The importance of basics
Seventeen essential questions for outpatient oncology clinics
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