Patients’ Perspectives on Quality of Serious Illness Care in Primary Care (S716)

Abstract

•Identify major themes in quality of serious illness care, in the context of overall quality in primary care, from the patient perspective.•Describe the importance of integrating the patient perspective into the development and/or enhancement of quality measures in serious illness care. Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. To explore patients’ perspectives on the quality of serious illness care in the primary care context. We interviewed 20 patients aged 60 and older who were participants in a primary care clinic advance care planning quality improvement initiative. We used a semi-structured, open-ended guide focusing on how patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes using MAXQDA 12. We used thematic analysis and a constant comparative method to refine emergent themes based on what was consistently reported and perceived into a finalized codebook reflecting quality of primary care. We identified five main themes pertinent to patients: (1) clinician-patient communication, (2) coordination of care, (3) shared decision-making, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between clinicians and patients, empowered patients’ role in shared decision-making, enhanced clinicians’ perceived competence and facilitated access. Although access to care is not traditionally considered an aspect of quality, patients considered it to be a key factor integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. For quality of serious illness care in the primary care context, patients identified communication as an overarching theme, as well as coordination, shared decision-making, competence and access.