Authors: Jeroen A S Bisschop Fabienne R Kloosterman Janneke E van LeijenZeelenberg Geert Willem Huismans Bernd Kremer Kenneth W Kross
Publish Date: 2017/01/28
Volume: 274, Issue: 5, Pages: 2245-2252
Abstract
The objective of this study is to report on an indepth evaluation of patient experiences and preferences at a Head and Neck Oncology outpatient clinic A qualitative research design was used to determine the experiences and preferences of Head and Neck Cancer patients in an Oncology Outpatient Clinic Maastricht University Medical Center The Netherlands Head and Neck Cancer Patients treated for at least 6 months at the Oncology Clinic were included A qualitative research design with patient interviews was used All interviews were recorded and transcribed verbatim to increase validity Analysis was done with use of the template approach and qualitative data analysis software Three of the six dimensions predominated in the interview 1 respect for patients’ values preferences and expressed need 2 information communication and education and 3 involvement of family and friends The dimensions physical comfort emotional support coordination and integration of care were considered to be of less significance The findings from this study resulted in a deeper understanding of patients’ experiences and preferences and can be useful in the transition towards a more patientcentered approach of health careWithin the medical community there is a tendency to create a higher quality of delivery of care The American National Academy of Medicine NAM formerly known as the Institute of Medicine IoM is one of the leading nonprofit institutions in the world operating in the field of medicine technology and science The NAM provides objective and independent advice in this field In advising policy makers health professionals and the public at large with evidencebased authoritative information the NAM aims to improve healthcare at large To conceptualize a high quality of care the NAM has stated several aims These aims entail “safety effectivity patient centeredness timeliness efficiency and equity” 1One of the aims the concept of patientcentered care PCC has gained increasing prominence in recent years as a key aim of healthcare delivery As set by the NAM the definition of PCC entails “Providing care that is respectful of and responsive to individual patient preferences needs and values and ensuring that patient values guide all clinical decisions” 1At the core of PCC lies the healing relationships between clinicians patients and family members 2 3 In a patientcentered approach interactions between clinicians and patients follow a twoway share of information 4 5 Clinicians help patients and their families make clinical decision and facilitate appropriate care This is especially important in the context of cancerrelated care In oncology the PCC approach often enables patients to follow through with invasive treatments or behavioral changes needed to improve health 6 This approach aims to improve clinical practice by building relationships that bridge differences between doctors and patients 2 3 6 In this way patients can be seen in context of their own social environmentIn practice it is noted that PCC is an important factor in creating a care unit in which there is more patient involvement which on its turn can increase the efficiency of care Improvements in efficiency of care can be seen in less frequent patient visits less scans gathering of more information and therefore reaching a diagnosis sooner 7 8At the core of patient centeredness is the idea that healthcare providers and the systems in which they work will deliver care that is attentive to the needs values and preferences of patients 9 For physicians the most important tool for making care more patient centered is communication 10Having PCC as one of the main aims of care delivery medical expertise is not the only role of the clinician anymore achieving patient understanding of the situation and following shared decisionmaking too plays an important role Furthermore it is the additional care that clinicians have to fulfill such as referrals to palliative care and management of side effects that contribute to achieving a PCC model 1 11The six dimensions described by the NAM are 1 respect for patients’ values expressed preferences and needs 2 information communication and education 3 coordination and integration of care 4 emotional support relieving fear and anxiety 5 physical comfort and 6 involvement of friends and family 1 In this study qualitative indepth analyses have been used to investigate these dimensions in detail Qualitative indepth analyses have shown to be a valuable addition to existing patient satisfaction questionnaires and other quantitative methods in the measurement of PCC More specifically the use of qualitative analysis can lead to deeper insights and facilitate improvements
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