- Individuals undergoing outpatient cancer care tend to report complaints about the patient-centeredness of their care more than the quality and safety of their care. This offers unique insight into the cancer patient experience, according to a study published in the Joint Commission Journal on Quality and Patient Safety.
Patient experience and satisfaction have become integral measures for value-based care, and although significant study has gone into understanding these factors, little has related to outpatient cancer care. Assessing the cancer patient experience by looking at the issues about which patients submit complaints can offer tremendous insight for quality improvement, the research team said.
“Complaints offer distinct perspectives that compliment data available in safety reporting systems,” the researchers explained. “In addition, information reported to Patient/Family Relations is uniquely focused on the patient perspective. Sharing this information with clinicians and hospital leaders provides an important opportunity to address problematic aspects of patient-centered care delivery.”
Investigating the care experience in outpatient cancer care is especially important because of the unique nature of cancer care. Cancer treatment is often longitudinal, requiring long-term relationships with an extensive care team. Cancer being a serious illness that calls for complex treatment protocol also emphasizes the need for clear and empathetic communication.
That communication – and other patient-centered care principles – often fall short, the researchers determined. In a content analysis of complaints submitted to the Patient/Family Relations Office at Dana Farber Cancer Institute, the researchers found that patients and families were more concerned with patient-provider relationships than with care quality and safety.
The team organized two years’ worth of complaints into the following categories:
- Institutional issues
- Timing and access
- Patient rights
From there, the researchers also stratified complaints by severity based on a standard set of criteria:
- Involvement of a prescribing oncologist, such as a physician or nurse practitioner
- Notation of strong affect of the complainant, including anger, within the narrative component of the complaint
- Allegation by the complainant of medical error or suboptimal medical care
- Request or desire to transfer care to another provider or institution
- Mention of malpractice or a desire to pursue legal action
Forty-one percent of complaints related to patient-provider relationships. Eighteen percent related to humanness and caring, 15 percent related to communication, and five percent related to patient-staff dialogue.
“These attributes are a reminder that patients need comprehensive and correct information but also expect that it be delivered with care, respect, and sensitivity,” the researchers reported. “The records we reviewed confirmed that even one negative, unkind, or disrespectful encounter can fundamentally alter a patient's perception of care.”
Only 11 percent of complaints related to patient safety and care quality, but these complaints were usually given a high severity rating.
“This finding also raises the possibility that quality and safety problems may have infrequently resulted in complaints, which could be the case if such incidents are handled with patients before complaints arise,” the researchers posited.
Dana Farber has an extensive care quality mitigation process, the researchers added. It is also possible that there were very few quality care issues in general, hence so few complaints about the matter.
The high severity of most quality and safety complaints ultimately highlight a need to pay more attention to these areas of care.
“The importance of quality and safety issues to patients and families should not be minimized,” the research team said. “When quality and safety concerns were raised, complaints were frequently of high severity, in part reflecting our severity taxonomy but also suggesting that their significance to patients was high.”
Forty-eight percent of all patient complaints pertained to administrative issues, such as billing, services, and access. These complaints were largely categorized as low severity, but the researchers maintained that the high prevalence demanded attention.
The researchers largely contended that each area in which patients made numerous complaints – interpersonal relationships, care quality and safety, and administrative issues – pointed to a need to make institutional improvements. However, the team noted that healthcare professionals should take special note of the importance patients place on patient-provider relationships and clear communication.
“Although complaints by outpatients at our cancer center covered a broad range of issues, the complaints we reviewed centered on patients' desire for care to be coordinated, seamless, and caring,” the researchers reported.
“These attributes are a reminder that patients need comprehensive and correct information but also expect that it be delivered with care, respect, and sensitivity,” the team added. “The records we reviewed confirmed that even one negative, unkind, or disrespectful encounter can fundamentally alter a patient's perception of care.”
The researchers also recommended adding patient complaint assessments to the litany of patient satisfaction and experience measures.
“On a broad level, evaluating rates and types of complaints across institutions may offer opportunity for quality benchmarking and evaluation of institutional performance over time,” the researchers concluded. “Individual centers can identify areas where the care experience is lacking by evaluating complaints, not only as single issues to be addressed on an individual basis but also as aggregate data revealing opportunities for improvement.”