Quality Of Supportive Care Research Articles

Understanding Consumer Perceptions and Awareness of Hospital-Based Maternity Care Quality Measures.

To explore factors that may influence use of comparative public reports for hospital maternity care. Four focus groups conducted in 2013 with 41 women and preintervention survey data collected in 2014 to 2015 from 245 pregnant women in North Carolina. As part of a larger randomized controlled trial, we conducted qualitative formative research to develop an intervention that will be evaluated through pre- and postintervention surveys. Analysis of focus group transcripts examined participants' perceptions of high-quality maternity care and the importance of different quality measures. Quantitative analysis included descriptive results of the preintervention survey and subgroup analyses to examine the impact of race, education, and being a first-time mom on outcomes. When describing high-quality maternity care, participants focused on interactions with providers, including respect for preferences and communication. The importance of quality measures was influenced by the extent to which they focused on babies' health, were perceived as the hospital's responsibility, and were perceived as representing "standard care." At baseline, 28 percent of survey respondents had used quality information to choose a hospital. Survey respondents were more aware of some quality measures (e.g., breastfeeding support) than others (e.g., episiotomy rates). Public reporting efforts could help increase relevance of maternity care quality measures by creating measures that reflect women's concerns, clearly explaining the hospital's role in supporting quality care, and showing how available quality measures can inform decisions about childbirth.

Unmet Supportive Care Needs in U.S. Dialysis Centers and Lack of Knowledge of Available Resources to Address Them

ContextBecause of high symptom burden, numerous comorbidities, and shortened life expectancy, dialysis patients are increasingly recognized as appropriate candidates for early and continuous supportive care. ObjectivesThe objectives of this study were to describe dialysis professionals' perceptions of the adequacy of supportive care in dialysis centers, barriers to providing it, suggestions for improving it, and familiarity with the existing evidence-based resources for supportive care of dialysis patients. MethodsThe Coalition for Supportive Care of Kidney Patients conducted an online survey of dialysis professionals and administrators solicited through the 18 End-Stage Renal Disease Networks and the Renal Physicians Association. ResultsOnly 4.5% of 487 respondents believed their dialysis centers were presently providing high-quality supportive care. They identified bereavement support, spiritual support, and end-of-life care discussions as the top three unmet needs. They reported that lack of a predictive algorithm for prognosis was the top barrier, and “guidelines to help with decision-making in seriously ill patients” was the top priority to improve supportive care. A majority of respondents were unaware that an evidence-based validated prognostic model and a clinical practice guideline to help with decision-making were already available. ConclusionDialysis professionals report significant unmet supportive care needs and barriers in their centers with only a small minority rating themselves as competently providing supportive care. There is an urgent need for education of dialysis professionals about available supportive care resources to provide quality supportive care to dialysis patients.

Patient Satisfaction With Nursing Care: Measuring Outcomes in an International Setting.

The purpose of this study was to assess patient satisfaction with nursing care. Patients' satisfaction with nursing care is considered an important factor in explaining patients' perceptions of service quality. The study was conducted in a major tertiary hospital in Riyadh, Saudi Arabia. An exploratory approach utilizing cross-sectional survey design was used. Data were collected from 424 patients through patients' interviews using the Arabic version of the Newcastle Satisfaction With Nursing Scale. The results showed a high level of satisfaction among patients in all hospital areas. Female patients were significantly more satisfied than males with no differences among other groups. Patient satisfaction with nursing care remains an important factor in explaining patients' perceptions of service quality. International healthcare settings should systematically monitor the relationship between nursing care and experience to support quality care provision.

Nursing staff interactions during the older residents' transition into long-term care facility in a nursing home in rural Norway: an ethnographic study.

BackgroundFuture challenges in many countries are the recruitment of competent staff in long-term care facilities, and the use of unlicensed staff. Our study describes and explores staff interactions in a long-term care facility, which may facilitate or impede healthy transition processes for older residents in transition.MethodsAn ethnographic study based on fieldwork following ten older residents admission day and their initial week in the long-term care facility, seventeen individual semi-structured interviews with different nursing staff categories and the leader of the institution, and reading of relevant documents.ResultsThe interaction among all staff categories influenced the new residents’ transition processes in various ways. We identified three main themes: The significance of formal and informal organization; interpersonal relationships and cultures of care; and professional hierarchy and different scopes of practice.ConclusionsThe continuous and spontaneous staff collaborations were key activities in supporting quality care in the transition period. These interactions maintained the inclusion of all staff present, staff flexibility, information flow to some extent, and cognitive diversity, and the new resident’s emerging needs appeared met. Organizational structures, staff’s formal position, and informal staff alliances were complex and sometimes appeared contradictory. Not all the staff were necessarily included, and the new residents’ needs not always noticed and dealt with. Paying attention to the playing out of power in staff interactions appears vital to secure a healthy transition process for the older residents.

Advances in treatment of de-novo pediatric acute myeloid leukemia.

To describe the current management of de-novo pediatric acute myeloid leukemia (AML), excluding promyelocytic leukemia and myeloid neoplasms of patients with constitutional trisomy 21. The biology of pediatric AML, which differs from that of its adult counterpart, is briefly discussed. Although survival of childhood AML has improved substantially over the past 40 years, progress has reached a plateau. Pediatric AML comprises several subtypes with diverse prognosis. Currently, about 35% of patients die of the disease, and survivors have many debilitating late effects. Clinical trials reported over the past 5 years have revealed several therapeutic concepts. First, initial intensive myelosuppressive chemotherapy is necessary to sufficiently reduce minimal residual disease and is associated with improved disease-free survival. Second, postremission chemotherapy with or without hematopoietic stem cell transplantation is necessary to eradicate AML. Third, central nervous system leukemia can be adequately managed with intrathecal chemotherapy and rarely requires radiotherapy. Finally, small differences in survival among clinical trials are explained by patient selection and quality of supportive care. The most crucial steps for progress are greater understanding of the biology of pediatric AML and introduction of new agents targeting specific AML subtypes and age-specific factors.

Quality of supportive care for patients with advanced lung cancer in the Veterans Health Administration.

Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care. To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality. We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care. Not all supportive care was evaluated. Care processes identified as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient's care to the correct facility. Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confirmed high-quality supportive care, while identifying significant facility-level variation in VHA.

Patient-reported quality of supportive care among patients with colorectal cancer in the Veterans Affairs Health Care System.

High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer. Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories. There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics. This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.

Early Care Planning Discussions Are Associated with Less Hospital Care at the End of Life in Veterans with Advanced Cancer (TH336-C)

1.List four factors that are associated with less intensive care at the end of life among veterans.2.Describe two components of early care planning discussions relevant to less intensive care at the end of life. Early discussions about end-of-life (EOL) care preferences are recommended in advanced cancer. Evaluate associations between early discussions about care preferences and intensity of EOL care among veterans with advanced cancer. We studied decedents from the VA National Cancer Quality ASSIST study, which evaluated the quality of supportive care for veterans diagnosed with Stage IV colorectal, lung, or pancreatic cancer in 2008. We assessed the multivariate relationship between discussion of care preferences in the first month after diagnosis and validated indicators of EOL care intensity (hospital care, intensive interventions, and chemotherapy in the last month of life or no/late hospice use), controlling for patient factors. Of 665 decedents (34% colorectal, 35% lung, 31% pancreatic), 47% had an early discussion of patient preferences. Mean survival time was 8 months. Patients who had an early discussion were less likely to receive hospital care at the EOL (OR:0.67; P=0.025) than patients who did not, although patients who were co-pay exempt were almost twice as likely to receive hospital care (OR:1.86; P =0.001) than those not exempt. Other patient factors associated with lower intensity of care at EOL included older age (patients>75 years were less likely than younger patients to receive EOL chemotherapy [OR:0.46; P =0.029) or no/late hospice [OR:0.59; P=0.014]); cancer type (lung [OR:0.60; P=0.014] and pancreatic [OR: 0.45; P=0.000] cancer patients were less likely to receive no/late hospice than colorectal cancer patients); and longer survival time (less likely to receive acute care [OR:0.95; P=0.000], intensive interventions [OR:0.94; P=0.013] and no/late hospice [OR:0.95; P=0.000]). Early discussions are associated with less hospital care among veterans at EOL. Older age, longer survival time, and certain cancer types are associated with lower, and co-pay exempt status with higher, intensity of care at EOL.

Patient-Reported Quality of Supportive Care Among Patients With Colorectal Cancer in the Veterans Affairs Health Care System

Patient-Reported Quality of Supportive Care Among Patients With Colorectal Cancer in the Veterans Affairs Health Care System

What type of feedback to clinicians best improves conformance to supportive care quality measures?

102 Background: Supportive care is under-addressed in oncology and an important area for quality improvement. Regular, directed feedback is an important component of effective quality management. What type of feedback yields the highest conformance to supportive care measures? Methods: Within the Carolinas Palliative Care Consortium, we conducted a series of three PDSA cycles, each one month-long, to evaluate various types of clinician-directed feedback on conformance to two supportive care measures. We collected data using a web-based, mobile health platform called QDACT-PC (Quality Data Collection Tool for Palliative Care). Every four weeks, feedback to clinicians on performance was changed in a stepwise fashion, from “no feedback” to “personal feedback” to “comparative feedback” (personal conformance compared to the rest of the Consortium). We monitored weekly changes to conformance to two quality measures: documentation of timely management of constipation and dyspnea. To meet the measures, symptoms with intensity of >3/10 on the Edmonton Symptom Assessment Scale required documentation of intervention within 24 hours. Conformance rates were calculated and compared to a historical baseline. Results: 23 providers participated in this quality improvement project, which spanned 465 patient encounters across 104 unique patients. Baseline data generated from 3/2008-10/2011 demonstrated baseline conformance to the dyspnea and constipation measures at 6% (27/457) and 4% (14/398), respectively. After addition of an electronic, prospective quality monitoring system alone (QDACT-PC), conformance increased to 93% (42/45) and 92% (23/25), respectively. With personalized, weekly feedback, these rates increased to 94% for dyspnea and 100% for constipation. Feedback comparing personal performance to the average of the rest of the Consortium further increased this to 100% for both. Conclusions: Regular, weekly feedback on performance increases conformance to supportive care quality measures. Adding comparative feedback versus other peers solidifies this effect. Duration of the effect is being evaluated.

Communication skills training for care staff: Supporting quality care for people with dementia living in the community

Communication skills training for care staff: Supporting quality care for people with dementia living in the community

Evaluation of how integrated HIV and TB programs are implemented in South Africa and the implications for rural-urban equity

In countries such as South Africa with a high prevalence of HIV and TB policy directives support program integration. Operational research suggests this is desirable, at least for increasing coverage of HIV and TB services, but warns that implementation models must take local health service infrastructure into account. A program evaluation of HIV and TB prevention and therapeutic services was performed at facility level in two purposefully selected districts in South Africa - one deep rural and an urban district - in order to describe integration and how it is implemented. Twenty-six rural and 146 urban public primary-care facilities were evaluated using secondary data generated from two large evaluations of HIV/TB/Sexually Transmitted Infections (STI) programs conducted in December 2008 and May 2009. The data collection tools consisted of a review of data in the routine health information system, a facility manager interview, a checklist for equipment and supplies, register reviews and a series of patient folder (health record) reviews. Data were collected on extent to which clients receive integrated services, as well as the quality of care, and the availability of key resources and system capacity to support quality care. Data were entered into MS Excel spreadsheets and proportions calculated for all indicators, and confidence intervals for proportions. Evidence of integration was found across two dimensions - disease programs and the prevention-therapeutic axis. Integration was enabled in both the rural and urban districts because HIV and TB services were co-located in the extensive network of general primary-care services. Smaller rural facilities did not always have staff trained in all the required services, nurses worked without the support of a doctor and supervision was weaker, threatening quality of care. In the rural district there were instances of clients receiving more integrated services. The quality of care in the TB program was high in both districts. In both the districts evaluated, integration across programs and the prevention-care-rehabilitation axis of services was achieved through co-location at primary-care level. Coupled with health system strengthening, this has the potential to improve access across the HIV/TB/STI cluster of services. The benefit is likely to be greater in rural areas. Quality of care was maintained in the long established TB programs in both settings.

Evolution of the Quality Oncology Practice Initiative Supportive Care Quality Measures Portfolio and Conformance at a Veterans Affairs Medical Center

A growing set of quality measures is being implemented to evaluate all components of cancer care, from diagnosis through the end of life. We investigated the Quality Oncology Practice Initiative (QOPI) quality measures portfolio. Additionally, we explored the effect of quality measure type on conformance. We performed QOPI data collections twice per year from fall 2007 through fall 2010 and spring 2012, using chart review of the Durham Veterans Administration outpatient oncology clinic. We categorized QOPI measures as nontreatment-related supportive care (NTSC), treatment-related supportive care (TSC), diagnostic, or therapeutic. Descriptive statistics and χ(2) were used to compare longitudinal conformance. The majority of QOPI measures in spring 2012 assess processes of chemotherapy treatment (therapeutic, 54.3%; TSC, 8.7%) or diagnostic modalities (19.6%). Measures targeting NTSC are few (17.4%) but increased from three measures in fall 2007 to eight measures in spring 2012. During those 5 years, average conformance to NTSC, TSC, diagnostic, and therapeutic measures was 71.4%, 86.1%, 89.3%, and 75.4%, respectively (P < .001). Within the NTSC measures, emotional well-being and constipation assessment were least documented (41.0% and 46.3%, respectively). In spring 2012, NTSC measure conformance (75.8%) remained significantly lower than diagnostic measure conformance (91.5%; P < .001). Most QOPI quality measures assess diagnosis or treatment processes of care and not supportive care. Aggregate conformance to the NTSC measures was lower than that of other categories. The differential conformance demonstrates the necessity of standardized documentation methods and quality improvement efforts that remain commensurate with the increasing portfolio of supportive care measures.

Conformance With Supportive Care Quality Measures Is Associated With Better Quality of Life in Patients With Cancer Receiving Palliative Care

As palliative care further integrates into cancer care, descriptions of how supportive care quality measures improve patient outcomes are necessary to establish best practices. We assessed the relationship between conformance to 18 palliative care quality measures and quality of life from data obtained using our novel point-of-care, electronic quality monitoring system, the Quality Data Collection Tool for Palliative Care (QDACT-PC). All patients with cancer from January 2008 through March 2011 seen in the Carolinas Palliative Care Consortium were evaluated for demographic, disease, prognostic, performance status, and measure conformance variables. Using univariate and multivariate regression, we examined the relationship between these variable and high quality of life at the initial specialty palliative care consultation. Our cohort included 459 patients, the majority of whom were over age 65 years (66%) and white (84%). Lung (29.1%) and GI (24.7%) cancers were most common. In univariate analyses, conformance to assessment of comprehensive symptoms, fatigue and constipation assessment, timely management of pain and constipation, and timely emotional well-being assessment were associated with highest levels of quality of life (all Ps < .05). In a multivariate model (C-stat = 0.66), performance status (odds ratio [OR], 5.21; P = .003), estimated life expectancy (OR, 22.6; P = .003), conformance to the measure related to emotional well-being assessment (OR, 1.60; P = .026), and comprehensive screening of symptoms (OR, 1.74, P = .008) remained significant. Oncology care pathways that routinely incorporate supportive care principles, such as comprehensive symptom and emotional well-being assessments, may improve patient outcomes.

The Evaluation of a New Supportive Care Screening Tool for Radiation Therapy Patients

ObjectivesIndividuals undergoing radiation therapy for cancer may experience a wide range of supportive care needs that are frequently not addressed. A screening tool was designed and tested for psychometric properties (technical characteristics) to assist radiation therapists to quickly identify those patients who require additional intervention during the course of their radiation treatment, allowing early and timely referral and facilitating the provision of quality, in-depth, and patient-centred supportive care. MethodologyA comprehensive and itemized screening tool was designed to identify the patient concerns and distress level, capture the patient desire to be helped with specific concerns, and inform the centre of alternative help provided. The tool was administered simultaneously with the standardized instrument quality-of-life questionnaire. One hundred and fifteen radiation therapy patients completed both instruments on three occasions; the first two were 2 days apart, and the third, 2 weeks later. To test the new tool for reliability and sensitivity, the agreement between the responses on the first two occasions and those between the first and third occasions were analysed for both instruments. Correlations between the responses on the two instruments were also examined for concurrent validity. ResultsMcNemar's test and the simple kappa coefficient both showed high agreement between item scores on the new screening tool when the first and the second occasions were compared. When the first and the third occasions were compared, the former test showed a shift from high agreement to lesser agreement across the item scores. The latter showed a shift in more than 97.7% of the items from a higher agreement to a lesser agreement. The new tool's sensitivity to change was further reinforced by the data from the validated quality-of-life questionnaire, which showed a similar change over time; the Pearson product moment correlation coefficient fell on average from 0.75 to 0.58 for the first and the second comparisons respectively, with all P values less than .0001. Concurrent validity was found to be acceptable. ConclusionsThe new screening tool was found to be reliable and sensitive, with acceptable validity. It is anticipated that the screening intervention will allow radiation therapists to standardize and formalize their approach to supportive care in radiation therapy outpatient clinics and enhance their capacity to identify and address patient concerns in a timely manner.

SIOP PODC: Recommendations for supportive care of children with cancer in a low‐income setting

These supportive care recommendations were prepared to guide doctors who practice in areas with significantly limited resources but who have sufficient infrastructure and training to treat children with cancer with curative intent. The success of any cancer treatment regimen depends largely on the availability and quality of supportive care and this also determines the intensity of treatment that can be delivered. We present practical recommendations on how to prevent infections, general nursing care, management of febrile neutropenia, nutritional assessment and support, treatment of co-infections and the social support to help prevent failure to complete treatment in resource poor settings.

Pediatric Scorpion Envenomation in the United States

In the Southwestern United States, the venom of the scorpion Centruroides sculpturatus (common name bark scorpion) can cause serious and potentially fatal neurotoxicity, with young children most vulnerable to its effects. Historically, advances in the quality of supportive care have made significant improvements in morbidity and mortality. In recent years, the development of effective antivenom therapies has changed the landscape of caring for these patients. This article reviews the background, pathophysiology, diagnosis, and treatment options for C. sculpturatus envenomation. Recent advances in immunotherapy and subsequent implications for pediatric emergency care providers are discussed.

Using Information Systems to better Support Quality Care at the end of Life

Quality is an important focus for every organisation involved in end-of-life care. Whether commissioning or providing services, organisations need to be able to measure progress in delivering care, demonstrate the progress in a systematic way and share best practice across their locality. Effective sharing of information is essential to the delivery of high-quality end-of-life care. This article describes how recent changes to the End of Life Care Quality Assessment (ELCQuA) Tool (National End of Life Care Intelligence Network, 2012) and the End of Life Care Coordination: Core Content. National Information Standard (ISB 1580) (National End of Life Care Programme (NEoLCP), 2012a) will help to support all those striving to commission and deliver the best care to people nearing the end of life. ELCQuA is a free, national, on-line tool, designed to support local service improvement and the commissioning of end-of-life care services (National End of Life Care Intelligence Network, 2012). It can be used by any organisation caring for people at the end of life, across the health, social care, voluntary and private sectors ( Table 1 ). Launched in May 2011, it was originally based on the national end-of-life care quality markers (Department of Health, 2009). It is now aligned with the National Institute for Health and …

Patient-reported Outcome Measures for Women with Vulvar Neoplasia – Current Situation and Future Directions

This article discusses concerns about women with vulvar neoplasia (vulvar intraepithelial neoplasia and vulvar cancer) and the available surgical treatment options. Given the gaps in the evidence base in terms of women with vulvar neoplasia and surgical treatment the women with vulvar Neoplasia-Patient Reported Outcome (WOMAN-PRO) research project focused on complications, symptoms and associated distress of women with surgically treated vulvar neoplasia. The main results of the research project are summarised, showing complications identified by clinicians, experiences reported by patients, the newly developed WOMAN-PRO instrument and symptom occurrence of each of 31 symptoms and the degree to which symptoms distressed women during the first seven days after discharge following surgical treatment for their vulvar neoplasia. Furthermore, based on the major findings of the project, suggestions for further research and clinical practice and conclusions are presented. We conclude that including patient self-report as a major element in follow-up care has the potential to enhance the quality of supportive care.

National evaluation of the VA’s quality of supportive care.

218 Background: Although known to provide more efficient end-of-life cancer care, the quality of VA’s end of life cancer care is unknown. We used Cancer Quality ASSIST to evaluate supportive care comprehensively in a national sample. Methods: We measured ASSIST QIs addressing symptoms, communication, treatment toxicities, and complications among 719 Veterans with a 2008 registry diagnosis of stage IV colorectal (37%), pancreatic (30%), or lung cancer (33%). We abstracted records from diagnosis for 3 years or until death among eligible Veterans (lived &gt;= 30 days following diagnosis with &gt;= 1 VA hospitalization or &gt;=2 VA outpatient visits). We determined patient-level overall and individual QI scores (%delivered/appropriate care) and confirmed reliability on a 5% sample, retaining 39 of 42 QIs. Results: Most Veterans were older (mean 66 years) male (97%), and white (68%) with 20% African American, and 3% Hispanic. 85% had &gt;=1 hospitalization and 93% died. Overall, subjects received 48% of recommended care. The average Veteran triggered 13 QIs, and scores ranged from 0-98% (pain 0-96%; dyspnea 11-98%, depression 36-79%, fatigue 4-80%, nausea/vomiting 41-87%, treatment toxicities 13-70%, care planning 18-86%). Notable gaps in care were identified. Inpatient pain screening was common (96%) but lacking for outpatients (58%). With opioids, bowel prophylaxis occurred for only 52% of outpatients and 70% of inpatients. Few patients had timely dyspnea evaluation (16%) or treatment (11%). Outpatient assessment of fatigue occurred for 32%. 24% of patients who received chemotherapy high risk for diarrhea were offered appropriate anti-diarrheals. Only 19% of Veterans had goals of care addressed in the month after a diagnosis of advanced cancer, and 63% of patients had timely discussion of goals following ICU admission. Most decedents (86%) were referred to palliative care or hospice before death. Single vs. multiple fraction radiotherapy should have been considered in 28 Veterans with bone metastasis, but none were offered it. Conclusions: These patient and family-centered supportive care gaps reflect important HRQOL impacts and targets for quality improvement in a system known for excellence in chronic disease care.