Search

Objective: This study aimed to examine whether being given the name of a clinical nurse specialist (CNS) is associated with better cancer patients' experiences across different points along their cancer care pathway. Methods: We identified 100,885 colorectal, lung, breast and prostate cancer patients who responded to the National Cancer Patient Experience Survey between 2010 and 2014. We compared experiences of four key aspects of cancer care among patients who reported being given a CNS name with those who did not, adjusting for age, sex, socio‐economic deprivation, ethnicity, route to diagnosis and disease stage. Results: Across all cancers, patients who reported being given the name of a CNS reported better experiences with involvement in treatment decisions, care coordination, treatment with more respect and dignity, and overall care experience. Experience of being involved in treatment decisions was the aspect of care most strongly associated with being given a CNS name (colorectal: OR 2.69, 95% CI: 2.45–2.96; lung: OR 2.41, 95% CI: 2.07–2.78; breast: OR 2.68, 95% CI: 2.47–2.92; and prostate: OR 2.11, 95% CI: 1.92–2.32). Conclusion: These findings may provide new evidence of the vital contribution CNS make to cancer care and suggest their input and support should be available to all patients after the diagnosis. [ABSTRACT FROM AUTHOR]

Abstract Background Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process. Methods One dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified. Results There were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’ aspects and were not always sufficiently detailed to identify specific improvement actions. Conclusions Our analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience.

Background English Cancer Patient Experience Survey (CPES) data show patients with brain cancer report the least-positive experiences of general practice support. We aimed to understand these findings by identifying the issues described in qualitative survey feedback and suggest how care may be improved. Methods We reviewed 2699 qualitative comments made to open questions about what was good or might be improved about National Health Service care between 2010 and 2014. We identified 84 (3%) specific comments about general practice care and used open coding and framework analysis to develop a thematic framework. Results We identified 3 key themes and 12 subthemes: first, the experience of initial diagnosis by a general practitioner (GP), including apparent complexity of making the diagnosis, apparent slowness in referral for investigation, referral made by patient or family, delay in receiving scan results, and whether the GP quickly identified the problem and referred to a specialist; second, the experience of care and support from the general practice, including lack of supportive response from the GP, lack of follow-up care from the GP, lack of family involvement by the GP, lack of GP knowledge about management, and whether the GP responded in a supportive way to the diagnosis; and third, the experience of overall coordination in care, including lack of communication between the hospital and general practice and good communication about the care plan. Conclusion Qualitative responses from patients with brain cancer reveal their needs for better emotional and practical support within primary care. Suggestions include increasing the speed of initial referral for investigation, the depth of discussion about diagnostic difficulties, and developing coordinated care plans with cancer centers. [ABSTRACT FROM AUTHOR]

Background National surveys of patients' experiences of English cancer services found improvements between 2000 and 2004, particularly in the areas of information, communication and trust in professionals. Objectives We assessed the potential such surveys might have to stimulate service improvements by comparing their inclusion criteria, sampling and timing and by investigating how representative they were of patients registered with cancer in South East England. Where hospital trusts had data from 50 patients with the same cancer, we determined whether national improvements in six key areas held at hospital trust level. Design Data were extracted from the two national surveys and from the Thames Cancer Registry. Results The 2000 survey achieved a higher response rate, included a larger number of hospital trusts, and a wider range of cancer sites, but a lower proportion with lung cancer. Each survey sampled patients at different points following diagnosis, with a year elapsing between data collection and reporting. Compared with cancer registry data, breast cancer patients appeared most well-represented. Only three hospital trusts had sufficiently large samples to allow comparison over time. We found no change in experience in three of the key areas, but a significant decline from previously high scores in two. Conclusion To provide information useful for quality improvement future surveys will need to sample larger numbers of patients from most hospital trusts, including patients with less common cancers or receiving palliative care. Surveys should also sample patients at a consistent time after diagnosis and feedback results more rapidly to services. [ABSTRACT FROM AUTHOR]

Rationale There was local concern over possible delays in the diagnosis and referral of patients with suspected colorectal cancer and interest in understanding more about patients’ experiences of diagnosis. Aims and objectives To use clinical audit, qualitative data from patients and feedback from general practitioners (GPs) to identify possible delays in referral, and to decrease these by implementing referral guidelines. Methods Audit of endoscopy referrals assessed how often these recorded rectal examination and whether patients were seen within 2 weeks. Qualitative interviews with 19 patients explored their experience of referral and diagnosis. Review of 33 case records assessed other possible delays. Results Most patients referred for endoscopy were seen within 2 weeks (67%, 119/177), but only 47% (71/151) of available referral letters mentioned rectal examination. Patients perceived most delay in secondary care and case records suggested that this occurred after non-urgent referral. Patients also identified some problems with communication, information and support about the diagnosis. We used the results to stimulate local acceptance of national referral guidelines and wider discussion about care. A consultation exercise with GPs informed the development of a faxable urgent referral pro forma and supporting educational meetings. We designed a database to monitor changes in waiting times and made plans to improve communication and support after diagnosis. Discussion Feeding back qualitative data from patients together with audit results seemed a powerful lever to stimulate action about hospital delays. Average waiting times dropped quickly and remained low due to the continuing national focus upon them. Seeking GP views may have promoted the use of referral pro formas, but monitoring waiting times distracted from a more thorough evaluation of their use. Qualitative data from patients raised awareness of their experience, but was time-consuming to collect and we had limited success in using it for specific initiatives around communication and support. [ABSTRACT FROM AUTHOR]