Abstract
ObjectivesPatients in oncological and palliative care (PC) often have complex needs, which require a comprehensive treatment approach. The assessment of patient-reported outcomes (PROs) has been shown to improve identification of patient needs and foster adjustment of treatment. This study explores occupational routines, attitudes and expectations of physicians and nurses with regards to a planned electronic assessment system of PROs.MethodsTen physicians and nine nurses from various PC settings in Southern Germany were interviewed. The interviews were analysed with qualitative content analysis.ResultsThe interviewees were sceptical about the quality of data generated through a patient self-assessment system. They criticised the rigidity of the electronic assessment questionnaire, which the interviewees noted may not fit the profile of all palliative patients. They feared the loss of personal contact between medical staff and patients and favoured in-person conversation and on-site observations on site over the potential system. Interviewees saw potential in being able to discover unseen needs from some patients. Interviewees evaluated the system positively in the case that the system served to broadly orient care plans without affecting or reducing the patient-caregiver relationship.ConclusionsA significant portion of the results touch upon the symbolic acceptance of the suggested system, which stands for an increasing standardisation and technisation of medicine where interpersonal contact and the professional expertise are marginalized. The study results can provide insight for processes and communication in the run-up to and during the implementation of electronic assessment systems.
Highlights
Current palliative care in own settingExpectations concerning the planned electronic assessment system Professional background. Setting background, special features of palliative care in setting. Structures, organization; working conditions; care goals; clientele. Processes of PC in setting. Needs assessment practices. Contact/relationship between nurses/physicians and patients. Needs assessment. Possibility to use and integration into routines. Changes in interaction and doctor-patient relationship. Need to use, benefits. Barriers to use. Possible changes on patient side.identify relevant needs
It is still unclear to what extent Patient-Reported Outcomes (PRO) are integrated into practice in daily patient care routines [4], studies suggest that integration is rather low in general practice [15,16,17,18] as well as PC [19]
Factors preventing the integration of PROs in practice include: medical staff being unconvinced by PROs assessment benefits; long, incomprehensible or inappropriate questionnaires; lack of training for medical staff to facilitate the interpretation and implementation of the assessment results [4, 14]
Summary
Interviewees criticise that standardised PROs do not adequately reflect the subjective reality of the patients and the complexity of their needs. They raise the question which subjects can be queried in “scales” at all. As a result of longer life expectancy and medical progress, the number of people living with an incurable, fatal disease is increasing [1] Previous studies have shown that early needs assessment and the ensuing treatment tailored to patient needs can result in a noticeable improvement in the quality of life of patients and the course of the disease [13]. Factors preventing the integration of PROs in practice include: medical staff being unconvinced by PROs assessment benefits; long, incomprehensible or inappropriate questionnaires; lack of training for medical staff to facilitate the interpretation and implementation of the assessment results [4, 14]
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