Development of indicators for patient-centred cancer care

Purpose

Assessment of current practice with a valid set of indicators is the key to successfully improving the quality of patient-centred care. For improvement purposes, we developed indicators of patient-centred cancer care and tested them on a population of patients with non-small cell lung cancer (NSCLC).

Methods

Recommendations for patient-centred care were extracted from clinical guidelines, and patients were interviewed to develop indicators for assessing the patient-centredness of cancer care. These indicators were tested with regard to psychometric characteristics (room for improvement, applicability, discriminating capacity and reliability) on 132 patients with NSCLC treated in six hospitals in the east Netherlands. Data were collected from patients by means of questionnaires.

Results

Eight domains of patient-centred cancer care were extracted from 61 oncology guidelines and 37 patient interviews and were translated into 56 indicators. The practice test amongst patients with NSCLC showed the most room for improvement within the domains ‘emotional and psychosocial support’, ‘physical support’ and ‘information supply’. Overall, 26 of the 56 indicators had good psychometric characteristics.

Conclusions

Developing a valid set of patient-centred indicators is a first step towards improving the patient centredness of cancer care. Indicators can be based on recommendations from guidelines, but adding patient opinions leads to a more complete picture of patient centredness. The practice test on patients with NSCLC showed that the patient centredness of cancer care can be improved. Our set of indicators may also be useful for future quality assessments for other patients with cancers or chronic diseases.

Diagnostic Yield of Transbronchial Histology Needle Aspiration in Patients with Mediastinal Lymph Node Enlargement

<i>Background:</i> Transbronchial needle aspiration (TBNA) is a safe, minimally invasive technique to assess the mediastinal spread of lung cancer. Excellent results have been published by experts. However, little information is available about the diagnostic yield of TBNA with the histology needle in a non-expert center. <i>Objectives:</i> The aim of this study is to assess the diagnostic yield of histology TBNA in the workup of suspected lung cancer. <i>Methods:</i> In a non-university teaching hospital, TBNA data from patients diagnosed with lung cancer between June 1998 and July 2000 were analyzed retrospectively. TBNA had been performed by six different bronchoscopists in patients eligible for surgery with accessible N2 and N3 lymph nodes on computed tomography of the chest during the workup of an undefined mass. Cytology and histology specimens were obtained with the same 19-gauge needle. TBNA results were considered to be diagnostic if cytologic or histologic examination revealed a malignant lesion or non-malignant lymphoid cells. However, TBNA outcome was called non-diagnostic if no representative cells were obtained. <i>Results:</i> From a group of 264 consecutive lung cancer patients, 106 (40%) patients were eligible for TBNA. In 79%, TBNA was diagnostic in cytology and/or histology specimens. Malignancy was demonstrated in 59% (63/106). In only 32/106 patients (30%), a histologic core of tissue could be sampled. In 87.5% of these patients (28/32), TBNA was diagnostic. For cytology only, this number was slightly lower (75%, 56/74). In 12 cases, diagnostic TBNA was verified by mediastinoscopy: these diagnoses were concordant. The sensitivity is 65% if all non-confirmed cases are considered false negative. Ten mediastinoscopies were avoided because TBNA demonstrated contralateral N2 (= N3) disease. The routine use of TBNA during bronchoscopy in suspected N2 disease is a cost-effective procedure, as the total additional costs of TBNA (9,540 EUR) were lower than the costs of 10 avoided mediastinoscopies (15,500 EUR). No complications were observed. <i>Conclusion:</i> The diagnostic yield of TBNA relied mainly on cytology specimens, despite the use of a histology needle. Representative histology specimens could only be obtained in 28/106 patients (26%). Since TBNA was performed in a general hospital by different bronchoscopists, this procedure is useful in the workup of lung cancer patients with enlarged lymph nodes.

Dose regimens of human growth hormone: effects of continuous infusion and of a gelatin vehicle on growth in rats and rate of absorption in rabbits

Different methods for administration of human growth hormone (hGH) have been examined with a view to efficient use of the limited amounts of hGH at present available for clinical use. We found that in hypophysectomized rats (1) hGH administered by continuous subcutaneous infusion induced a greater increase in body weight (referred to throughout as growth) than hGH administered by intermittent (daily) injection and (2) intermittent injections of hGH dissolved in 16% gelatin induced more growth than hGH dissolved in a glycine buffer. It was further found that (1) hGH dissolved in 16% gelatin compared with hGH dissolved in a glycine buffer induced lower maximal levels of immunoreactive plasma hGH and between 7 and 9 h after treatment higher plasma levels when injected subcutaneously in rabbits, (2) 125I-labelled hGH added as a tracer to hGH in gelatin was removed more slowly from subcutaneous injection sites in rabbits than 125I-labelled hGH given with hGH in glycine buffer and (3) changes in the ratio of hGH to gelatin had little effect on the time-course of plasma levels of hGH in the rabbit. Addition of the protease inhibitors aprotinin or 6-aminohexanoic acid, to injection of hGH in gelatin or glycine did not induce any consistent increase in plasma levels of hGH.