Improving the quality of palliative care for ambulatory patients with lung cancer

• Published in: BMJ Vol. 330; no. 7503; pp. 1309 - 1313
• Main Authors: von Plessen, Christian, Aslaksen, Aslak
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 04.06.2005; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Appointments and Schedules; Attitude of Health Personnel; Biological and medical sciences; Chemotherapy; Customer satisfaction; Focus groups; General aspects; Health care organizations; Health care waiting times; Hematologic tests; Hospitals, University; Humans; Job satisfaction; Lung cancer; Lung neoplasms; Lung Neoplasms - therapy; Medical sciences; Norway; Nurses; Oncology; Oncology Service, Hospital - standards; Outpatient care facilities; Outpatient clinics; Outpatient Clinics, Hospital - standards; Palliative Care - standards; Patient Satisfaction; Physicians; Pneumology; Quality Assurance, Health Care - methods; Quality Improvement Report; Quality Improvement Reports; Quality of Life; Quality of service; Time Factors; Tumors of the respiratory system and mediastinum; Waiting Lists; Norway; Human; Medicine; Lung disease; Respiratory disease; Lung cancer; Quality; Palliative care; Patient; Ambulatory
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.330.7503.1309

Problem Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time and energy in organisational aspects of care that could be better used in direct interaction with patients. Design Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding satisfaction with working conditions. Setting Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care. Key measures for improvement Waiting time and time wasted during consultations; calmer working situation at the clinic; satisfaction among patients. Strategies for change Rescheduled patients' appointments, automated retrieval of blood test results, systematic reporting in patients' files, design of an information leaflet, and refurnishing of the waiting area at the clinic. Effects of change Interventions resulted in increased satisfaction for patients and staff, reduced waiting time, and reduced variability of waiting time. Lessons learnt Direct observation, focus groups, questionnaires on patients' satisfaction, and measurement of process time were useful in systematically improving care in this outpatient clinic. The description of this experience can serve as an example for the improvement of a microsystem, particularly in other settings with similar problems.