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Singh N, Giannitrapani KF, Gamboa RC, O’Hanlon CE, Fereydooni S, Holdsworth LM, Lindvall C, Walling AM, Lorenz KA. What Patients Facing Cancer and Caregivers Want From Communication in Times of Crisis: A Qualitative Study in the Early Months of the COVID-19 Pandemic. Am J Hosp Palliat Care 2024; 41:558-567. [PMID: 37390466 PMCID: PMC10315453 DOI: 10.1177/10499091231187351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Interpersonal communication is a cornerstone of patient-centered care. We aimed to identify what patients with cancer and caregivers may want from communication during a public health crisis. METHODS We interviewed 15 patients (8 Veteran, 7 non-Veteran) and caregivers from regionally, racially, and ethnically diverse backgrounds across the US about serious illness care and quality of care during the COVID-19 pandemic Using an iterative, inductive and deductive process, 2 coders analyzed content associated with the code "Communication," which appeared 71 times, and identified 5 themes. RESULTS Participants identified as White (10), Latino/a (3), Asian (1), and Black (1). (1) Help patients and caregivers prepare for care during crisis by communicating medical information directly and proactively. (2) Explain how a crisis might influence medical recommendations and impact on recovery from illness. (3) Use key messengers to improve communication between primary teams, patients, and caregivers. (4) Include caregivers and families in communication when they cannot be physically present. (5) Foster bidirectional communication with patients and families to engage them in shared decision-making during a vulnerable time. CONCLUSION Communication is critical during a public health crisis yet overwhelmed clinicians may not be able to communicate effectively. Communicating with caregivers and family, transparent and timely communication, ensuring diverse providers are on the same page, and effective listening are known gaps even before the COVID-19 pandemic. Clinicians may need quick interventions, like education about goals of care, to remind them about what seriously ill patients and their caregivers want from communication and offer patient-centered care during crises.
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Affiliation(s)
- Nainwant Singh
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Karleen F. Giannitrapani
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Raziel C. Gamboa
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | | | | | | | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anne M. Walling
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare Center, Los Angeles, CA, USA
| | - Karl A. Lorenz
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA HSR&D Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
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O’Hanlon CE, Walling AM, McClean M, Chu K, Lindvall C, Lee M, Stockdale SE, Leung LB. Depression care quality among patients with solid tumor cancers detected to have depression in Veterans Health Administration primary care clinics. Psychol Serv 2023; 20:764-769. [PMID: 37616079 PMCID: PMC10843783 DOI: 10.1037/ser0000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Patients with cancer, especially advanced cancer, experience depression at high rates. We aimed to evaluate the quality of depression care received by patients with solid tumor cancer and advanced solid tumor cancer in Veterans Affairs (VA) primary care clinics. This is a retrospective cohort study of patients seen in 82 VA primary care clinics who newly screened positive for depression on the Patient Health Questionnaire (PHQ-2). Outcomes included timely follow-up within 84 or 180 days (3+ mental health specialty, 3+ psychotherapy, or 3+ primary care visits with depression diagnosis codes) and minimum treatment within 1 year (60+ days antidepressants prescribed, 4+ mental health specialty visits, or 3+ psychotherapy visits). 608,042 individuals were seen in VA primary care clinics during this period; 49,839 patients (8.2%) had solid tumor cancer and 9,278 (1.5%) had advanced or poor-prognosis solid tumor cancer. For 686 observations of patients with cancer and new depression, rates of appropriate follow-up were 22.3% within 84 days and 38.2% within 180 days. For 73 observations of patients with advanced or poor-prognosis cancer and new depression, rates of appropriate follow-up were 21.9% within 84 days and 34.3% within 180 days. Rates of minimum treatment within 1 year were 68.4% and 64.4% for patients with cancer and patients with advanced or poor-prognosis cancer, respectively. Quality of timely depression management is low in patients with solid tumor cancers. Even in health systems with well-integrated mental health services, care gaps remain for patients with cancer and depression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Claire E. O’Hanlon
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Anne M. Walling
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy, UCLA Department of General Internal Medicine and Health Services Research
| | - Michael McClean
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Karen Chu
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Charlotta Lindvall
- Dana-Farber Cancer Institute Department of Psychosocial Oncology and Palliative Care (POPC), Brigham and Women’s Hospital Department of Medicine
| | - Martin Lee
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Susan E. Stockdale
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy
| | - Lucinda B. Leung
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy, UCLA Department of General Internal Medicine and Health Services Research
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O’Hanlon CE, Giannitrapani KF, Gamboa RC, Walling AM, Lindvall C, Garrido M, Asch SM, Lorenz KA. Integrating Patient and Expert Perspectives to Conceptualize High-Quality Palliative Cancer Care for Symptoms in the US Veterans Health Administration: A Qualitative Study. Inquiry 2023; 60:469580231160374. [PMID: 36891952 PMCID: PMC9998402 DOI: 10.1177/00469580231160374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 03/10/2023]
Abstract
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.
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Affiliation(s)
- Claire E. O’Hanlon
- RAND Corporation, Santa Monica, CA, USA
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA
| | - Karleen F. Giannitrapani
- Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Raziel C. Gamboa
- Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Anne M. Walling
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA
- University of California Los Angeles, Los Angeles, CA, USA
| | - Charlotta Lindvall
- Dana-Farber Cancer Institute, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Melissa Garrido
- Partnered Evidence-Based Policy Resource Center (PEPReC), Boston, MA, USA
- Boston University School of Public Health, Boston, USA
| | - Steven M. Asch
- Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Karl A. Lorenz
- Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
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Affiliation(s)
- Claire E. O’Hanlon
- grid.417119.b0000 0001 0384 5381Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (151), Los Angeles, CA 90073 USA
| | - Arpan Patel
- grid.19006.3e0000 0000 9632 6718Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, UCLA David Geffen School of Medicine, Division of Digestive Diseases, 11301 Wilshire Blvd (151), Los Angeles, CA 90073 USA
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OHanlon CE, O’Hanlon CE, Saliba D, Douglas J, Mitchell MN, Callaway-Lane C, Kramer J. SPREAD OF QUALITY IMPROVEMENT PROJECTS IMPLEMENTED IN A GERIATRICS WORKFORCE DEVELOPMENT PROGRAM. Innov Aging 2019. [PMCID: PMC6845193 DOI: 10.1093/geroni/igz038.2817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This project characterizes spread of quality improvement (QI) projects initiated in the U.S. Department of Veterans Affairs (VA) Geriatric Scholars Program (GSP) workforce development program. This mixed methods study analyzes a recent cross-sectional survey of GSP participants and program-level data on participant characteristics and QI project topics. We surveyed 578 scholars who had completed all program requirements to that point, and still worked for VA; 207 (35%) responded. The majority of respondents who had been in the program for at least six months (70%) reported sustainment of their QI project beyond initial implementation and nearly a third (30.4%) reported any spread beyond their own care team. QI project topics spanned many domains and percent of projects reporting spread varied across domains from 0% to 67%. A workforce development capstone activity in which participants demonstrate substantive and methodological competency can foster bottom-up QI activities in a large, diverse health care system.
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Affiliation(s)
- Claire E OHanlon
- VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
| | - Claire E O’Hanlon
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California, United States
| | - Debra Saliba
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy University of California; Los Angeles Borun Center for Gerontological Research, Los Angeles, California, United States
| | - Joseph Douglas
- Geriatric Research Education Clinical Center, VA Greater Los Angeles Healthcare System (contractor), North Hills, California, United States
| | - Michael N Mitchell
- Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy, North Hills, California, United States
| | - Carol Callaway-Lane
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research Education Clinical Center, Nashville, Tennessee, United States
| | - Josea Kramer
- Veterans Affairs Greater Los Angeles Healthcare System Geriatric Research Education Clinical Center Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, North Hills, California, United States
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