Abstract
BACKGROUNDIt is important to maintain high-quality cancer care while reducing spending. This requires an understanding of how stakeholders define “quality.” The objective of this literature review was to understand the perceptions patients, physicians, and managed care professionals have about quality cancer care, especially chemotherapy.METHODSA computerized literature search was conducted for articles concerning quality cancer care in patients who received chemotherapy. Among >1100 identified sources, 25 presented interviews/survey results from stakeholders.RESULTSPatients defined quality cancer care as being treated well by providers, having multiple treatment options, and being part of the decision-making process. Waiting to see providers, having problems with referrals, going to different locations for treatment, experiencing billing inaccuracies, and navigating managed care reimbursement negatively affected patients' quality-of-care perceptions. Providers perceived quality cancer care as making decisions based on the risks-benefits of specific chemotherapy regimens and patients' health status rather than costs. Providers objected to spending substantial time interacting with payers instead of delivering care to patients. Payers must control the costs of cancer care but do not want an adversarial relationship with providers and patients. Payers' methods of managing cancer more efficiently involved working with providers to develop assessment and decision-assist tools.CONCLUSIONSDelivering quality cancer care is increasingly difficult because of the shortage of oncologists and rising costs of chemotherapy agents, radiation therapy, and imaging tests. The definition of quality cancer care differed among stakeholders, and healthcare reform must reflect these various needs to maintain and improve quality while controlling costs. Cancer 2011. © 2010 American Cancer Society
Highlights
It is important to maintain high-quality cancer care while reducing spending
PubMed medical subject heading (MeSH) terms included ‘‘Neoplasms/Drug Therapy’’; ‘‘Neoplasms/Radiotherapy’’; ‘‘Neoplasms/Surgery’’; ‘‘Cancer Care Facilities’’; ‘‘Oncology Service, Hospital’’; and ‘‘Radiation Oncology.’’ MeSH terms to capture studies on quality of care were ‘‘Quality of Health Care’’; ‘‘Quality Assurance, Health Care’’; and ‘‘Quality Indicators, Health Care.’’ For this study, we reviewed 875 article abstracts and applied inclusion/exclusion criteria (Fig. 1)
The conference abstracts were searched using the following terms: ‘‘quality of healthcare,’’ ‘‘quality of healthcare,’’ ‘‘quality assurance,’’ ‘‘quality indicators,’’ ‘‘quality care,’’ and ‘‘quality of care.’’ Additional articles were obtained from the selected article bibliographies and from online searches informed by content from the selected articles
Summary
It is important to maintain high-quality cancer care while reducing spending. This requires an understanding of how stakeholders define ‘‘quality.’’ The objective of this literature review was to understand the perceptions patients, physicians, and managed care professionals have about quality cancer care, especially chemotherapy. RESULTS: Patients defined quality cancer care as being treated well by providers, having multiple treatment options, and being part of the decision-making process. Providers perceived quality cancer care as making decisions based on the risks-benefits of specific chemotherapy regimens and patients’ health status rather than costs. The definition of quality cancer care differed among stakeholders, and healthcare reform must reflect these various needs to maintain and improve quality while controlling costs.
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