| Autor: |
O'Hanlon CE; RAND Corporation, Santa Monica, CA, USA.; Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA., Giannitrapani KF; Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA.; Stanford University School of Medicine, Stanford, CA, USA., Gamboa RC; Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA.; Stanford University School of Medicine, Stanford, CA, USA., Walling AM; Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.; University of California Los Angeles, Los Angeles, CA, USA., Lindvall C; Dana-Farber Cancer Institute, Boston, MA, USA.; Brigham and Women's Hospital, Boston, MA, USA., Garrido M; Partnered Evidence-Based Policy Resource Center (PEPReC), Boston, MA, USA.; Boston University School of Public Health, Boston, USA., Asch SM; Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA.; Stanford University School of Medicine, Stanford, CA, USA., Lorenz KA; Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA.; Stanford University School of Medicine, Stanford, CA, USA. |
| Abstrakt: |
Quality measurement is typically the domain of clinical experts and health system leaders; patient/caregiver perspectives are rarely solicited. We aimed to describe and integrate clinician and patient/caregiver conceptualizations of high-quality palliative symptom care for patients receiving care for advanced cancer within the US Veterans Health Administration in the context of existing quality measures. We conducted a secondary qualitative analysis of transcripts from prioritization discussions of process quality measures relevant to cancer palliative care. These discussions occurred during 2 modified RAND-UCLA appropriateness panels: a panel of 10 palliative care clinical expert stakeholders (7 physicians, 2 nurses, 1 social worker) and a panel of 9 patients/caregivers with cancer experience. Discussions were recorded, transcribed, and independently double-coded using an a priori logical framework. Content analysis was used to identify subthemes within codes and axial coding was used to identify crosscutting themes. Patients/caregivers and clinical experts contributed important perspectives to 3 crosscutting themes. First, proactive elicitation of symptoms is critical. Patients/caregivers especially emphasized importance of comprehensive and proactive screening and assessment, especially for pain and mental health. Second, screening and assessment alone is not enough; information elicited from patients must inform care. Measuring screening/assessment and management care processes separately has important limitations. Lastly, high-quality symptom management can be broadly defined if it is patient-centered; high-quality care takes an individualized approach and might include non-medical or non-pharmacological symptom management. Integrating the perspectives of clinical experts and patients/caregivers is critical for health systems to consider as they design and implement quality measures for palliative cancer care. |
