Providing coordinated cancer care: a population-based survey of patients' experiences and preferences

Improving cancer care coordination is a key priority for health services. Understanding the patient experience and who is at risk of receiving poorly coordinated care is crucial to underpin service improvement. However, there is little understanding of the adequacy of care coordination within Australia.

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Providing coordinated cancer care: a population-based survey of patients' experiences and preferences from Cancer Institute NSW

Authors

Ivana Durcinoska, Jane M Young, Michael Solomon

Aims

To i) ascertain patient experience of care coordination among a population-based sample of colorectal cancer patients in New South Wales (NSW), ii) investigate patient- and system-related predictors of poorly coordinated care, and Hi) identify patient preferences for resources to assist coordination of care.

Method

Cross-sectional survey of patients notified to the NSW Central Cancer Registry between November 2012 and May 2013. Participants completed the Patient Experience of Cancer Care Coordination questionnaire 6 months post diagnosis. Multivariate regression models were constructed to identify significant predictors of poor care coordination.

Results

Of 1027 patients contacted, 560(55%) participated. Respondents had a mean age of 68 years, 60% male and 24% had rectal cancer. Care coordination scores were normally distributed (mean 76.1, SD10.9). Patients who experienced poorer care coordination had little or no understanding of the health system (0-4.4, 95% CI:-6.18,-2.49, p=<0.001), more than 2 comorbid conditions (0-4.57, 95%CI:-7.44,-1.69, p=0.01) and no regular GP (0-4.1, 95% CL-8.17,-0.21, p=0.05). Furthermore, those who didn't receive a written plan prior to treatment (0-4.15, 95% CI:-6.02,-2.28, p=<0.001) and those who didn't see a cancer care coordinator or specialist cancer nurse (13-3.29, 95% CI:-5.31,-1.27, p=0.001) experienced poorer care coordination. There were no significant associations with age, sex or cancer site. The most preferred resources to enhance care coordination were, information packs (95%), written plans before and after treatment (91%), access to a cancer care coordinator by phone post discharge (87%), and copies of their medical records (electronic 90%, paper 87%).

Implications

These findings suggest patients would benefit from more timely and targeted education and information prior to treatment, together with greater access to cancer care coordinators or specialist nurses. This information will provide a focus for the development of targeted strategies, particularly for patients with other risk factors of receiving poorly coordinated care.