Key Messages

•    The domain which shows the biggest discrepancy between the Rossy Cancer Network (RCN) and the Canadian average is “Access to care” (60.8% vs 69.5%). RCN patients perceive that they wait longer than expected in the waiting room before seeing their clinician and/or receiving chemotherapy or radiation therapy.

•    “Emotional Support” is the lowest rated of the six dimensions of care for the RCN, consistent with the rest of Canada (51.9 % vs 53.4%).

•    A higher percentage of RCN patients respond they were referred to other care providers to help with anxieties and fears than the Canadian average (53.6% vs 43.5%).

Background

Understanding the patients’ views provides essential information to guide us in providing a better patient experience. 

To measure the experience of patients receiving cancer treatment (radiation therapy, chemotherapy or surgery) on an outpatient basis, the RCN uses the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). This survey was developed by the National Research Corporation Canada and is currently used in eight Canadian provinces. 

The AOPSS combines individual survey items to develop six dimension of care “domains”, covering:  
•    Emotional support
•    Continuity and coordination of care
•    Respect for patient preferences
•    Physical comfort
•    Information, education and communication
•    Access to care

Charts & Tables

What Do the Results Mean?

In comparison with other Canadian cancer patients, RCN patients reported slightly lower scores on the six dimensions of care. 

Emotional support at the RCN is the domain with the lowest score, consistent with the rest of Canada. There are 8 questions that are tabulated to give a final score for this domain: some questions measure if the patient received enough information on changes in sexual activity, emotions, and relationships with the spouse or partner: other questions measure if the patient was referred to other care providers for anxieties and fears at the time of initial diagnosis or within 6 months of treatment. The RCN performs better than the Canadian average in this realm.

Access to care is the domain which shows the biggest discrepancy between the RCN and the Canadian average. This domain measures patient perception and expectations of waiting times before seeing their clinician and/or, receiving chemotherapy or radiation therapy, and if the health care providers did everything they could to make patients more comfortable during this wait time. The results show that across the RCN, patients perceive that they wait longer than expected for treatment, as compared to other Canadian patients.

Efforts

Access to Care

Initiatives were put in place to address the issue of patients waiting too long in the waiting room before starting chemotherapy treatment.  A 2-day system (blood tests on separate day from chemotherapy appointment) was implemented to reduce wait time on the day of treatment, optimize efficient use of the chemotherapy clinic, and improve safety. While the 2-day system reduces wait time on the chemotherapy treatment day, it does require the patient to visit the hospital twice, which is still not optimal.

As a separate initiative, a waiting room management system was implemented in the Cedars Cancer Centre at the MUHC, which has reduced lines and waiting at the registration desk. In addition, a mobile application is being developed to empower patients with their own information/data. This app will be integrated into the waiting room management system and will include wait time predictions and the ability to call patients to their appointments via their phones. This should reduce the stress of waiting and allow patients the flexibility of leave the waiting room without worrying about missing the call for their appointment.

Emotional Support

There is a Canada-wide effort to address emotional support and ensure distress screening for cancer patients using patient-reported outcome measures. One example is a patient questionnaire called the Edmonton Symptom Assessment System (ESAS). This measures nine commonly reported cancer-related symptoms such as pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, lack of well-being and shortness of breath.  The answers are reviewed by the patients’ health care team, who are able to direct the patient to the support  they need. For example, a patient may need a change in care plan, psychosocial intervention, referral to another practitioner or closer monitoring of their symptoms. Measuring patient reported outcomes improves communication and symptom control.

Within the RCN partner hospitals, screening is being used for patients requiring psychosocial support. For other patients, the RCN is participating in a pilot project called iPEHOC (Improving Patient Experience and Health Outcomes Collaborative), in which patients are systematically queried at multiple time points in their treatment concerning their fatigue, pain, anxiety and/or depression.  This pilot is ongoing at SMHC, in the gynecology clinic at the JGH and in one lung cancer clinic at the MUHC.

In addition, patient information needs and emotional support are being increasingly addressed through patient-support groups such as Hope & Cope at the JGH and Cedars CanSupport at the MUHC. 

Other Efforts

AOPSS is a rich data resource with over 2500 surveys collected from 2012 to 2016. Every question is an opportunity for improvement, regardless of the Canadian average. Each RCN partner hospital is continuing to analyze responses and data with the aim of improving the patient experience in targeted ways.

Notes