From the Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, Massachusetts.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
J Patient Saf. 2021 Dec 1;17(8):e1278-e1284. doi: 10.1097/PTS.0000000000000510.
Many patients with cancer believe that something has gone wrong in their care but are reluctant to speak up. This pilot study sought to evaluate the impact of an intervention of active outreach to patients undergoing cancer treatment, wherein patients were encouraged to speak up if they had concerns about their care and to describe the types of concerns patients reported.
Patients receiving cancer care at two sites were randomly assigned to an intervention or control group. Intervention patients received a brochure encouraging them to speak up about any concerns and an outreach telephone call during which the interviewer explicitly asked about concerns. Participants in both groups received baseline and follow-up questionnaires assessing their perceptions of their care and whether anything had "gone wrong" and provided ratings of health care providers' communication and responsiveness. Qualitative content coding was used to categorize patient-reported concerns collected through the baseline and follow-up questionnaires (both groups) and during telephone outreach (intervention patients only). The primary outcome was the number of patients reporting a concern about their care. Communication and responsiveness ratings for intervention and control group patients were compared using t tests.
Of the 60 patients in the intervention group, 34 (56.7%) reported at least one problem or concern, compared with 16 (29.1%) of the 55 patients in the control group (P = 0.003). The telephone outreach in particular resulted in more than half of those reached reporting a new concern (55.3%). We detected no impact of the intervention on patients' ratings of communication or support for speaking up.
Patients in this study reported a variety of concerns in response to active outreach, demonstrating that active outreach to patients can provide healthcare teams and systems the opportunity to offer a real-time response to the patient, identify where system improvements are needed, and implement policies, procedures, or programs to prevent recurrences.
许多癌症患者认为他们的治疗出了问题，但不愿表达出来。本研究旨在评估一种主动接触癌症患者的干预措施的影响，即鼓励患者对护理提出担忧，并描述患者报告的担忧类型。
在两个地点接受癌症治疗的患者被随机分配到干预组或对照组。干预组患者收到了一份宣传册，鼓励他们对任何担忧提出意见，并在随访期间接到了一次外展电话，电话中采访者明确询问了他们的担忧。两组患者均在基线和随访时填写问卷，评估他们对护理的看法，以及是否有任何“出问题”的地方，并对医疗保健提供者的沟通和反应能力进行评分。使用定性内容编码对通过基线和随访问卷（两组）以及电话外展（仅干预组患者）收集的患者报告的担忧进行分类。主要结局是报告对护理有担忧的患者人数。使用 t 检验比较干预组和对照组患者的沟通和反应评分。
在干预组的 60 名患者中，有 34 名（56.7%）报告了至少一个问题或担忧，而对照组的 55 名患者中有 16 名（29.1%）（P = 0.003）。特别是电话外展导致超过一半的受访者报告了新的担忧（55.3%）。我们没有发现干预对患者沟通或支持表达意见的评分有影响。
本研究中的患者对主动外展做出了各种回应，这表明主动接触患者可以为医疗团队和系统提供实时响应患者的机会，确定需要改进的系统，并实施政策、程序或计划，以防止再次发生。
