The first step in ensuring patient-centred quality of care: ask the patient

Abstract

Health providers may not be aware of their patients' needs or preferences, and patients reluctant to raise their concerns. Consequently, the first step in ensuring quality of care is to ask the patient about the care that they would like. A cross-sectional sample of 244 medical oncology outpatients were surveyed about provider-asking behaviours across six dimensions of patient-centred care defined by the Institute of Medicine. Specifically, were patients asked by clinic staff at the treatment centre about their physical and emotional symptoms, information needs to enable decision-making, preferences for involvement in decision-making, involvement of family and friends, and appointment scheduling. Patients were significantly (Cochran's χ (9) = 122.541, P < 0.001) less likely to be asked about emotional symptoms (35% infrequently asked), preferences for the involvement of family and friends (25% infrequently asked), and preferences for involvement in medical decision-making (23% infrequently asked). Only a minority of patients were infrequently asked about their treatment-related information needs (8%), physical symptoms (13% pain, 14% fatigue) and preferences for appointment scheduling (13%). Younger age, not Australian born and greater educational qualifications were associated with being infrequently asked. Improvements to care delivery can be made if clinic staff were to more regularly elicit patient's emotional symptoms, and their preferences for the involvement of family/friends and participation in medical decision-making.

Experiences and preferences of patients visiting a head and neck oncology outpatient clinic: a qualitative study

“…The significance of involving family and friends is in line with the findings at the outpatient ORL department and in cancer care worldwide [22, 25, 26]. …”

Patient and caregiver perceptions of lymphoma care and research opportunities: A qualitative study

“…For patients with hematological cancers, individualized health communication previously has been suggested to fill knowledge gaps and address provider dissatisfaction caused by miscommunication of patient priorities . For example, research has demonstrated that patients with cancer rarely are asked about their mental health, yet they consider their mental health to be in the poorest state after completing treatment . Additional research questions raised by the current study centered around mental health treatment and resources impacting patient outcomes.…”

“…Survivorship is a burgeoning field for oncologists and researchers as factors determining these priorities change. Unfortunately, survivors' emotional and psychological burdens during the cancer experience often are unaddressed because providers rarely emphasize any aspect of patient care other than the patient's physical needs . Examining and addressing these unmet psychosocial needs can improve the overall well‐being of patients and survivors …”

“…Unfortunately, survivors' emotional and psychological burdens during the cancer experience often are unaddressed because providers rarely emphasize any aspect of patient care other than the patient's physical needs. 2 Examining and addressing these unmet psychosocial needs can improve the overall well-being of patients and survivors. 3 Survivorship after the course of lymphoma treatment is an important emerging field of cancer research, but to our knowledge rarely has been addressed in the literature.…”

Not asking cancer patients about their preferences does make a difference. A cross-sectional study examining cancer patients’ preferred and perceived role in decision-making regarding their last important cancer treatment

“…A considerable number of studies have looked at whether patients’ preferences for involvement in decision‐making match their experiences (Tariman et al., ; Vogel, Helmes, & Hasenburg, ). Also, numerous studies have suggested that to provide patient‐centred decision‐making in cancer care, healthcare providers should ask patients about their preferences for involvement in decision‐making regarding their care (Lee et al., ; Zucca et al., ). However, to our knowledge, no study has assessed whether asking patients about their decision‐making preferences is associated with discordance between patients’ preferred and perceived involvement in deciding on their cancer treatment.…”