Operationalizing patient-centered cancer care: A systematic review and synthesis of the qualitative literature on cancer patients' needs, values, and preferences

Determinants of Health-Related Quality of Life After Transarterial Chemoembolization in Hepatocellular Carcinoma Patients: A Systematic Review

Background/Objectives: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide, with transarterial chemoembolization (TACE) commonly used as a palliative approach for patients who are not candidates for surgical resection. Understanding the factors that influence health-related quality of life (HRQoL) after TACE is essential for improving patient-centered care. This systematic review seeks to consolidate current evidence on the variables that impact HRQoL in HCC patients post-TACE. Methods: In adherence to PRISMA guidelines, a comprehensive search was conducted across five English and Chinese databases-PubMed, Scopus, Web of Science, CNKI, and Wanfang-covering studies from database inception to May 2025. Eligible studies were observational and examined factors affecting HRQoL in post-TACE HCC patients. Two independent reviewers performed screening, data extraction, and quality assessment using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Nine studies met the inclusion criteria, including six cohort studies and three cross-sectional studies. The quality assessment rated seven studies as high quality and two as moderate. A range of validated HRQoL assessment tools was used, with the EORTC QLQ-C30 and FACT-G being the most commonly employed. The factors influencing HRQoL were grouped into five categories: (1) demographic factors (e.g., age, gender, education level); (2) clinical indicators (e.g., liver function, tumor burden); (3) psychological factors (e.g., depression, anxiety, spiritual well-being); (4) social support (e.g., financial status, coping mechanisms); and (5) physical symptoms (e.g., fatigue, pain, appetite loss). Across studies, both symptom severity and psychological distress were consistently associated with lower HRQoL. Conclusions: The HRQoL of HCC patients following TACE is influenced by a complex interplay of demographic, clinical, psychological, social, and symptomatic factors. Tailored, multidimensional interventions addressing these diverse aspects are crucial to optimizing recovery and improving overall well-being.

Nurses' Perceptions of Their Involvement in Shared Decision-Making for Advanced Cancer Treatment and Palliative Care; a Qualitative Interview Study

AIM

To explore nurses' perceptions of their involvement in shared decision-making for advanced cancer treatment and palliative care, and their contributions to patient involvement.

DESIGN

Exploratory qualitative research.

METHODS

In-depth interviews conducted in March-October 2023 with 15 nurses from two Norwegian hospitals were analysed using reflexive thematic analysis.

RESULTS

Two broad themes were constructed: Theme (1) 'Person-centredness; acquiring and sharing knowledge'; with subthemes; 'Knowing and speaking for the person with cancer', and 'Providing informational, emotional and practical facilitation and support', and Theme (2) Enacting the professional nurse role in complex situations'; with subthemes: 'Palliative cancer care decision-making is particularly complex', 'Systems and cultures shape nurses' roles and contributions', and 'Balancing beneficence and patient autonomy'.

CONCLUSION

Participants perceived themselves as contributing to shared decision-making, while facing challenges and dilemmas in their professional roles. More supportive interprofessional working might improve how health professionals involve patients in shared decision-making.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Increased development of nurses' contributions to shared decision-making about advanced cancer and palliative care could support their facilitation of patient involvement.

IMPACT

Although nurses can support people receiving palliative cancer treatment and care in shared decision-making, nursing's particular role and contribution has been unclear. Study findings suggest that nurses' important person-centred approach is challenging to maintain in treatment decision-making. These insights into nurses' involvement in shared decision-making could inform and contribute to the further development of interprofessional education, training, and leadership.

REPORTING METHOD

COREQ. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Provides in-depth knowledge on nurses' perceptions of their contributions to shared decision-making with patients and caregivers. Supports an increasing focus on nurses' role in facilitating and supporting patient involvement in treatment decision-making.

PATIENT OR PUBLIC CONTRIBUTION

A patient and public involvement group participated in study design and conduct.

The Impact of Person-Centered Care Indicators on Care Strain Among Care Aides in Long-Term Care Homes in New Brunswick: A Cross-Sectional Study

Background: Person-centered care (PCC) approaches are widely recognized for improving the quality of life of residents living with dementia in long-term care (LTC). However, residents are only one part of the care dyad, and it remains unclear whether PCC also impacts nursing care aides in similarly adventitious ways. Care aides in this context experience significant care strain, which refers to the physical, emotional, and psychological burden experienced by caregivers. While PCC approaches are promoted as the best approach for supporting residents living with dementia, there is limited research on whether their implementation also impacts care aides. This study examined potential associations between organization-level PCC indicators and care strain among nursing care aides who work with residents living with dementia in LTC homes in New Brunswick, Canada. Methods: A cross-sectional survey design was used to explore the relationship between PCC approaches and care strain. Care strain was measured using the strain in dementia care scale, including the daily emotions subscale. A modified version of the Dementia Policy Questionnaire assessed the extent to which PCC approaches were implemented in participants' workplaces. Descriptive statistics characterized the sample, and multivariable regression analyses examined associations between PCC indicators and care strain, adjusting for demographic factors. Results: Twenty-eight participants completed both measures. Overall, participants reported high levels of care strain but also high levels of positive daily emotions. Findings partially supported the hypothesis that PCC indicators were associated with lower care strain and more positive daily emotions. Certain PCC indicators, such as structured education and ethical support, appeared particularly beneficial. Implications for Practice: Strengthening PCC practices-especially through hands-on training and ethical support-may help reduce care strain and enhance care aides' emotional well-being. LTC facilities that prioritize these strategies over policy implementation alone may improve both staff well-being and quality of care for residents.

"Care needs to be integrated" Patient and provider perspectives on a cancer shared-care model

PURPOSE

Current early-stage breast and gynecological cancer care models often begin with a referral from a primary care provider (PCP) or gynecologist (OB/Gyn) and end with a patient being transitioned back to the referring provider at the completion of treatment. There is frequently little communication between oncologists and the referring provider during treatment, and this pattern continues after the patient completes their treatment.

METHODS

We convened a diverse Patient Advisory Board (PAB) to identify areas where breast or gynecological cancer patients felt they could benefit from additional support during and after their cancer care. PAB members attended five Zoom meetings and completed four online surveys. Semi-structured interviews were conducted with primary care or OB/Gyn physicians to collect information on current practices.

RESULTS

Patients identified multiple areas in which they needed additional support from their PCP. Providers also identified topics on which they could use additional training. However, there was little overlap between patient and provider priority topics. Both patients and providers agreed that there was inadequate communication between the cancer center and PCPs before, during, and after cancer treatment.

CONCLUSIONS

A shared-care model that emphasizes communication between primary care providers, the oncology care team, and patients is urgently needed. Patients indicated the need for additional support from their PCP on specific topics, and PCPs were interested in continuing their education to better serve their patients with cancer.

IMPLICATIONS FOR CANCER SURVIVORS

The importance of consistent communication among all parties during the entire cancer journey was emphasized as a key area for improvement.

The renewed Development Model for Integrated Care: a systematic review and model update

BACKGROUND

Organising integrated health services beyond domains in interorganizational networks, can be supported by conceptual models to overview the complexity. The Development Model for Integrated Care (DMIC) is a systematically developed generic model that has been applied to innovate and implement integrated care services in a large range of (international) healthcare settings. After a decade, it is important to incorporate new available literature in the model. Therefore, our aim was to update and further develop the DMIC by incorporating the current body of knowledge.

METHODS

A systematic literature review and subsequent stepwise systematic update of the DMIC.

RESULTS

The review of the literature resulted in 179 included studies and eventually 20 new elements for the development model, which could be positioned in the nine clusters. New elements address the importance of the social system and community of the client, proactive care during the life span, digital (care) services and ethical and value driven collaboration in interorganizational networks that cross domains. The added elements for integrated care build further on the nine thematic clusters and the model as a whole, expanded with new accents.

CONCLUSION

The renewed model emphasizes the connectedness of care within a larger eco-system approach and inter-organizational networks. The model captures current knowledge which can be supportive as a generic conceptual model to develop, implement or innovate integrated services towards health value in societies. Further, it can serve for healthcare services research purposes to reflect on an monitor developments in integrated care settings over time on multiple levels.

A qualitative study exploring the experiences of nurses delivering bacillus Calmette-Guérin therapy

BACKGROUND

Intravesical bacillus Calmette-Guérin (BCG) is an effective treatment for preventing recurrence and progression of non-muscle-invasive bladder cancer; however, patients often withdraw early from the treatment. Nurses have an integral role in delivering and overseeing treatment. The aim of this study was to explore nurses' perspectives on the factors that contribute to patients successfully completing BCG treatment.

METHOD

Three focus group interviews were conducted with nurses working at different hospitals in Norway. The empirical material was analysed using reflexive thematic analysis.

FINDINGS

The identified themes were 'relationship and continuity', 'knowledge and overview' and 'managing side effects'.

CONCLUSION

The study reveals several areas that nurses experience as contributing to patients completing their BCG treatment. The study also sheds light on how to improve practice through improved nurse training and optimalisation of interdisciplinary collaboration with urologists in order to assess and manage side effects in a more standardised way.

Cancer rehabilitation in clinical practice: a qualitative study exploring contact nurses' views on prerequisites

BACKGROUND

Individualized cancer rehabilitation should be an integral part of cancer care. Contact nurses play a key role in identifying patient needs and coordinating evidence-based interventions to support rehabilitation. However, cancer rehabilitation remains marginal in current practice, as contact nurses face challenges due to the lack of systematic processes for assessment, intervention, and follow-up, limiting its implementation across the cancer care trajectory. This study aims to explore contact nurses in cancer care views on their role in and prerequisites for cancer rehabilitation.

METHODS

Data were collected through 20 individual interviews with contact nurses working in Swedish cancer care and analyzed using qualitative content analysis.

RESULTS

A holistic approach to cancer rehabilitation was emphasized, yet establishing routines for assessment and addressing patients' changing needs was described as challenging. Contact nurses experienced themselves as responsible for rehabilitation even though their role often was unclear. Rehabilitation was further seen as a process often determined by the medical trajectory rather than patients' needs. To establish prerequisites for cancer rehabilitation supportive leadership and sufficient resources is essential.

CONCLUSION

There is a gap between cancer rehabilitation guidelines and their implementation in clinical practice, emphasizing the need for structure to support contact nurses to provide evidence-based individualized cancer rehabilitation. To enable cancer rehabilitation, supportive leadership at the organizational level is essential for contact nurses to establish routines in their clinical practice. These routines should align the rehabilitation process with patient needs, ensuring that rehabilitative services are effectively integrated into regular healthcare visits.

CLINICAL TRIAL NUMBER

Not applicable.

Patient-relevance of outcome measures in breast cancer clinical trials: a cross-sectional comparative analysis of patient preferences and trials conducted between 2014 and 2024

BACKGROUND

Worldwide, many clinical trials are performed using clinical outcomes and surrogate outcomes as endpoints. Surrogate outcomes are used, for instance, if there is not enough follow-up time to measure the outcome of interest. Surrogate outcomes might not be patient-relevant, however. This study assesses to what extent patient-relevant outcomes are measured in clinical trials for breast cancer drugs.

RESEARCH DESIGN AND METHODS

A cross-sectional comparative analysis was conducted in which patient preferences for outcomes derived from the literature were compared to outcomes measured in phase III breast cancer trials conducted between 2014 and 2024.

RESULTS

Patients prefer outcomes addressing survival benefits, treatment effectiveness, adverse events and health-related quality of life. Minor improvements in survival benefits are greatly valued. The majority of patients are willing to accept some side effects for a positive outcome. The primary outcome used most frequently in trials is progression-free survival. The most common secondary outcomes are adverse events, mortality, overall response rate, and health-related quality of life.

CONCLUSION

Phase III trial outcomes appear to align largely with breast cancer patients' preferences. Nevertheless, patients and trial designers emphasize different outcomes. Improvement is therefore needed to enhance the relevance of trial data for patients.

Cancer Care Experiences, Resilience, and Psychological Symptoms Among Patients During the COVID-19 Pandemic: A Mixed-Methods Study

PROBLEM STATEMENT

The aims of this study were to characterize patients' distress, psychological symptoms, and resilience during the COVID-19 pandemic, and to evaluate differences in the experiences, resilience, and psychological symptoms of patients with and without distress.

DESIGN

Convergent parallel mixed-methods.

DATA SOURCES

Semistructured interviews and structured questionnaires.

ANALYSIS

Interview transcripts were analyzed using content analysis. Differences in demographic and clinical characteristics, depression, anxiety, and resilience were identified using chi-square, Fisher's exact, and independent sample t tests. Joint displays facilitated data integration and meta-inferences.

FINDINGS

Of 54 patients, 25 patients who were distressed were more likely to have low resilience, exhibit symptoms of anxiety and depression, report difficulty paying their bills, and identify as Hispanic.

IMPLICATIONS FOR PRACTICE

A patient-centered approach to cancer care in which clinicians assess psychological, social, and economic resources and make referrals to supportive care services is warranted.

The journey of patients in cancer clinical trials: A qualitative meta-synthesis on experiences and perspectives

OBJECTIVE

To synthesize findings from qualitative studies focusing on adult cancer patients and their experiences and perspectives on clinical trials.

METHODS

A meta-synthesis was conducted on the literature retrieved from Scopus, Embase, PubMed, and PsycInfo databases. Patient quotes from papers were coded line-by-line using Nvivo software, and themes were created.

RESULTS

45 papers were included. Three large themes were identified based on the timeline of trials: (1) "pre-trial participation" includes sub-themes regarding informational needs, experience with the decision, and representations. (2) "Ongoing trial" includes subthemes covering supportive care, practical and psycho-physical burdens, identity and comparison with others, and the importance of maintaining hope. (3) "Post-trial," with subthemes covering comprehension of results and attitudes towards data sharing, perception of being left unattended, and hindsight and regretful thoughts.

CONCLUSION

This work emphasizes the importance of contextualizing patient experiences and holistically viewing trials. Additionally, this review stresses that patient narratives in the post-trial period are underrepresented in the literature.

PRACTICE IMPLICATIONS

Further research should prioritize the post-trial stage to enhance patients' psychological well-being and address concerns such as regret to reduce trial dropout rates. Emphasizing patient connections, providing clear trial-related information, and offering remote participation options, particularly for rural patients, are crucial steps in improving patient experience and trial adherence.

Patient Preferences for First-Line Treatment of Locally Advanced or Metastatic Urothelial Carcinoma: An Application of Multidimensional Thresholding

OBJECTIVES

Patient preferences have the potential to influence the development of new treatments for locally advanced/metastatic urothelial carcinoma (la/mUC), and therefore we explored how patients with la/mUC value different attributes of first-line treatments.

METHODS

An online preference survey and multidimensional thresholding (MDT) exercise were developed following a targeted literature review and qualitative interviews with physicians, patients with la/mUC, and their caregivers. Treatment attributes included two benefits (overall response rate [ORR], pain related to bladder cancer [scored 0-100; 100 being the worst pain possible]) and four treatment-related risks (peripheral neuropathy, severe side effects, mild to moderate nausea, mild to moderate skin reactions). A Dirichlet regression was used to estimate average preference weights. Marginal utility and the reduction in ORR that patients would accept in exchange for a 10-point decrease or a 10% decrease in other attributes were calculated.

RESULTS

A total of 100 patients were recruited and self-completed the survey and MDT. Mean patient age was 64.9 years (standard deviation, 7.6), 54% were female, and 38% identified as white. All included treatment attributes had a statistically significant impact on preferences. Changes in ORR had the largest impact, followed by cancer-related pain and treatment-related risks. Patients were willing to accept an 8.4% decrease in ORR to reduce their pain level by 10 points or a 7.8% decrease in ORR to reduce the risk of peripheral neuropathy by 10%. For a 10% decrease in severe side effects, mild to moderate nausea, or skin reaction, patients would accept decreases in ORR of 5.5%, 3.7%, or 3.4%, respectively.

CONCLUSIONS

Of the attributes tested, changes in ORR were most important to patients. Patients made tradeoffs between treatment attributes indicating that a lower ORR may be acceptable for an improvement in other attributes such as reduced cancer-related pain or the risk of treatment-related adverse events.

[Translation and transcultural adaptation of the Person-Centered Practice Inventory-Care for Spanish patients]

BACKGROUND

Person-centered care (PCC) positively impacts individuals by enhancing self-care, autonomy, well-being, skills, quality of life, and satisfaction with their care experience. The Person-Centered Practice Inventory-Care (PCPI-C), grounded in the Person-Centered Practice theoretical framework, is designed to assess healthcare users' perceptions of the PCC they receive. This study aims to develop the first Spanish version of the PCPI-C, translated and adapted to the Spanish context.

METHODS

The translation and cultural adaptation process followed the "Translation and Cultural Adaptation of Patient-Reported Outcomes Measures: Principles of Good Practice" guideline, which included a session with a group of experts and healthcare users. The clarity and relevance of each item, as well as the whole instrument, were assessed using the content validity index.

RESULTS

No difficulties were found during the process. The committee unanimously agreed to include the definition of compassion in the instrument due to its complexity and potential confusion with other terms. Regarding clarity and relevance, the content validity index revealed excellent results for all 18 items in terms of relevance and for 16 items in terms of clarity. The overall validity index for the instrument showed excellent result for both clarity and relevance (=0.95).

CONCLUSIONS

The first Spanish-adapted version of the PCPI-C, conceptually and semantically aligned with the original, is now available and demonstrates excellent scores for both clarity and relevance.

Higher and Middle Management Perspectives on Patient-Centered Care in an Oncology Setting: A Qualitative Study

BACKGROUND

Patient center care (PCC) plays a crucial role in achieving the organizational and patient outcomes. Literature suggests that PCC enhance patient's adherence to treatment, lower the cost of health care organization. This study aimed explore the higher and middle managers' perceptions of patient-centered care (PCC) in an oncology setting, identify the PCC implementation challenges in the oncology setting, and understand the role of managers in facilitating PCC within the oncology context.

METHODS

Sampling involved the use of the purposive sampling technique on 17 middle managers and 6 upper managers who had been working in an oncology setting. The six-step thematic analysis method was used for data analysis.

RESULTS

The interviews identified six main themes and seventeen subthemes: "comprehensive care, partnership, and informed decision-making", "infrastructure and support systems", "leadership influence on patient-centered care", "cultural and operational barriers", "perceived outcomes", and "strategies to enhance PCC in oncology". The subthemes of comprehensive care included fostering partnerships and enabling informed decisions. The infrastructure and support systems encompassed educational empowerment and service integration. Leadership influence highlighted the role of elevating awareness, providing organizational support, and promoting comprehensive care. The cultural and operational barriers addressed the challenges faced in implementation. The perceived outcomes focused on the results of patient-centered care, while strategies to enhance PCC in oncology provided actionable insights for improvement. This provides a comprehensive understanding of the perceptions of middle and higher managers on patient-centered care (PCC) in oncology settings. It identifies key challenges in PCC implementation, highlights the critical role of managers in facilitating PCC, and offers actionable strategies for enhancing PCC.

Measurement of Patients' Acceptable Symptom Levels and Priorities for Symptom Improvement in Advanced Prostate Cancer

Purpose

Limited research has evaluated the success criteria and priorities for symptom improvement of patients with cancer to inform patient-centered care. In this study, we adapted and tested a measure of these constructs, the Patient-Centered Outcomes Questionnaire (PCOQ), for patients with advanced prostate cancer. We compared acceptable symptom severity levels following symptom treatment across 10 symptoms and identified patient subgroups based on symptom importance.

Methods

Patients with advanced prostate cancer (N = 99) participated in a one-time survey, which included a modified version of the PCOQ, standard symptom measures, and additional clinical characteristics.

Results

The modified PCOQ demonstrated construct validity through its correlations with related theoretical constructs. There was a moderate correlation between symptom severity and importance. Acceptable symptom severity levels were generally low, with sexual dysfunction having a higher acceptable severity than most other symptoms. Three patient subgroups were identified: (1) those who rated all symptoms as low in importance (n = 43); (2) those who rated all symptoms as moderately important (n = 33); and (3) those who rated all symptoms as highly important (n= 18). Subgroups were associated with functional status, fatigue, sleep problems, pain, and emotional distress.

Conclusion

The modified PCOQ demonstrated preliminary evidence of construct validity. Patients generally considered low symptom severity to be acceptable, with variations across symptoms. Results suggest that symptom severity and importance are related but distinct aspects of the symptom experience in advanced prostate cancer. Patients' diverse priorities for symptom improvement point to the need for individualized treatment plans.

Exploring transitions in care among patients with head and neck CANCER: a multimethod study

BACKGROUND

Patients with head and neck cancers (HNC) experience many transitions in care (TiC), occurring when patients are transferred between healthcare providers and/or settings. TiC can compromise patient safety, decrease patient satisfaction, and increase healthcare costs. The evidence around TiC among patients with HNC is sparse. The objective of this study was to improve our understanding of TiC among patients with HNC to identify ways to improve care.

METHODS

This multimethod study consisted of two phases: Phase I (retrospective population-based cohort study) characterized the number and type of TiC that patients with HNC experienced using deterministically linked, population-based administrative health data in Alberta, Canada (January 1, 2012, to September 1, 2020), and Phase II (qualitative descriptive study) used semi-structured interviews to explore the lived experiences of patients with HNC and their healthcare providers during TiC.

RESULTS

There were 3,752 patients with HNC; most were male (70.8%) with a mean age at diagnosis of 63.3 years (SD 13.1). Patients underwent an average of 1.6 (SD 0.7) treatments, commonly transitioning from surgery to radiotherapy (21.2%). Many patients with HNC were admitted to the hospital during the study period, averaging 3.3 (SD 3.0) hospital admissions and 7.8 (SD 12.6) emergency department visits per patient over the study period. Visits to healthcare providers were also frequent, with the highest number of physician visits being to general practitioners (average = 70.51 per patient). Analysis of sixteen semi-structured interviews (ten patients with HNC and six healthcare providers) revealed three themes: (1) Navigating the healthcare system including challenges with the complexity of HNC care amongst healthcare system pressures, (2) Relational head and neck cancer care which encompasses patient expectations and relationships, and (3) System and individual impact of transitions in care.

CONCLUSIONS

This study identified challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within cancer care, which was perceived to have an impact on quality of care. These findings provide crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of TiC within this patient population.

The black box of the relationship between breast cancer patients and accompanying patients: the accompanied patients' point of view

BACKGROUND

The PAROLE-Onco program was introduced in the province of Quebec, Canada in 2019. It integrates accompanying patients (APs), i.e., people who have been affected by cancer, into the clinical team as full members. These APs use their experiential knowledge with people undergoing treatment and with clinical teams. The aim of this paper is to evaluate, within the framework of two university medical centers, the perceptions of breast cancer patients who receive support from APs, particularly in terms of their active involvement in their care trajectory.

METHODS

A qualitative study based on semi-structured interviews with accompanied patients was performed. Fourteen individual interviews were conducted between July and September 2021 with women presenting different profiles in terms of age, education, professional status, type of treatment, family situation, and clinical background. The data were analyzed using thematic analysis, focusing on patients' perceptions of APs' contributions and suggested improvements for accessing AP support.

RESULTS

Three themes emerged from the semi-structured interviews: communication modalities used to connect patients with their APs, the characteristics of the support provided by APs, and the perceived effects of this support on the patients. Patients expressed a preference for telephone communication, highlighting its convenience and accessibility. The support provided by APs included emotional and informational support, neutrality, and adaptability. This relationship improved patient communication, reduced anxiety, helped regain control, and enhanced overall quality of life. The results emphasized the added value of APs in complementing the support offered by healthcare professionals. Patients noted the critical role of APs in helping them navigate the healthcare system, better understand their treatment processes, and manage their emotions. The ability of APs to provide practical advice and emotional reassurance was particularly valued. Overall, the findings underscored the significant impact of AP support on patients' experiences and highlighted areas for enhancing this service.

CONCLUSION

This study highlights, during the care trajectory of people affected by breast cancer, APs' contribution to patients' emotional well-being because they improve, in particular, the management of emotions and communication with health professionals.

Using value-focused thinking to elicit oncologic inpatients' life and treatment objectives: a qualitative interview study

OBJECTIVE

Value-focused thinking (VFT) is a decision-making method that places the qualitative elicitation of decisionmakers' objectives at the beginning of the decision-making process. A potential healthcare application of VFT is to elicit patients' objectives to better understand what matters to them. Only then can treatments be tailored accordingly. This is particularly important for patients with life-threatening diseases such as cancer. Thus, this interview study used VFT to elicit the life and treatment objectives of non-terminal oncologic inpatients.

METHODS

Fifteen cancer inpatients (median age 66 years) were sampled in a German university hospital in September 2019. The participants completed questionnaires, the data of which were used to semi-structure the subsequent interviews. Data were analysed using inductive category formation to identify objectives in the transcribed interviews.

RESULTS

Sixteen objectives in five life domains (optimising physical wellbeing, optimising mental wellbeing, optimising personal life, optimising family life and optimising financial life) were identified.

CONCLUSION

Comparison of the findings with previous research indicated that VFT is a reliable approach to elicit patients' objectives. The identified objectives could increase understanding of the outcomes that cancer inpatients care about.

'It is important to feel invited': what patients require when using the Utrecht Symptom Diary - 4 Dimensional, a qualitative exploration

Background

In palliative care, the Utrecht Symptom Diary - 4 Dimensional (USD-4D), a Dutch-adapted and validated patient-reported outcome measure, supports multidimensional symptom management through identification and monitoring of, as well as dialogue on symptoms and needs. For the USD-4D to optimally support patients' autonomy, it is essential to know what patients need to use it.

Objective

This study aims to identify what patients need when using the USD-4D in clinical palliative care.

Design

A generic qualitative design with primary and secondary analyses of semistructured interviews.

Methods

Patients ⩾18 years with a life-limiting illness were purposefully recruited within hospice and home care settings if they were in their last year of life as identified by the surprise question. Patients had to be aware of their life-threatening condition. Patients were selected in two tranches. In the first tranche, patients had to have completed the USD-4D at least once. The second tranche consisted of patients who were not familiar with the USD-4D in clinical practice and were interviewed in a previous study on the content validity of the USD-4D. The interviews were transcribed verbatim and were subjected to thematic analysis.

Results

Twenty-five patients were included (14 men, ages 44-87). Patients' needs when using the USD-4D were summarized in three themes: (1) feeling invited, (2) being aware of the purpose and function of the USD-4D, and (3) experiencing a personal and nonjudgmental approach.

Conclusion

For patients to optimally benefit from the USD-4D as a supportive measure of their autonomy in clinical palliative care, it is essential that they feel invited to use it. Healthcare providers are tasked with setting the right preconditions for patients to want and to be able to use the USD-4D. For patients, this means healthcare providers should always be attuned to their personal preferences when communicating the purpose and function of the USD-4D and when they enter into dialogue with them.

Explorative observational study of Dutch patient-clinician interactions: operationalisation of personal perspective elicitation as part of shared decision-making in real-life audio-recorded consultations

OBJECTIVES

Patients' preferences, values and contexts are important elements of the shared decision-making (SDM) process. We captured those elements into the concept of 'personal perspective elicitation' (PPE), which reflects the need to elicit patients' preferences, values and contexts in patient-clinician conversations. We defined PPE as: 'the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or contexts potentially relevant to decision-making'. Our goal was to operationalise the concept of PPE through the evaluation of preferences, values and contexts and explore how PPE occurs in clinical encounters.

DESIGN

Cross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied.

SETTING

We audio-recorded patient-clinician interactions at three Dutch outpatient clinics. PPE was analysed using a novel observational coding scheme, distinguishing preferences, contexts and four Armstrong taxonomy value types (global, decisional, external and situational). We measured SDM using the Observer OPTION5.

PARTICIPANTS

Twenty patients who suffered from psoriasis or ovarian cysts; four clinicians.

RESULTS

We included 20 audio-recordings. The mean Observer OPTION5 score was 57.5 (SD:10.1). The audio-recordings gave a rich illustration of preferences, values and contexts that were discussed in the patient-clinician interactions. Examples of identified global values: appearance, beliefs, personality traits. Decisional values were related to the process of decision-making. External values related to asking advice from for example, the clinician or significant others. An identified situational value: a new job ahead. Contexts related to how the illness impacted the life (eg, sexuality, family, sports, work life) of patients.

CONCLUSIONS

The operationalisation of PPE, an important aspect of SDM, explores which preferences, values and contexts were discussed during patient-clinician interactions where an ePDA was used. The coding scheme appeared feasible to apply but needs further refinement.

Medical encounters with patients diagnosed with cancer: The association between physicians' behavior and perceived patient centered care and anxiety

PURPOSE

To evaluate the association between physicians' behavior and cancer patients' perceived patient-centered care (PCC) and anxiety following medical encounters.

METHODS

A prospective study design with 100 encounters, including 100 cancer patients and 22 oncology/surgery physicians, was performed between November 2019 and July 2021. Before the medical encounters, patients were asked to complete the validated State-Trait Anxiety Inventory (STAI), and physicians and patients completed sociodemographic and clinical data. During the medical encounters, structured 'real-time' observations of the physicians' behaviors were performed using the Four Habits Coding Scheme (4HCS). Following the medical encounters, patients were asked to re-complete the STAI and to fill the validated Perceived PCC questionnaire.

RESULTS

Mean 4HCS was positively associated with perceived PCC (β = 0.351, p < 0.001) and contributed 10.5% to the total 25.3% explained variance beyond the sociodemographic and clinical variables. Of the 4HCS sub scales, 'Demonstrate Empathy' displayed the lowest correlation with perceived PCC as compared to informational behaviors. In contrast, mean 4HCS was not associated with post-meeting anxiety (p > 0.05).

CONCLUSION

Our 'in-vivo' observations of medical encounters expands on previous studies in educational settings in showing how physicians' behaviors impact real patients' experience. The findings may provide a more accurate picture of physicians' supportive and unsupportive behaviors that impact on perceived PCC and anxiety. Patients may prefer their physicians to focus on the informational content related to their disease trajectory rather than focusing on empathy with their emotions. Physicians should be trained in ways to support patients on how to regain emotional control in stressful medical situations.

Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.

Effect of a Nurse Navigation Intervention on Mental Symptoms in Patients With Psychological Vulnerability and Breast Cancer: The REBECCA Randomized Clinical Trial

Importance

The unmet needs regarding symptom management of psychological distress among patients with breast cancer must be addressed. However, little evidence exists on effective interventions, such as nurse navigation.

Objective

To compare the long-term effects of the REBECCA (Rehabilitation After Breast Cancer) nurse navigation intervention vs usual care in patients with breast cancer who were psychologically vulnerable.

Design, Setting, and Participants

This parallel randomized clinical trial recruited and evaluated for eligibility adult female patients with newly diagnosed breast cancer and symptoms of psychological distress (distress score of ≥7 points on Distress Thermometer) at Rigshospitalet in Copenhagen, Denmark, from August 2017 to October 2019. This study continued the work of a pilot study, extending the follow-up to 18 months. Patients who met the inclusion criteria were randomized to either standard care or the REBECCA intervention. Intention-to-treat analyses were performed from June 2021 to October 2022.

Interventions

Patients who were randomized to the REBECCA intervention received nurse navigation and symptom screening as well as standard care. Standard care included regular treatment, nurse support at chemotherapy and radiotherapy appointments, and municipality-based rehabilitation.

Main Outcomes and Measures

The primary outcome was distress, as measured using the Distress Thermometer. The secondary outcomes included symptoms of anxiety, symptoms of depression, breast cancer-specific health-related quality of life, fear of recurrence, sleep, cognitive function, patient activation, pain, health behavior, body mass index, and need for support. Long-term effects at 6, 12, and 18 months were examined using mixed-effect models, adjusting for randomization strata of age and treatment modality.

Results

A total of 309 female patients were included in the analysis, with 153 patients randomized to the standard care group and 156 patients randomized to the REBECCA intervention group. Mean (SD) age was 56 (11) years with only small between-group differences. Patients receiving the REBECCA intervention compared with standard care had reduced (although not significant) symptoms of distress, especially at the 12-month follow-up (estimated effect = -0.51 [95% CI, -1.05 to 0.04]; effect size [ES] = -0.49). Significant effects were seen for symptoms of depression at 6 months (estimated effect = -1.39 [95% CI, -2.33 to -0.44]; ES = -0.27), and breast cancer-specific health-related quality of life at 12 months (estimated effect = 4.03 [95% CI, 1.28- 6.77]; ES = 0.31). Nonsignificant reductions were seen for symptoms of anxiety at 6 months (estimated effect = -1.00 [95% CI, -1.95 to -0.06]; ES = -0.21) and 12 months (estimated effect = -1.01 [95% CI, -1.97 to -0.04]; ES = -0.21), and a nonsignificant increase was seen for patient activation at 18 months (estimated effect = 3.52 [95% CI, -0.09 to 7.12]; ES = 0.25). Stronger intervention effects were observed for younger age, low patient activation, less education, and low social support.

Conclusions and Relevance

Results of this study indicate that patients with breast cancer who were psychologically vulnerable (ie, having moderate to high psychological distress) did not experience significant reduction in distress with nurse navigation. Further research is needed to develop the intervention's framework and investigate its potential use in clinical practice.

Trial Registration

ClinicalTrials.gov Identifier: NCT03254875.

Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel

OBJECTIVE

For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy.

DESIGN

The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys.

SETTING

The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care.

PARTICIPANTS

The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems.

OUTCOME MEASURES

The study planned to formulate a research agenda, implications for practice and recommendations for policy.

RESULTS

For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients.

CONCLUSIONS

Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.

Cancer treatments touch a wide range of values that count for patients and other stakeholders: What are the implications for decision-making?

BACKGROUND

Cancer rates and expenditures are increasing, resulting in debates on the exact value of this care. Perspectives on what exactly constitutes worthwhile values differ. This study aims to explore all values-elements regarding new oncological treatments for patients with cancer and all stakeholders involved and to assess their implications in different decision-making procedures.

METHOD

Thirty-one individual in-depth interviews were conducted with different stakeholders to identify values within oncology. A focus group with seven experts was performed to explore its possible implications in decision-making procedures.

RESULTS

The overarching themes of values identified were impact on daily life and future, costs for patients and loved ones, quality of life, impact on loved ones, societal impact and quality of treatments. The expert panel revealed that the extended exploration of values that matter to patients is deemed useful in patient-level decision-making, information provision, patient empowerment and support during and after treatment. For national reimbursement decisions, implications for the broad range of values seems less clear.

CONCLUSION

Clinical values are not the only ones that matter to oncological patients and the stakeholders in the field. We found a much broader range of values. Proper recognition of values that count might add to patient-level decision-making, but implications for reimbursement decisions are less clear. The results could be useful to guide clinicians and policymakers when it comes to decision-making in oncology. Making more explicit which values counts for whom guarantees a more systematic approach to decision-making on all levels.

The healthcare experiences of women with cardiac disease in pregnancy and postpartum: A qualitative study

INTRODUCTION

Cardiac disease affects an estimated 1%-4% of all pregnancies and is a leading cause of maternal morbidity and mortality. There is a lack of data on the healthcare experiences of affected women to inform health service delivery and person-centred care. This study sought to explore and understand the healthcare experiences of women with cardiac disease in pregnancy and postpartum.

METHODS

This qualitative study used semi-structured interviews with women who had cardiac disease in pregnancy or the first 12 months postpartum. Data were analysed using thematic analysis.

RESULTS

Participants were 25 women with pre-existing or newly diagnosed acquired, genetic and congenital cardiac disease. Analysis of the interviews highlighted the discrepancy between care aspirations and experiences. The participants had a wide range of cardiac diseases and timing of diagnoses, but had similar healthcare experiences of being dismissed, not receiving the information they required, lack of continuity of care and clinical guidelines and of feeling out of place within a healthcare system that did not accommodate their combined needs as a mother and a cardiac patient.

CONCLUSION

This study identified a lack of person-centred care and responsiveness of the healthcare system in providing fit-for-purpose healthcare for women with complex disease who are pregnant or new mothers. In particular, cardiac and maternity care providers have an opportunity to listen to women who are the experts on their emergent healthcare needs, contributing to development of the knowledge base on the healthcare experiences of having cardiac disease in pregnancy and postpartum.

PATIENT OR PUBLIC CONTRIBUTION

Public and patient input into the value and design of the study was gained through NSW Heart Foundation forums, including the Heart Foundation's women's patient group.

Quality of internet information to aid patient decision making in locally advanced and recurrent rectal cancer

BACKGROUND

To review whether online decision aids are available for patients contemplating pelvic exenteration (PE) for locally advanced and recurrent rectal cancer (LARC and LRRC).

METHODS

A grey literature review was carried out using the Google Search™ engine undertaken using a predefined search strategy (PROSPERO database CRD42019122933). Written health information was assessed using the DISCERN criteria and International Patient Decision Aids Standards (IPDAS) with readability content assessed using the Flesch-Kincaid reading ease test and Flesch-Kincaid grade level score.

RESULTS

Google search yielded 27, 782, 200 results for the predefined search criteria. 131 sources were screened resulting in the analysis of 6 sources. No sources were identified as a decision aid according to the IPDAS criteria. All sources provided an acceptable quality of written health information, scoring a global score of 3 for the DISCERN written assessment. The median Flesch-Kincaid reading ease was 50.85 (32.5-80.8) equating to a reading age of 15-18 years and the median Flesch-Kincaid grade level score was 7.65 (range 3-9.7), which equates to a reading age of 13-14.

CONCLUSIONS

This study has found that there is a paucity of online information for patients contemplating PE. Sources that are available are aimed at a high health literate patient. Given the considerable morbidity associated with PE surgery there is a need for high quality relevant information in this area. A PDA should be developed to improve decision making and ultimately improve patient experience.

Understanding the Delivery of Patient-Centered Survivorship Care Planning: An Exploratory Interview Study With Complex Cancer Survivors

Introduction:

Understanding key elements of the survivorship care planning process, such as patient-centered communication (PCC) and health self-efficacy, are critical for delivering patient-centered survivorship care to cancer survivors with multiple chronic conditions (“complex cancer survivors”). Building upon our team’s recent research efforts to examine the survivorship care planning process from a patient-centered lens, this exploratory study leveraged an ongoing quasi-experimental trial to elucidate the experience of complex cancer survivors with survivorship care planning and post-treatment management.

Methods:

We conducted a hypothesis-generating thematic content analysis on 8 interview transcripts.

Results:

Survivors reported positive experiences communicating with their oncology care team but the presence of multiple chronic conditions in addition to cancer creates additional barriers to patient-centered survivorship care.

Conclusion:

These findings support the need for further in-depth research aimed at improving PCC across all care teams and enabling self-management by delivering more personalized survivorship care planning that aligns with survivor’s needs, values, and preferences.

Patients' and oncologists' perspectives on a novel Clinician-led Fear of Cancer Recurrence (CIFeR) Intervention

PURPOSE

Despite strong demand from breast cancer survivors, there is a dearth of flexibly delivered, accessible psychological interventions addressing fear of cancer recurrence (FCR). This study aimed to explore patients' and clinicians' perspectives concerning the experience, utility and barriers to a novel clinician-led FCR intervention (CIFeR).

METHODS

Twenty female participants (mean age, 59.8, SD = 11.43), diagnosed with early-stage breast cancer (mean years since diagnosis = 2.8, SD = 1.37 years) participated in telephone interviews, and their five oncologists completed a semi-structured electronic survey. Thematic qualitative analyses were performed on interview transcripts and survey responses.

RESULTS

Findings indicated both patients and clinicians were positive about CIFeR with perceived cognitive, behavioural and emotional benefits of CIFeR most pronounced for patients with clinically significant FCR. All patients, however, found that receiving CIFeR (especially the tailored prognostic information) from their oncologists with whom they had a long-standing relationship added a much-needed human element to addressing FCR. Similarly, clinicians valued CIFeR as a clear and consistent way to address unmet needs around FCR, with some barriers around time, language and cultural issues noted.

CONCLUSION

Overall, all participants perceived CIFeR as strongly beneficial in reducing FCR and related worries, thus warranting further evaluation of its utility in clinical practice.