Bansal Meghana, Abdallah Al-Ola, Pennisi Angela, Arnaoutakis Konstantinos, Makhoul Issam, Mehta Paulette
Division of Hematology and Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Division of Hematology and Oncology, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.
J Cancer Educ. 2016 Dec;31(4):736-741. doi: 10.1007/s13187-015-0897-x.
Using the standardized ASCO Quality Oncology Practice Initiative (QOPI) guidelines for assessing quality cancer care, we identified communication about intent of chemotherapy as an area needing improvement in our program at the University of Arkansas for Medical Sciences (UAMS) and the Central Arkansas Veterans Healthcare System (CAVHS). We organized training in communications on intent of treatment (palliative vs curative) and added optional checkboxes to our electronic templates for progress notes. Afterwards, we conducted a retrospective review of electronic medical records of initially often randomly selected patient charts. The first 10 patient charts after 1 month of implementation showed intent of treatment in 80 % of charts compared to 74 % at baseline. We then changed checkboxes from mandatory to optional and reviewed 30 randomly selected patient charts. Intent of treatment was documented in 96.7 % of cases compared to 74 % at baseline. We also assessed patient satisfaction through surveys distributed in clinic. Patient satisfaction scores were close to 100 % for receiving clear information, understanding the reason for which they were receiving chemotherapy, and willingness of oncologists to listen carefully, to take time to answer questions, to explain things clearly, and to spend adequate time with them. In this study, we showed that training in communication of intent of chemotherapy and use of checkboxes in progress note templates could improve competency in communication of intent of therapy in cancer patients.
我们运用标准化的美国临床肿瘤学会肿瘤医疗质量改进计划（QOPI）指南来评估优质癌症护理情况，发现在阿肯色大学医学科学部（UAMS）和阿肯色州中部退伍军人医疗系统（CAVHS）的项目中，关于化疗意图的沟通是一个需要改进的领域。我们组织了关于治疗意图（姑息性治疗与根治性治疗）沟通的培训，并在电子病历模板中添加了可选的复选框。之后，我们对最初随机选取的患者病历的电子医疗记录进行了回顾性审查。实施1个月后的前10份患者病历显示，80%的病历中有治疗意图，而基线时这一比例为74%。然后，我们将复选框从必填改为可选，并审查了30份随机选取的患者病历。96.7%的病例记录了治疗意图，而基线时为74%。我们还通过在诊所发放的调查问卷评估了患者满意度。对于收到清晰的信息、理解接受化疗的原因以及肿瘤学家愿意认真倾听、花时间回答问题、清楚解释事情并与他们充分交流，患者满意度得分接近100%。在本研究中，我们表明化疗意图沟通培训以及在病程记录模板中使用复选框可提高癌症患者治疗意图沟通能力。
