The im­por­tance of basics

Seventeen es­sen­tial ques­tions for out­pa­tient on­col­ogy clin­ics

Modern Healthcare - - OPINIONS COMMENTARY - Dan Shapiro

Since writ­ing a can­cer mem­oir in 2000, I’ve given talks at more than 150 hos­pi­tals and on­col­ogy clin­ics. I learned that many cen­ters and clin­ics in­vest far more in their cof­fee sta­tions, light airy in­fu­sion rooms and brochures than on the basics that make a dif­fer­ence to pa­tients.

If can­cer cen­ters truly want to im­prove the pa­tient ex­pe­ri­ence, here are 17 ques­tions clinic man­agers might want to ask them­selves:

How long do you make pa­tients wait for scan re­sults? There are few things in life more chal­leng­ing than wait­ing to find out if you’re go­ing to die soon. Ev­ery ex­tra hour of wait­ing for re­sults is ex­cru­ci­at­ing.

How long must pa­tients wait af­ter ar­riv­ing for a rou­tine visit? A pa­tient shouldn’t wait for more than 15 min­utes with­out a trans­par­ent ex­pla­na­tion. Long delays sig­nal staffing short­ages and com­mu­ni­cate to ed­u­cated pa­tients that the care is likely to be de­liv­ered by har­ried and pos­si­bly burned-out pro­fes­sion­als.

Are there en­gag­ing dis­trac­tions in wait­ing rooms? It’s emo­tion­ally chal­leng­ing to wait for chemo­ther­apy that’s sure to make us feel as if we’ve been run over by an ab­sent-minded trol­ley driver. Pa­tient-cen­tered clin­ics for adults should have dis­tract­ing ameni­ties, which in to­day’s world means open ac­cess for In­ter­net and smart­phone con­nec­tions.

Do you treat pa­tients like in­di­vid­u­als? If a pa­tient can get through an en­tire clinic visit with­out any staff ad­dress­ing them by name, there’s a prob­lem.

What is the en­ergy in the clinic? Pa­tients can sense clin­ics with good morale through the ca­sual ban­ter. In clin­ics with poor morale, staff don’t speak to one an­other ex­cept when nec­es­sary. Pa­tients can mis­tak­enly in­ter­pret si­lence as in­di­cat­ing some­thing omi­nous.

Do on­col­o­gists ask about the costs of care? Re­search re­veals that pa­tients are ea­ger to talk about costs but rarely bring it up un­less physi­cians ask. Most pa­tients worry about costs and far too few health pro­fes­sion­als ad­dress the is­sue di­rectly.

Does the clinic track rou­tine mis­takes? On­col­ogy clin­ics should teach staff to track mis­takes and ad­dress those that im­pact pa­tients. Even sim­ple mis­takes should be ac­knowl­edged and dis­closed.

How easy is it to park and re­trieve a ve­hi­cle to leave quickly? Many large clin­ics now of­fer valet park­ing, a god­send to sick pa­tients. When leav­ing a clinic af­ter chemo­ther­apy, many are nau­se­ated or at best, un­com­fort­able. They want to get home as quickly as pos­si­ble.

Are pa­tients given chemo­ther­apy by the same nurse each time they visit (or ra­di­a­tion by the same ra­di­a­tion tech)? Does the nurse who draws blood know the pa­tient’s chal­lenges with ports or other is­sues? Even if the same nurse is un­avail­able, staff can be aligned by team, so that a small duo or trio of pro­fes­sion­als al­ways cares for the pa­tient.

Is food avail­able for fam­ily mem­bers or friends while pa­tients have long in­fu­sions—or do fam­ily mem­bers have to leave the pa­tient if they need sus­te­nance?

How ac­ces­si­ble are physi­cians or nurse prac­ti­tion­ers af­ter hours? Are pa­tients who call af­ter hours val­i­dated for phon­ing or treated like a nui­sance? How long does it take to reach some­one?

When call­ing the treat­ment pro­gram, how many voice-mail prompts must a pa­tient nav­i­gate be­fore talk­ing to a hu­man? When some­one an­swers, do they have ac­cess to sched­ules? While many clin­ics mea­sure “drops” and time to an­swer, the na­ture of the an­swer is just as im­por­tant.

If physi­cians use an elec­tronic health record, are they able to an­swer ques­tions sit­ting side by side with the pa­tient? It’s dis­con­cert­ing to de­scribe chal­leng­ing sex­ual per­for­mance side ef­fects to some­one who’s mum­bling and look­ing at a com­puter screen.

Is the clinic part of the com­mu­nity? Is it easy to learn about up­com­ing events, al­ter­na­tive prac­ti­tion­ers sanc­tioned by the clinic and ed­u­ca­tional of­fer­ings or sup­port groups?

How hard is it for pa­tients to get their records? Many pa­tients rou­tinely work with more than one cen­ter. Clin­ics that make it dif­fi­cult or ex­pen­sive to share in­for­ma­tion can im­pact care by in­hibit­ing clear com­mu­ni­ca­tion be­tween health­care providers in dif­fer­ent sys­tems. Pa­tients don’t care if you are com­pet­ing with the hos­pi­tal or clinic across town. Don’t take it out on them by re­fus­ing to make records eas­ily ac­ces­si­ble to other pro­fes­sion­als.

Is there a sur­vivor­ship clinic for long-term care? There are 12 mil­lion can­cer sur­vivors in the U.S., and the num­ber is grow­ing. They are at in­creased risk for late ef­fects. But there are far too few pri­mary-care prac­ti­tion­ers who un­der­stand th­ese risks.

Fi­nally, the true mark of the care at a given clinic is how it treats the dy­ing. Many clin­ics and health pro­fes­sion­als still rou­tinely aban­don dy­ing pa­tients. This is para­dox­i­cal be­cause in many cases this is when pa­tients and fam­i­lies need care the most. Re­fer­ral to hospice is not an ex­cuse to pre­cip­i­tously end care.

Most of th­ese in­ter­ven­tions do not re­quire more money. All they re­quire is on-the­ground lead­er­ship, emo­tional in­vest­ment and fol­low-through.

Dan Shapiro is a clin­i­cal

psy­chol­o­gist and chair­man of the hu­man­i­ties depart­ment at Penn State Col­lege of Medicine. He is also the author of And In Health: A Guide for Cou­ples Fac­ing Can­cer


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