ◽  
Treatment Options ◽  
Patient Centered Care ◽  
Molecular Testing ◽  
Distress Screening ◽  
Patient Centered ◽  
Treatment Practices ◽  
Molecular Tests ◽  
Centered Care

232 Background: For patients who have ALK or ROS1+ NSCLC, targeted therapies have greatly improved treatment options, though challenges personalizing care have hindered effective integration. In a quality improvement (QI) program conducted in 2 community oncology systems, practices involving the use of targeted therapies for NSCLC were assessed. Methods: Between 01-04/2020, retrospective EMR audits of 100 patients with ALK or ROS1+ NSCLC were analyzed for demographics, molecular testing, disease characteristics, treatment history, and shared decision-making (SDM). Surveys were administered to evaluate healthcare professionals’ (HCP; N = 47) challenges and barriers. HCP teams participated in audit-feedback sessions and developed action plans for resolving identified gaps. Results: 64% of HCPs indicated high confidence in utilizing molecular tests to inform treatment and properly sequencing targeted therapies; however, the EMR audit demonstrated challenges efficiently integrating guideline-aligned testing into practice. The mean time from diagnosis to molecular testing results was 22 days and documentation of testing for genetic aberrations other than ALK/ROS1 during work-up were low (Table). Delays in receiving molecular testing results may have presented challenges aligning treatment practices to guidelines as some patients were not receiving frontline targeted therapies (31% ALK+, 24% ROS1+). Additionally, EMR audits suggested sub-optimal use of distress screening (37%), tobacco counseling (38%), quality of life screening (60%), and engagement/documentation of various aspects of SDM (Table) for patient-centered care. Importantly, given the role internalized stigma can play in lung cancer, only 59% of those surveyed indicated that they routinely use tools to identify patients affected by stigma. During audit-feedback sessions, teams identified increased documentation, improved molecular testing/collaboration with pathology team, and provision of patient-centered care, including reduction of smoking-associated stigma as action items. Conclusions: These findings reveal important performance gaps in providing targeted and patient-centered treatment for NSCLC in community settings. These findings may be relevant for future QI programs. [Table: see text]

scholarly journals Patients’ Perceptions of Portal Use Across Care Settings: Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Ann Scheck McAlearney ◽  
Cynthia J Sieck ◽  
Alice Gaughan ◽  
Naleef Fareed ◽  
Jaclyn Volney ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Centered Care ◽  
Theory Approach ◽  
Access To Information ◽  
Engagement In Care ◽  
Care Providers ◽  
Patient Centered ◽  
Centered Care

BACKGROUND Patient portals are a promising instrument to improve patient-centered care, as they provide patients information and tools that can help them better manage their health. The implementation of portals in both the inpatient and outpatient setting gives health care providers an opportunity to support patients both during hospitalization and after discharge. Thus, there is a need to better understand how inpatient and outpatient portals are used across care contexts. OBJECTIVE This study aimed to examine patients’ perceptions of using inpatient and outpatient portals across the care settings, including how they used the portals and the benefits and concerns associated with portal use. METHODS This study was conducted in a large Midwestern academic medical center consisting of seven hospitals. We interviewed 120 patients who had used an inpatient portal during their hospitalization, at 15 days and 6 months postdischarge, to determine their perspectives of portal use in both hospital and outpatient settings. Interview transcripts were analyzed inductively and deductively by using team coding processes consistent with a grounded theory approach. RESULTS Interviews focused on three main areas of portal use: experience with the portal features, perceived benefits, and concerns. Responses at 15 days (n=60) and 6 months (n=60) postdischarge were consistent with respect to perceptions about portal use. Patients identified viewing their health information, managing their schedule, and communicating with providers as notable activities. Convenience, access to information, and better engagement in care were indicated as benefits. Concerns were related to technology issues and privacy/security risks. CONCLUSIONS Implementation of inpatient portals as a complement to outpatient portals is increasing and can enable patients to better manage aspects of their care. Although care processes vary substantively across settings, the benefits of convenience, improved access to information, and better engagement in care provide opportunities for portal use across care settings to support patient-centered care.

Psychometric Evaluation of the Korean Version of Patient-Centered Care Scale for Hospital Nurses

2018 ◽  
Vol 42 (3) ◽  
pp. 344-365 ◽  
Author(s):  
Yun Mi Lee ◽  
Ju-Eun Song ◽  
Chanhee Park ◽  
Youn-Jung Son
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Goodness Of Fit ◽  
Discriminant Validity ◽  
Patient Centered Care ◽  
Care Providers ◽  
University Hospitals ◽  
Patient Centered ◽  
Korean Version ◽  
Centered Care

Patient-centered care (PCC) encourages active collaboration and effective communication among patients, their family caregivers, and health-care providers to achieve high-quality care. Despite its importance, there is no validated and reliable Korean instrument for assessing PCC among health-care providers yet. This study aimed to establish a Korean version of the PCC (K-PCC) Scale using international translation guidelines and systematically evaluating its psychometric properties. The participants in this study were 424 nurses with a mean age of 28.07 years (±4.56) from two university hospitals in South Korea. Confirmatory factor analysis identified that the revised model, which included three factors (holistic, collaborative, and responsive care), had a satisfactory goodness of fit. The testing of item convergent and item-discriminant validity revealed a 100% scaling success. Criterion validity showed that nurses who had positive perceptions of K-PCC were more likely to practice PCC ( r = .692, p < .001). The internal consistency for 23 items as a whole was good, at .935. From these results, K-PCC is considered a valid and reliable instrument for measuring health-care providers’ perceptions of PCC among Korean populations. Scale brevity and simplicity, together with rigorous testing, indicate that validation of the PCC Scale may be helpful for ensuring quality improvement in hospital settings.

scholarly journals Inducing a sense of worthiness in patients: the basis of patient-centered palliative care for cancer patients in Iran

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mir Hossein Aghaei ◽  
Zohreh Vanaki ◽  
Eesa Mohammadi
Keyword(s):  
Palliative Care ◽  
Content Analysis ◽  
Cancer Patients ◽  
Patient Centered Care ◽  
Care Providers ◽  
Patient Centered ◽  
Centered Care ◽  
Recorded Data ◽  
Main Components ◽  
Perception Of Care

Abstract Background Patient-centered care is one of the main components in providing palliative care for cancer patients. This issue has been the subject of numerous studies and practices in nursing for many years. Few studies, however, have explored the perception of nurses about patient-centered treatments. This study aimed at exploring the perception of care-providers about offering patient-centered care to cancer patients. Method For attaining that aim, 18 care-providers were purposefully selected for an interview which allowed the researchers to explore the enriched experiences of these participants about offering patient-centered palliative care to cancer patients. After transcribing the recorded data, analysis was carried out based on Graneheim and Lundman’s method of content analysis. The research was qualitative in nature and conducted in 2019 in Iran. Results From content analysis, 3 main categories; considering patient’s spirituality, maintaining patient’s dignity during care, and reducing patient’s suffering, were found. The essence of these categories reflect on the care-providers’ consideration and effort in “inducing a sense of worthiness” in patients by providing patient-centered care. These categories also reflect on the perspective of care-providers about nurse- patient relationship for providing high qualified palliative care. Conclusion For providing patient-centered care inducing a sense of worthiness in patients, is the most fundamental component in providing palliative care to cancer patients. Therefore, by considering the structures and settings where the care is to be provided in the healthcare system, it is possible to direct the necessary educational, research, and administrative programs related to inducing a sense of worthiness in patients towards providing a more effective palliative care.

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