Manali I Patel1,2, Vyjeyanthi S Periyakoil2, David Moore3, Andrea Nevedal2, Tumaini R Coker4. 1. 1 Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA. 2. 2 VA Palo Alto Health Care System, Palo Alto, CA, USA. 3. 3 Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA. 4. 4 Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Abstract
OBJECTIVES: Persistent gaps in end-of-life cancer care delivery and growing associated expenditures remain imminent US public health issues. The objective of this study was to understand clinical providers' experiences delivering cancer care for patients at the end of life and their perspectives on potential solutions to improve quality of care. METHODS: Semistructured interviews were conducted with 75 cancer care providers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis. RESULTS: Providers identified 3 major cancer care delivery challenges including lack of time to educate patients and caregivers due to clinical volume and administrative burdens, ambiguity in determining both prognosis and timing of palliative care at the end-of-life, and lack of adequate systems to support non-face-to-face communication with patients. To address these challenges, providers endorsed several options for clinical practice redesign in their settings. These include use of a lay health worker to assist in addressing early advance care planning, proactive non-face-to-face communication with patients specifically regarding symptom management, and community and in-home delivery of cancer care services. DISCUSSION: Specific strategies for cancer care redesign endorsed by health-care providers may be used to create interventions that can more efficiently and effectively address gaps in end-of-life cancer care.
OBJECTIVES: Persistent gaps in end-of-life cancer care delivery and growing associated expenditures remain imminent US public health issues. The objective of this study was to understand clinical providers' experiences delivering cancer care for patients at the end of life and their perspectives on potential solutions to improve quality of care. METHODS: Semistructured interviews were conducted with 75 cancer care providers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis. RESULTS: Providers identified 3 major cancer care delivery challenges including lack of time to educate patients and caregivers due to clinical volume and administrative burdens, ambiguity in determining both prognosis and timing of palliative care at the end-of-life, and lack of adequate systems to support non-face-to-face communication with patients. To address these challenges, providers endorsed several options for clinical practice redesign in their settings. These include use of a lay health worker to assist in addressing early advance care planning, proactive non-face-to-face communication with patients specifically regarding symptom management, and community and in-home delivery of cancer care services. DISCUSSION: Specific strategies for cancer care redesign endorsed by health-care providers may be used to create interventions that can more efficiently and effectively address gaps in end-of-life cancer care.
Authors: Manali I Patel; Vandana Sundaram; Manisha Desai; Vyjeyanthi S Periyakoil; James S Kahn; Jay Bhattacharya; Steven M Asch; Arnold Milstein; M Kate Bundorf Journal: JAMA Oncol Date: 2018-10-01 Impact factor: 31.777
Authors: Ramy Sedhom; Richard Nudotor; Karen M Freund; Thomas J Smith; Lisa A Cooper; Jill T Owczarzak; Fabian M Johnston Journal: JCO Oncol Pract Date: 2021-01-21