Nurse-led outpatient clinics in oncology care – Patient satisfaction, information and continuity of care
Introduction
Patients' experiences are considered valuable indicators in the evaluation of the quality of care and important end points in quality assessment at many hospitals (Brédart et al., 2010). Patient satisfaction has been defined as the patient's evaluation of the care, including both actual experiences and the patient's characteristics (Brédart, 2001). Although much empirical work has been performed, there are gaps in the theoretical underpinning regarding the concept patient satisfaction (Sitzia and Wood, 1997, Ware et al., 1983, Williams, 1994). Nevertheless, positive associations have been reported between high levels of patient satisfaction with care, adherence to treatment and health outcomes (Borras et al., 2001, Gupta et al., 2013).
Communication/information and continuity of care have been identified as important factors for patient dissatisfaction in addition to waiting time, duration of consultations, availability and accessibility (Säilä et al., 2008). Questionnaires being used for measuring patient satisfaction within oncology outpatient settings commonly include items comprising of education, the possibility of making choices and continuity of care, reflecting their importance (Brédart et al., 2014). Despite the usually high levels of patient satisfaction with care, patients often report deficiencies in patient information. Having access to correct, comprehensible information is a prerequisite for making informed decisions. Additionally, adequately informed patients report lower levels of anxiety and better quality of life (Cox et al., 2006, Davies et al., 2008, Husson et al., 2011). Meeting patients' information needs have been described as a core component in cancer care (Harrison et al., 2009). Yet, it has been shown that health care providers usually underestimate patients information needs (Caprici et al., 2005). Positive associations between reduced health information needs and experienced continuity of care have been reported among cancer patients (King et al., 2008). Improvement of the continuity of care was one of the main requests from outpatients with cancer (Bergenmar et al., 2006). Continuity of care has been defined in several ways but usually with insufficient conceptual clarity. Consequently, continuity of care has been measured in many different ways (Reid et al., 2002). However, the following prerequisites need to be met in order to fulfil the lowest common denominator; care have been provided over time and received and experienced by an individual patient (Reid et al., 2002). During cancer treatment, actions should be taken to increase the consistency of staff and information (Barnet and Shaw, 2013). In the “National cancer strategy for the future”, it was formulated that every cancer patient should be assigned a named nurse navigator who is responsible for keeping the patient informed and ensure the patient's involvement and influence in their care (Swedish Government Official Reports SOU, 2009:11).
During the last decades, there has been a considerable shift from inpatient admissions to outpatient visits within cancer care. In addition, the rapid development of treatments within oncology continuously requires new care interventions to meet patients' needs and to ensure their safety. Different strategies have been tested in order to meet patients' needs, e.g. follow-up by telephone and at nurse-led clinics (Cusack and Taylor, 2010, Lewis et al., 2009). At the Department of Oncology, Karolinska University Hospital, Solna, nurse-led clinics currently account for about 15% of outpatient care episodes, excluding radiotherapy and ambulatory chemotherapy. Nurse-led clinics are embedded in the clinical pathway for patients during their course of treatment at the Department of Oncology and patients attending the nurse-led clinics are undergoing curative, adjuvant or palliative treatments. Nurses perform symptom controls, controls of side effects and skin examinations; they administer treatment; they inform, support and educate patients and families before and during oncological treatment. Surveys to show patients' perception of nurse-led clinics have been performed every two years since 2007 in order to evaluate how patients' needs are met in terms of satisfaction, information and continuity of care (Sitzia and Wood, 1997).
The main objectives of this study were to investigate:
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Patients' satisfaction with nurse-led clinics over time
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Patients' perception of received information
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Associations between continuity of care and satisfaction with information
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The agreement between patient reported and registered continuity of care
Section snippets
Patients, measurement points and procedures
Surveys of patients' perception of nurse-led outpatient care were performed at the Department of Oncology, Karolinska University Hospital, Solna in 2007, 2009, 2011 and 2013. An information letter, questionnaire and a pre-paid envelope were sent to all patients who had attended the nurse-led clinics shortly after their visit. The letter informed patients about confidentiality and that it was voluntary to respond. One reminder was sent to those not responding within two weeks. Patients who did
Results
In Fig. 1, the sources of data, i.e. questionnaires and information from patients' medical records, by year and response rates are presented. The results of patients' satisfaction with nurse-led clinics are based on data from 962 patients (79%) who responded in one of the four surveys, which have been performed regularly every second year, starting in 2007. The fractions of missing values were between 3 and 4%, for responders, on all 12 items.
Discussion
The findings in the present study are based on the responses from four consecutive samples of patients at nurse-led clinics who completed questionnaires on satisfaction shortly after their visit. Patients' perceptions of the nurse-led clinic were stable over time. Of the 962 responding patients, more than 90% rated their waiting time as “acceptable”, the length of the appointment as “sufficient”, their nurse's interpersonal manners and the care at the clinic as “good”. Reported deficiencies
Conflicts of interest
None declared.
Acknowledgements
We thank Karolinska University Hospital, Department of Oncology for support and research time.
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