Understanding Patient Experience with Outpatient Cancer Rehabilitation Care

Abstract

Background: Understanding patient experience is key to optimize access and quality of outpatient cancer rehabilitation (physical or occupational therapy, PT/OT) services. Methods: We performed a retrospective mixed-method analysis of rehabilitation medical record data to better understand patient experience and aspects of care that influenced experience. From the medical record, we extracted case characteristics, patient experience data (Net Promoter Survey®, NPS) and patient-reported outcome (PRO) data. We categorized cases as ‘promoters’ (i.e., highly likely to recommend rehabilitation) or ‘detractors’, then calculated NPS score (−100 [worst] to 100 [best]). We identified key themes from NPS free-text comments using inductive content analysis, then used Pearson [r] or Spearman [ρ] correlation to explore relationships between NPS, characteristics, and PRO improvement. Results: Patients (N = 383) were 60.51 ± 12.02 years old, predominantly women with breast cancer (69.2%), and attended 14.23 ± 12.37 visits. Most were ‘promoters’ (92%); NPS score was 91.4. Patients described two experiences (themes) that influenced their likelihood to recommend rehabilitation: (1) feeling comfortable with the process and (2) observable improvement in health/functioning, and described attributes of clinic staff, environment and clinical care that influenced themes. Likelihood to recommend rehabilitation was associated with achieving the minimal clinical important difference on a PRO (ρ = 0.21, p < 0.001) and cancer type (ρ = 0.10, p < 0.001). Conclusion: Patients who received specialized cancer PT/OT were highly likely to recommend rehabilitation. Feeling comfortable with the rehabilitation process and making observable improvements in health and/or functioning influenced likelihood to recommend. Rehabilitation providers should leverage the findings of this study optimize access to and quality of cancer rehab services.

Impact of Real-World Outpatient Cancer Rehabilitation Services on Health-Related Quality of Life of Cancer Survivors across 12 Diagnosis Types in the United States

“…In doing so, we provide a pragmatic and generalizable understanding of how patients within several different cancer populations may present on evaluation to rehabilitation and their potential for improvement. Coupled with existing research demonstrating the high prevalence of unmet HRQOL needs within the growing population of cancer survivors and the potential value of rehabilitation services in terms of patient outcomes [26], satisfaction [50], and cost-effectiveness [29,31], the findings of this study suggest that widespread participation in real-world cancer rehabilitation services could enhance HRQOL for cancer survivors at the population level and add value to oncology care.…”

“…For cancer survivors, previous studies have qualitatively described a lack of understanding of cancer rehabilitation as a barrier to participation [32,33]. These data, coupled with other evidence demonstrating the importance of survivors experiencing an improvement in how they feel [50], relate to the importance of evaluating HRQOL as an outcome of rehabilitation. This study can help inform survivors of what they expect from cancer rehabilitation services, providing an incentive to attend.…”

“…Outpatient cancer rehabilitation is a relatively low-cost service that is generally covered by insurance. In previous studies of individuals with cancer who attend cancer rehabilitation, patient-rated acceptability was high and most agreed they would recommend the service to others because they could recognize the value in attending [50]. For cancer survivors, previous studies have qualitatively described a lack of understanding of cancer rehabilitation as a barrier to participation [32,33].…”

In-Clinic versus Hybrid Cancer Rehabilitation Service Delivery during the COVID-19 Pandemic: An Outcome Comparison Study

“…At an aggregate level, the NPS score is calculated by subtracting the proportion of detractors from the proportion of promoters (NPS score = [% promoters] − [% detractors]); the possible range is −100 to 100. An accepted NPS score benchmark for the outpatient rehabilitation industry is 84 [39]; however, within the institution, 90.1 [38] and 91.4 [40] are the accepted benchmarks for orthopedic and cancer rehabilitation services, respectively, and therefore these were used as the benchmark in this study. The NPS was administered automatically by the EMR system after an initial evaluation, 6 weeks after the evaluation, and following discharge.…”