Organizational determinants of patients' experiences of care for breast, lung and colorectal cancers

Abstract

Organizational characteristics in English NHS hospitals and the experiences of patients with three common cancers – breast, colorectal and lung – were examined using secondary data analyses. Two specific measures of satisfaction, Respect and Dignity, reflecting inpatient care, and Communication reflecting hospital outpatient care, were drawn from a national survey of cancer patients after first hospital treatment. They were compared at hospital level with hospital cancer service standards, and measures of hospital provision, each drawn from national surveys. Respect and Dignity was greater in hospitals with fewer complaints, slower admission procedures and a greater proportion of medicine consultants, for breast and colorectal cancers only. For breast cancer alone, Respect and Dignity was greater in hospitals achieving more participation in meetings by lead team members at the cancer unit level. For lung cancer alone, there were tumour-specific team organizational measures (relating to outpatient assessment) associated with Communication. However, the majority of recorded standards did not show associations, and there were occasional negative associations (dissatisfaction). The impact of organizational factors on patients may be examined through observational studies when experimental designs are not possible. Understanding how organizational factors affect quality of care for cancer patients can contribute to planning and management of cancer services.

Cancer patient and clinician acceptability and feasibility of a supportive care screening and referral process

“…Overcoming the lack of private space was logistically difficult, especially in the shared spaces such as the chemotherapy unit or shared rooms on the ward; drawing the dividing curtain was the most practical means of creating privacy. While studies of patient–clinician communication identify walled cubicles and private rooms to achieve greater privacy, studies also report that patients still report satisfaction with their care, confidentiality of their information, trust in the staff and feel respect for privacy by staff when only a dividing curtain existed . Time to conduct the discussion emerged as a third feasibility issue, particularly for clinicians.…”

“…While studies of patientclinician communication identify walled cubicles and private rooms to achieve greater privacy, studies also report that patients still report satisfaction with their care, confidentiality of their information, trust in the staff and feel respect for privacy by staff when only a dividing curtain existed. [40][41][42][43] Time to conduct the discussion emerged as a third feasibility issue, particularly for clinicians. Clinicians wanted to spend the time with their patients but felt their current workload was already stretched.…”

Determinants of patient-reported experience of cancer services responsiveness

“…Four potential organizational attributes were identified in the literature on patient satisfaction and quality of care as being more critical: specialization based on the hospital’s mandate, academic affiliation, geographic location, and cancer interdisciplinary team size and diversity [ 14 , 21 – 26 ]. Detailed descriptions of these variables are provided in Additional file 1 .…”

“…In these studies, the clinical or socio demographic factors were used to describe the sample and not to investigate the individual or organizational determinants of health services responsiveness. Further, while evidence on clinical and sociodemographic determinants of perceived quality of cancer care has accumulated over the last decade [ 5 , 13 ], evidence for organizational determinants of patient perception of the quality of cancer care is still lacking [ 14 , 15 ]. According to Zapka and colleagues, intensive investigations of a combination of potential determinants of organizational, provider, and patient characteristics are required to improve quality of cancer care [ 16 ].…”

Facility Characteristics and Quality of Lung Cancer Care in an Integrated Health Care System

“…As the burden of cancer and its care continually increases within the VHA, 16,17 identifying organizational determinants of care introduces the unique opportunity for global management of cancer services and the implementation of facility-level interventions that improve quality of care in a centralized, effective, and potentially more cost-effective manner. 8,18 Indeed many of the pioneering programs to evaluate quality of care for hospitals and cancer programs, including efforts by The Joint Commission and the ACOS Commission on Cancer, are based on primarily structural determinants of quality. 2,[19][20][21] With the important (and intuitive) exceptions of on-site lung biopsy, palliative care, counseling services, and diagnosis and treatment within the same facility, we did not identify any organizational characteristics or resources that predicted better performance on process quality indicators for lung cancer care, which would aid in recommendations for changes to improve the care at facilities with lower performance.…”