Development of indicators for patient-centred cancer care

Abstract

Purpose Assessment of current practice with a valid set of indicators is the key to successfully improving the quality of patient-centred care. For improvement purposes, we developed indicators of patient-centred cancer care and tested them on a population of patients with non-small cell lung cancer (NSCLC). Methods Recommendations for patient-centred care were extracted from clinical guidelines, and patients were interviewed to develop indicators for assessing the patientcentredness of cancer care. These indicators were tested with regard to psychometric characteristics (room for improvement, applicability, discriminating capacity and reliability) on 132 patients with NSCLC treated in six hospitals in the east Netherlands. Data were collected from patients by means of questionnaires. Results Eight domains of patient-centred cancer care were extracted from 61 oncology guidelines and 37 patient interviews and were translated into 56 indicators. The practice test amongst patients with NSCLC showed the most room for improvement within the domains 'emotional and psychosocial support', 'physical support' and 'information supply'. Overall, 26 of the 56 indicators had good psychometric characteristics. Conclusions Developing a valid set of patient-centred indicators is a first step towards improving the patient centredness of cancer care. Indicators can be based on recommendations from guidelines, but adding patient opinions leads to a more complete picture of patient centredness. The practice test on patients with NSCLC showed that the patient centredness of cancer care can be improved. Our set of indicators may also be useful for future quality assessments for other patients with cancers or chronic diseases.

Time to treatment as a quality metric in lung cancer: Staging studies, time to treatment, and patient survival

“…This definition was derived from a proposed quality measure that states that therapy should be started within 35 calendar days from the patient's first visit to the pulmonologist. This quality measure was evaluated in prior studies of relatively small cohorts [5,7,8] and proposed as a relevant metric for evaluating care quality in the United States [6]. However, because only 44.7% of patients in our cohort were seen by a pulmonologist within 3 months before diagnosis, we chose to evaluate time from diagnosis to treatment, rather than time from pulmonary consultation to treatment.…”

“…In addition, studies of PET early in treatment for locoregionally confined NSCLC have shown that these changes in PET are correlated with overall survival in this setting [4]. Thus consensus panels have recommended that treatment be initiated in a timely manner, defined as within 35 days of pulmonary consultation [5][6][7][8]. However, the prevalence, impact, and factors contributing to such delays remain unknown.…”

Tabriz Clinical Governance Research Project (TCGRP): Study Protocol

“…One of the other main functionalities of indicators is to evaluate and measure performance and the degree to which predetermined goals have been reached [22]. Using literature review, expert panel and Delphi technique to develop the performance indicators was prevalent in previous studies [23][24][25][26]. As indicated in previous studies, Delphi method can be a useful and systematic approach to consensus building about a real subject [13,14,27,28] and facilitate the systematic cycle of indicator development [26].…”

The lung cancer patient, the pneumologist and palliative care: a developing alliance

“…In addition to the generally poor prognosis, the majority of lung cancer patients undergoes a progressive deterioration in terms of symptom burden or well-being during the course of their disease, as depicted most recently by KOCZYWAS and co-workers [140,141] in their observational studies involving NSCLC stage I-III (n=103) as well as NSCLC stage IV patients (n=114) over a period of up to 1 year. Thus, outcome analyses for lung cancer patients have already been extended far beyond sole survival or relapse data acquisition [142][143][144][145][146][147][148]. Nonetheless, due to its complexity, thriving research of palliative care scientific questions cannot be based on classical clinical trial designs alone but needs an enhanced methodological repertoire, such as quality of care and quality improvement research approaches [149][150][151][152][153][154].…”