scholarly journals Conformance With Supportive Care Quality Measures Is Associated With Better Quality of Life in Patients With Cancer Receiving Palliative Care

2013 ◽  
Vol 9 (3) ◽  
pp. e73-e76 ◽  
Author(s):  
Arif H. Kamal ◽  
Janet Bull ◽  
Charles S. Stinson ◽  
Debra L. Blue ◽  
Amy P. Abernethy
Keyword(s):  
Palliative Care ◽  
Patient Outcomes ◽  
Assessment Tool ◽  
Quality Measures ◽  
Care Quality ◽  
Quality Data ◽  
Patients With Cancer ◽  
Data Assessment ◽  
The Relationship

The authors used a quality data assessment tool to examine the relationship between conformance with palliative care quality measures and patient outcomes.

What type of feedback to clinicians best improves conformance to supportive care quality measures?

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 102-102
Author(s):  
Arif Kamal ◽  
Amy Pickar Abernethy ◽  
Janet Bull ◽  
Jonathan Nicolla ◽  
Joseph Kelly ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Supportive Care ◽  
Symptom Assessment ◽  
Quality Measures ◽  
Care Quality ◽  
Quality Data ◽  
Improvement Project ◽  
Edmonton Symptom Assessment Scale ◽  
Comparative Feedback

102 Background: Supportive care is under-addressed in oncology and an important area for quality improvement. Regular, directed feedback is an important component of effective quality management. What type of feedback yields the highest conformance to supportive care measures? Methods: Within the Carolinas Palliative Care Consortium, we conducted a series of three PDSA cycles, each one month-long, to evaluate various types of clinician-directed feedback on conformance to two supportive care measures. We collected data using a web-based, mobile health platform called QDACT-PC (Quality Data Collection Tool for Palliative Care). Every four weeks, feedback to clinicians on performance was changed in a stepwise fashion, from “no feedback” to “personal feedback” to “comparative feedback” (personal conformance compared to the rest of the Consortium). We monitored weekly changes to conformance to two quality measures: documentation of timely management of constipation and dyspnea. To meet the measures, symptoms with intensity of >3/10 on the Edmonton Symptom Assessment Scale required documentation of intervention within 24 hours. Conformance rates were calculated and compared to a historical baseline. Results: 23 providers participated in this quality improvement project, which spanned 465 patient encounters across 104 unique patients. Baseline data generated from 3/2008-10/2011 demonstrated baseline conformance to the dyspnea and constipation measures at 6% (27/457) and 4% (14/398), respectively. After addition of an electronic, prospective quality monitoring system alone (QDACT-PC), conformance increased to 93% (42/45) and 92% (23/25), respectively. With personalized, weekly feedback, these rates increased to 94% for dyspnea and 100% for constipation. Feedback comparing personal performance to the average of the rest of the Consortium further increased this to 100% for both. Conclusions: Regular, weekly feedback on performance increases conformance to supportive care quality measures. Adding comparative feedback versus other peers solidifies this effect. Duration of the effect is being evaluated.

Characteristics of Advance Care Planning in Patients With Cancer Referred to Palliative Care

2021 ◽  
Vol 17 (2) ◽  
pp. e94-e100
Author(s):  
Callie M. Berkowitz ◽  
Steven P. Wolf ◽  
Jesse Troy ◽  
Arif H. Kamal
Keyword(s):  
Palliative Care ◽  
Data Collection ◽  
Advance Care Planning ◽  
Care Quality ◽  
Quality Data ◽  
Care Planning ◽  
Data Collection Tool ◽  
Serious Illness ◽  
Patients With Cancer ◽  
Advance Care

PURPOSE: Advance care planning (ACP) is a process in which patients share their values, goals, and preferences regarding future medical care. ACP can improve care quality, yet may be challenging to address for patients with cancer. We sought to characterize key components of ACP in patients with cancer as compared with patients with noncancer serious illness referred to palliative care (PC). METHODS: We performed a retrospective cross-sectional analysis of initial outpatient PC visits from the Quality Data Collection Tool for PC database from 2015 to 2019. Quality Data Collection Tool is a web-based point-of-care specialty PC registry to track quality metrics. RESULTS: We analyzed 1,604 patients with cancer and 1,094 patients without cancer: 44% of patients were female, 87% were White, and 98% were non-Hispanic. The average age was 72.2 years (standard deviation [SD] 15.4). Patients with cancer were on average younger than patients without cancer (66.5 [SD: 13.9] v 80.5 [SD: 13.8]) and had a higher Palliative Performance Scale (PPS) (59.5 [SD: 22.4] v 33.4 [SD: 25.1]). In our unadjusted comparison, patients with cancer were less likely to be DNR/DNI (37% v 53%; P < .0001) and less likely to have an advance directive (53% v 73%; < .0001); rates of healthcare proxy identification were similar (92.8% v 94.5%; P = .10). These differences did not persist when we accounted for age, race, sex, and PPS, with age being the primary explanatory factor. CONCLUSION: Despite having serious illness meriting PC referral, many patients with cancer in our study lacked advance directives. This highlights both the important role of oncologists in facilitating ACP and the utility of PC playing a complementary role.

scholarly journals Relationship Between Health Literacy and Social Support and the Quality of Life in Patients With Cancer: Questionnaire Study

10.2196/17163 ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. e17163
Author(s):  
Rei Kobayashi ◽  
Masato Ishizaki
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Colon Cancer ◽  
Health Literacy ◽  
Assessment Tool ◽  
Japanese Version ◽  
Internet Survey ◽  
Patients With Cancer ◽  
The Relationship

Background Low health literacy is associated with factors such as not taking medication as prescribed as well as poor health status and increased hospitalization and mortality risk, and has been identified as a risk factor for decreased physical function in older individuals. Health literacy is becoming an increasingly important issue because of the increased number of people affected by cancer who must make complicated treatment decisions. Health literacy has been shown to be positively associated with quality of life (QOL), and social support has been identified as important for addressing health-related problems and reducing the relative risk of mortality in patients with cancer. However, few studies have examined the relationship between health literacy, social support, age, and QOL. Objective The aim of this study is to examine the effects of health literacy, social support, and age on the QOL of patients with cancer. Methods An anonymous, self-administered online questionnaire was conducted from March 28 to 30, 2017, in Japan on patients with lung, stomach, or colon cancer that were voluntarily registered with an internet survey company. The survey covered basic attributes, health literacy, social support, and QOL. The European Health Literacy Survey Questionnaire, a comprehensive measure of health literacy instrument, was used to measure health literacy; the Japanese version of the Social Support Scale was used to measure social support; and the Japanese version of the Functional Assessment of Cancer Therapy-General (7-item version) assessment tool was used to measure QOL. Results A total of 735 survey invitations were randomly sent to patients with lung, stomach, or colorectal cancer, and responses were obtained from 619 (82.2% response rate). Significant effects on the QOL in patients with lung, stomach, or colon cancer were observed for health literacy, social support, and age, and for the interactions of health literacy and social support and of social support and age. Health literacy, social support, and the interaction between these variables also showed a significant effect on the QOL in patients 50 years or older, but not on those younger than 50 years. Conclusions The results of this study revealed that higher health literacy, social support, and age were associated with the QOL in patients with cancer. In addition, the relationship with QOL was stronger for social support than for health literacy. These findings suggest the importance of health literacy and social support and indicate that social support has a greater effect on QOL than does health literacy, while the QOL in patients with cancer aged younger than 50 years was lower than that of those 50 years or older. Therefore, elucidating the needs of these patients and strengthening social support based on those needs may improve their QOL.

scholarly journals Palliative and end-of-life care in glioblastoma: defining and measuring opportunities to improve care

2016 ◽  
Vol 4 (3) ◽  
pp. 182-188 ◽  
Author(s):  
Lauryn E Hemminger ◽  
Christine A Pittman ◽  
David N Korones ◽  
Jennifer N Serventi ◽  
Susan Ladwig ◽  
...  
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
End Of Life ◽  
Patient Outcomes ◽  
Advance Directives ◽  
Advance Directive ◽  
Quality Measures ◽  
Care Quality ◽  
Home Setting ◽  
Palliative Care Consultation

Abstract Background American Society for Clinical Oncology (ASCO) quality measures for terminal cancers recommend early advance care planning and hospice at the end of life. We sought to evaluate adherence to 5 palliative care quality measures and explore associations with patient outcomes in glioblastoma. Methods This is a retrospective analysis of 117 deceased glioblastoma patients over 5 years. Records were reviewed to describe adherence to palliative care quality measures and patient outcomes. Data regarding emotional assessments, advance directives, palliative care consultation, chemotherapy administration, hospice, location of death, and overall survival were collected. Results Median overall survival was 12.9 months. By the second oncology visit, 22.2% (26/117) had an emotional assessment completed. Advance directives were documented for 52.1% (61/117) by the third neuro-oncology visit (30/61 health care proxy), yet 26.5% (31/117) did not have any advance directive before the last month of life. With regard to other ASCO quality measures, 36.8% (43/117) had a palliative care consult; 94.0% (110/117) did not receive chemotherapy in the last 14 days of life; 59.8% (70/117) enrolled in hospice >7 days before death; and 56.4% (66/117) died in a home setting. Patients who enrolled in hospice >7 days before death were 3.56 times more likely to die in a home setting than patients enrolled <7 days before death or with no hospice enrollment (P = .002, [OR 3.56; 95% CI, 1.57–8.04]). Conclusions Late advance directive documentation, minimal early palliative care involvement, and the association of early hospice enrollment with death in a home setting underscore the need to improve care and better define palliative care quality measures in glioblastoma.

Development of an electronic point-of-care quality monitoring system for palliative care.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 291-291
Author(s):  
Arif Kamal ◽  
Janet Bull ◽  
Amy Pickar Abernethy
Keyword(s):  
Palliative Care ◽  
User Interface ◽  
Data Collection ◽  
Point Of Care ◽  
Quality Measures ◽  
Care Quality ◽  
Quality Monitoring ◽  
Quality Data ◽  
Usability Study ◽  
Feasibility Testing

291 Background: Most current quality monitoring programs involve retrospective, manual data collection. These are inherently limited by accuracy issues and do not integrate well with national efforts to integrate electronic data documentation in all parts of medical practice. We aimed to build and test a prospective system for continuous quality monitoring in palliative care. Methods: Within a four-organization, academic/community quality consortium, we first conducted a focus group to inventory characteristics of an effective system. Then, with an interdisciplinary team of providers informatics, data security, and software programmers, we created an electronic solution for quality data collection and reporting. A usability study with think-aloud protocols followed using twenty providers and two mock cases across paper, laptop, and tablet computer platforms. Finally, a feasibility test assessing satisfaction, burden, and logistical issues was conducted. Results: Identified priorities for a proposed system were: 1. Use of information technology (IT); 2. Point-of-care use; and 3. Immediate, provider-level reporting on quality conformance. A previous systematic review of quality measures informed the development of a 92 item dataset comprised of variables drawn from validated clinical instruments and aligned with the National Consensus Project quality domains. To foster electronic, point-of-care data capture, the Quality Data Collection Tool (QDACT) user interface was then developed. Use at point-of-care in community-based palliative care settings can inform 82% (125) of identified relevant quality measures; a color-code reminder system provides immediate conformance feedback. The usability study demonstrated high satisfaction with electronic platforms, less than 15 minutes for completion, and a low error rate. Feasibility testing across 572 patient encounters demonstrated high acceptability and further improvements to the user interface. Feedback from an additional cycle of feasibility testing will inform further changes. Conclusions: Electronic systems that can integrate point-of-care quality monitoring and clinical assessments are buildable and usable in palliative care.

scholarly journals Correction to: The relationship between comorbidity medication adherence and health related quality of life among patients with cancer

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Dana Drzayich Antol ◽  
Adrianne Waldman Casebeer ◽  
Raya Khoury ◽  
Todd Michael ◽  
Andrew Renda ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medication Adherence ◽  
Health Related Quality ◽  
Patients With Cancer ◽  
Related Quality ◽  
Health Related ◽  
The Relationship

An amendment to this paper has been published and can be accessed via the original article.

Does a Patient-Held Quality-of-Life Diary Benefit Patients With Inoperable Lung Cancer?

2009 ◽  
Vol 27 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Moyra E. Mills ◽  
Liam J. Murray ◽  
Brian T. Johnston ◽  
Chris Cardwell ◽  
Michael Donnelly
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Health Care Professionals ◽  
Standard Care ◽  
Care Quality ◽  
Care Group ◽  
Consistent Difference ◽  
Life Questionnaire

Purpose To examine the effect of weekly completion of a patient-held quality-of-life (QOL) diary in routine oncology practice for palliative care patients. Patients and Methods In a pragmatic randomized controlled trial, 115 patients with inoperable lung cancer were randomly assigned to receive either standard care or a structured QOL diary (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and the related lung cancer module LC13) that they completed at home each week for 16 weeks. Patients were encouraged to share the QOL information with health professionals involved in their care. Changes in QOL over time (measured by the Functional Assessment of Cancer Therapy–Lung questionnaire and the Palliative Care Quality of Life Index), discussion of patient problems, and satisfaction with communication and general care were assessed at baseline and at 2 and 4 months after baseline. Results Analysis of QOL indicated a small but consistent difference between patients in the diary group and the standard care group. The diary group had a poorer QOL in many domains. Two different QOL summary scores (total and overall QOL) indicated a statistically significant between-group difference. No effects were found in relation to satisfaction with care, communication, or the discussion of patient problems. Conclusion The regular completion of a QOL questionnaire without appropriate feedback to health care professionals and without the provision of appropriate support may have a negative impact on inoperable lung cancer patients. Further research should focus on identifying features such as feedback loops that are required for the successful and meaningful use of QOL questionnaires in routine patient care.

Evaluation of Ceiling Lifts in Health Care Settings

AAOHN Journal ◽  
2009 ◽  
Vol 57 (9) ◽  
pp. 374-380 ◽  
Author(s):  
Hasanat Alamgir ◽  
Olivia Wei Li ◽  
Erin Gorman ◽  
Catherine Fast ◽  
Shicheng Yu ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Pressure Ulcer ◽  
Care Facility ◽  
Care Quality ◽  
Patient Perceptions ◽  
Term Care ◽  
Health Care Settings ◽  
The Relationship

Ceiling lifts have been introduced into health care settings to reduce manual patient lifting and thus occupational injuries. Although growing evidence supports the effectiveness of ceiling lifts, a paucity of research links indicators, such as quality of patient care or patient perceptions, to the use of these transfer devices. This study explored the relationship between ceiling lift coverage rates and measures of patient care quality (e.g., incidence of facility-acquired pressure ulcers, falls, urinary infections, urinary incontinence, and assaults [patient to staff] in acute and long-term care facilities), as well as patient perceptions of satisfaction with care received while using ceiling lifts in a complex care facility. Qualitative semi-structured interviews were used to generate data. A significant inverse relationship was found between pressure ulcer rates and ceiling lift coverage; however, this effect was attenuated by year. No significant relationships existed between ceiling lift coverage and patient outcome indicators after adding the “year” variable to the model. Patients generally approved of the use of ceiling lifts and recognized many of the benefits. Ceiling lifts are not detrimental to the quality of care received by patients, and patients prefer being transferred by ceiling lifts. The relationship between ceiling lift coverage and pressure ulcer rates warrants further investigation.

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