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Evidence-Based Oncology Patient-Centered Oncology Care 2016

Responding to Patient Needs Central to Providing Value in Cancer Care

Christina Mattina
At the 5th annual Patient-Centered Oncology Care® meeting, Nell Wood Buhlman of Press Ganey explained that oncology providers must focus on patient needs and minimize suffering in order to truly provide value in cancer care.
NELL WOOD BUHLMAN, SENIOR VICE PRESIDENT of clinical and analytic services at Press Ganey, discussed how oncologists can use patient surveys to anticipate and respond to their patients’ needs during her presentation at the Patient-Centered Oncology Care® meeting, held November 17-18, 2016, in Baltimore.

Buhlman’s presentation, “Understanding & Responding to Patient Needs: The Cancer Patient Experience,” was built upon her work to harness information from patient experiences and use that data to create a strategy toward personalized care. At Press Ganey, Buhlman said, there is a focus on identifying “opportunities that are going to deliver the greatest benefit” to organizations and patients.

According to Buhlman, one of these opportunities is to reduce patient suffering by providing compassionate care. Press Ganey was one of the first to introduce the concept of patient suffering, which is just now starting to be acknowledged after it had initially been rejected by some as sounding too “sensational.” The organization classified patient suffering into “inherent suffering” and “avoidable suffering.”

Inherent suffering, or the suffering associated with cancer diagnosis and treatment, may not be possible for providers to mitigate or eliminate entirely. It includes psychosocial pain, such as the loss of autonomy and privacy that often accompanies oncology treatment. Oncologists may view these anxieties as outside their domain of responsibility, but these worries can have a dramatic impact on a patient’s overall wellness and response to treatment, Buhlman said.

Providers can help alleviate this type of suffering by ensuring that patients receive information they understand, by safeguarding patient privacy, and by empowering patients to make choices regarding their treatment. Overall, the best way to respond to inherent suffering is to meet patient needs by providing care in an empathic way, she explained.

The other type of suffering, avoidable suffering, arises from anything done by the healthcare industry “that causes additional suffering to be layered upon the patient.” Avoidable suffering should be eliminated entirely, in part by avoiding unnecessary delays and improving the coordination of care among providers. While offering adequate amenities can help prevent avoidable suffering, Buhlman cautioned that a disproportionate focus on the extras can distract providers from what is most important to the patient. A focus on “delighting” or “wowing” these patients “assumes you have everything else taken care of. If you are baking chocolate chip cookies and offering massages and manicures and pedicures, you better have all of the tough stuff under lock.”

Healthcare providers, she said, must work toward improving the patient experience at every opportunity because “we don’t, as an industry, have the right to make care worse for patients.” To become more patient centered, practices must strategically leverage the information gathered from patient surveys. These surveys can provide insight into “defects in the process” that are important to the patient, like long wait times, poor teamwork, or lack of patient input in decision making.

Press Ganey recommends that its clients use a framework that organizes the domains within the surveys around patients and their needs, not around providers. They have developed a realigned survey that reflects a pyramid of patient-centered domains: culture is the foundation and above that are operational efficiency, clinical excellence, and finally caring behaviors at the tip.

By highlighting the results of a study, Buhlman demonstrated that the patient experience differs based on “micro” factors like condition and setting of care, such that oncology providers looking at surveys from an entire body of patients could miss important nuances. The study, which compared inpatient surveys of cancer patients in 2 settings to a baseline of non cancer patients, indicated that cancer patients in a medical setting have different needs and experiences than those of cancer patients in a surgical setting. Patients receiving surgical care reported that all of their needs in the 4 domains were being met at higher rates than the baseline, while the satisfaction rates of cancer patients in the medical setting lagged behind. For instance, just 61% of medical cancer patients reported that their pain was under control, as opposed to 70% of surgical cancer patients and 64% of non cancer patients.

Another survey revealed perceptions of unmet needs among oncology patients at medical practices. The gaps between optimal performance and actual patient experience were widest in areas that included wait time and preparation for transition. These gaps, Buhlman said, indicate the need to “drill down to understand opportunities for improvement.”

Patients can also be segmented by disease to highlight areas of dissatisfaction. To illustrate this point, Buhlman summarized another study that compared the unmet need among lung cancer and breast cancer patients with assessments by cancer patients overall. Breast cancer patients gave more positive assessments of their care than the average of all cancer patients, while lung cancer patients reported some opportunities for improvement. Compared with the baseline of all cancer patients, fewer lung cancer patients said they received instructions on how to care for themselves at home or felt that the staff was concerned about their privacy, among other examples.

In response to an audience question about the capabilities of information technology (IT) to integrate data across providers, Buhlman indicated there is still work left to be done. “It’s going to be like Monet’s Water Lilies. When you think about the picture we’re going to paint, you know what you’re looking at,” Buhlman said. “It’s not going to be the most precise thing, but as the IT and the information services side gets better, we’ll be able to grab it and do a photograph-like version of it as well.”
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