Thomas W LeBlanc1, Christine S Ritchie2, Fred Friedman3, Janet Bull4, Jean S Kutner5, Kimberly S Johnson6, Arif H Kamal3. 1. Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: thomas.leblanc@duke.edu. 2. University of California at San Francisco School of Medicine, San Francisco, California, USA. 3. Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA. 4. Four Seasons, Flat Rock, North Carolina, USA. 5. University of Colorado School of Medicine, Aurora, Colorado, USA. 6. Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Geriatrics Research Education and Clinical Center, Durham VAMC, Durham, North Carolina, USA.
Abstract
CONTEXT: Measuring What Matters (MWM) prioritizes quality measures in palliative care practice. Hematologic malignancy patients are less likely to access palliative care, yet little is known about their unique needs. Differences in MWM adherence may highlight opportunities to improve palliative care in hematology. OBJECTIVES: To assess adherence to MWM measures by palliative care clinicians caring for patients with hematologic malignancies, compared to those with solid tumors. METHODS: We used the Quality Data Collection Tool to assess completion of MWM measures across nine sites. RESULTS: We included data from 678 patients' first visits and various care settings; 64 (9.4%) had a hematologic malignancy, whereas 614 (90.6%) had a solid tumor. Hematology patients were more likely to be seen in a hospital (52 or 81.3% vs. 420 or 68%), whereas solid tumor patients were more frequently seen at home or in clinics (160 or 26% vs. 7 or 10.9%). Of the nine MWM measures we assessed, high adherence (>90%) was seen regardless of tumor type in measures #3 (Pain Treatment), #7 (Spiritual Concerns), #8 (Treatment Preferences), and #9 (Care Consistent With Preferences). Clinicians seeing hematology patients were significantly less likely to meet measures #2 (Screening for Physical Symptoms; 57.8% vs. 84.2%, P < 0.001), and #5 (Discussion of Emotional Needs; 56.3% vs. 70.0%, P = 0.03). CONCLUSION: MWM adherence regarding symptom assessment and meeting emotional needs was lower for patients with hematologic malignancies compared to those with solid tumors. This finding suggests two key areas for quality improvement initiatives in palliative care for patients with hematologic malignancies.
CONTEXT: Measuring What Matters (MWM) prioritizes quality measures in palliative care practice. Hematologic malignancypatients are less likely to access palliative care, yet little is known about their unique needs. Differences in MWM adherence may highlight opportunities to improve palliative care in hematology. OBJECTIVES: To assess adherence to MWM measures by palliative care clinicians caring for patients with hematologic malignancies, compared to those with solid tumors. METHODS: We used the Quality Data Collection Tool to assess completion of MWM measures across nine sites. RESULTS: We included data from 678 patients' first visits and various care settings; 64 (9.4%) had a hematologic malignancy, whereas 614 (90.6%) had a solid tumor. Hematology patients were more likely to be seen in a hospital (52 or 81.3% vs. 420 or 68%), whereas solid tumorpatients were more frequently seen at home or in clinics (160 or 26% vs. 7 or 10.9%). Of the nine MWM measures we assessed, high adherence (>90%) was seen regardless of tumor type in measures #3 (Pain Treatment), #7 (Spiritual Concerns), #8 (Treatment Preferences), and #9 (Care Consistent With Preferences). Clinicians seeing hematology patients were significantly less likely to meet measures #2 (Screening for Physical Symptoms; 57.8% vs. 84.2%, P < 0.001), and #5 (Discussion of Emotional Needs; 56.3% vs. 70.0%, P = 0.03). CONCLUSION: MWM adherence regarding symptom assessment and meeting emotional needs was lower for patients with hematologic malignancies compared to those with solid tumors. This finding suggests two key areas for quality improvement initiatives in palliative care for patients with hematologic malignancies.