RAND Corporation, Santa Monica, CA, USA.
Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.
Inquiry. 2023 Jan-Dec;60:469580231160374. doi: 10.1177/00469580231160374.
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 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.
质量衡量通常是临床专家和医疗系统领导者的领域；很少征求患者/照顾者的意见。我们旨在描述和整合临床医生和患者/照顾者对美国退伍军人健康管理局（VHA）中接受晚期癌症治疗的患者进行高质量姑息症状护理的概念，这些概念是在现有质量衡量标准的背景下提出的。我们对与癌症姑息治疗相关的过程质量衡量标准的优先排序讨论的记录进行了二次定性分析。这些讨论是在 2 个经修改的 RAND-UCLA 适宜性小组中进行的：一个是由 10 名姑息治疗临床专家利益相关者（7 名医生、2 名护士、1 名社会工作者）组成的小组，另一个是由 9 名有癌症经验的患者/照顾者组成的小组。讨论被记录、转录，并使用逻辑框架进行独立的双编码。内容分析用于识别代码内的子主题，轴编码用于识别交叉主题。患者/照顾者和临床专家为 3 个交叉主题提供了重要的观点。首先，主动引出症状至关重要。患者/照顾者特别强调全面和主动筛查和评估的重要性，特别是针对疼痛和心理健康。其次，仅进行筛查和评估是不够的；从患者那里获得的信息必须为护理提供依据。单独衡量筛查/评估和管理护理过程有重要的局限性。最后，如果以患者为中心，那么高质量的症状管理可以被广泛定义；高质量的护理采用个体化的方法，可能包括非医疗或非药物的症状管理。在设计和实施姑息癌症护理质量衡量标准时，将临床专家和患者/照顾者的观点整合起来对医疗系统至关重要。
