KS-012049 eCQ 11-1 Newsletter
Volume 11, Issue 1
Older Patients with Serious Illness Value Communication Most in Primary Care Setting
From the perspective of older patients, quality of care for serious illness in the pri- mary care setting includes aspects of care such as shared decision making, coordina- tion of care, and a clinician who is knowl- edgeable, skillful, and compassionate. But the most important aspect, and the one that ties all others together, is patient-centered communication. “Our results suggest a relationship be- tween communication and all other themes,” write the authors of a report published in the American Journal of Hospice and Palliative Medicine. “These themes demonstrate the essence of patient-centeredness, as patients perceive it.” Primary care is an increasingly important setting for the care of older patients with serious illness, note the authors. However, recent initiatives to improve such care rarely incorporate the perspectives of seriously ill older patients themselves. Understand- ing the aspects of care these patients deem important can help improve the quality of care delivery. Investigators analyzed interview respons- es of older, community-dwelling patients (n = 20; mean age, 70.6 years; female, 65%; white race, 75%) who were living with or at risk for serious illness in 2016 and had participated in a quality improvement initiative for advance care planning at an academic primary care clinic. Five key themes emerged. KEY THEMES OF QUALITY CARE Patient-centered communication. This predominant theme was deemed most im- portant by all participants, and intersected with all other themes. Patients appreciated
detailed explanations regarding their diag- noses, the relevance of tests and treatment, treatment options based on their expressed preferences, and the expected impact of their illness on their quality of life. Coordination of care. Patients felt that their primary care physicians played a cen- tral role in coordinating care with specialty and other clinicians. They considered that at the heart of quality integrated care was communication to ensure that all clinicians responsible for their care were informed about each other’s involvement and about the goals of care. Shared decision making. Patients saw decision making as an interactive process, and appreciated when their primary care clinician presented different treatment op- tions to choose from and educated them about their care.Again, communicationwas the unifying theme. Clinician competence. Patients empha- sized the importance of both clinicians’ knowledge of and expertise in treating older persons with serious illness and their use of a compassionate, comprehensive approach to care, treating the patient as a whole person, listening, and responding to their unique needs. Access to care. Older patients found access to care challenging, but were willing to sacrifice convenience of location for access to high-quality care. Source: “Older Patients’ Perspectives on Quality of Serious Illness Care in Primary Care,” American Journal of Hospice and Palliative Medicine; October 2018; 35(10):1330–1336. Abu Al Hamayel N, Dy SM, et al; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore.
Mother’s Touch is Joint Commission Accredited.
Page 1 Older Patients with Serious Illness Value Communication Most in Primary Care Setting Page 2 Lay Health Worker Intervention Improves Satisfaction and Outcomes Among Advanced Cancer Patients Page 3 Cirrhosis Patients Have Poor Understanding of Advanced Disease, Desire More Information Page 4 A Lack of Training in Palliative Care Linked to More Aggressive Treatment Recommendations by Surgeons
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