Integrating Patient and Expert Perspectives to Conceptualize High-Quality Palliative Cancer Care for Symptoms in the US Veterans Health Administration

A Qualitative Study

Bibliographic Data

ID13775180
AuthorsClaire E O’Hanlon (0000-0001-6398-5845, RAND Corporation, Santa Monica, CA, USA, corresponding author), Karleen F Giannitrapani (0000-0003-0987-6204, Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA), Raziel Gamboa (Center for Innovation), Raziel C Gamboa (Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA), Anne M Walling (0000-0001-6026-3249, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA), Charlotta Lindvall (0000-0003-2090-2039, Dana-Farber Cancer Institute, Boston, MA, USA), Melissa M Garrido (0000-0002-8986-3536, Boston University), Melissa Garrido (Partnered Evidence-Based Policy Resource Center (PEPReC), Boston, MA, USA), Steven M Asch (0000-0001-5838-5335, Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA), Karl Lorenz (0000-0001-7371-2365, Center for Innovation), Karl A Lorenz (Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA)
Year2023
Volume60
Pages469580231160374-469580231160374
Publication date2023-01-01
Open AccessYes
TypeARTICLE
VenueINQUIRY The Journal of Health Care Organization Provision and Financing (JOURNAL)
Journal identifiersISSN: 0046-9580 • E-ISSN: 1945-7243
PublisherSAGE Publishing (PUBLISHER • US)
DOI10.1177/00469580231160374
PMID36891952
OpenAlexW4323652406
LanguageEN
References cited31

Quality measurement is typically the domain of clinical experts and health system leaders; patient/caregiver perspectives are rarely solicited. We aimed to describe and integrate clinician and patient/caregiver conceptualizations of high-quality palliative symptom care for patients receiving care for advanced cancer within the US Veterans Health Administration in the context of existing quality measures. We conducted a secondary qualitative analysis of transcripts from prioritization discussions of process quality measures relevant to cancer palliative care. These discussions occurred during 2 modified RAND-UCLA appropriateness panels: a panel of 10 palliative care clinical expert stakeholders (7 physicians, 2 nurses, 1 social worker) and a panel of 9 patients/caregivers with cancer experience. Discussions were recorded, transcribed, and independently double-coded using an a priori logical framework. Content analysis was used to identify subthemes within codes and axial coding was used to identify crosscutting themes. Patients/caregivers and clinical experts contributed important perspectives to 3 crosscutting themes. First, proactive elicitation of symptoms is critical. Patients/caregivers especially emphasized importance of comprehensive and proactive screening and assessment, especially for pain and mental health. Second, screening and assessment alone is not enough; information elicited from patients must inform care. Measuring screening/assessment and management care processes separately has important limitations. Lastly, high-quality symptom management can be broadly defined if it is patient-centered; high-quality care takes an individualized approach and might include non-medical or non-pharmacological symptom management. Integrating the perspectives of clinical experts and patients/caregivers is critical for health systems to consider as they design and implement quality measures for palliative cancer care

Context (archaeology · Health care · Palliative care · Qualitative research · Quality (philosophy · Cancer survivorship and care · Medicine · Nursing · Palliative Care and End-of-Life Issues · Patient Dignity and Privacy · Psychology

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