Patient Roundtable for Experience Improvement

Background: Breast cancer is a highly emotional diagnosis; patient experience should be monitored to limit emotional distress.^1-6

Objectives: By interviewing patients, seek to find experiences that made a quality impact for patients to implement throughout our program to enhance their experience.

Methods: Postsurgery breast cancer patients surveyed. Patients interviewed in one-on-one setting. Interview guide tool developed by administrator and nurse navigator. Questions were open-ended format. Questions included presentation for finding cancer; experience during testing and diagnosis; surgeon’s office experience; hospital surgery preoperative, imaging, surgical, and postoperative arenas; follow-up care received; survivorship experience; and general feedback.

Results: Eight patients were selected, having completed their journey within 30 days prior to study. Four patients completed interviews. Ages ranged from 38 to 67 years. Presentation revealed 4/4 had MD review of imaging with them in person; 2/4 had immediate biopsy after imaging diagnosis; 1/4 preferred to wait for primary care provider consult; and 1/4 needed pause for authorization. Surgery feedback included requests for camisole with pouches for drains at time of surgery (3/4); 3/4 had difficulties finding preoperative areas; 4/4 appreciated preoperative testing was “one-stop shop” and could return to routine prior to surgery; 4/4 requested virtual support group to help prepare for surgery; 4/4 liked phone preregistration; 2/2 found the pectoral blocks to be beneficial for pain control; 4/4 appreciated the same nurse to contact patient for introduction prior to surgery and follow-up postdischarge. 1/1 did not like the nonroutine process for very important patient “VIP,” as 1/1 was given her sedative, another nurse voiced short-term memory loss in seniors; 1/1 family was set up for text updates during surgery, and none occurred. For 3/4 the physician office experience showed staff was not welcoming, could not explain results, and didn’t seem as knowledgeable as expected. 4/4 appreciated navigator involvement at diagnosis; 2/2 found a staging poster in office helpful and would have liked a copy; 2/4 finding way to office needed improving; and 1/4 preferred not to receive genetic or diagnostic test results via phone. 4/4 requested better education about drain removal, pain with implant expansion. Survivorship evaluation revealed 4/4 were unable to move on emotionally in a self-identified timely manner, and 4/4 worry if the cancer will come back.

Conclusions: By interviewing patients, a candid format for feedback was given. When concluded, met with physicians and gave them feedback. Changes made were: (1) added camisoles, given immediately postop; (2) during phone preregistration, scripting is used, including way finding for locations; (3) nurses call the patient the evening before surgery; (4) perioperative director to educates staff on appropriate communication; (5) navigator consulted at time of diagnosis and provides staging sheets to patients; (6) physicians updating office processes; and (7) patients are being educated in detail about the JP drains and the injections for tissue expanders.

We will be doing follow-up interviews to ascertain if the patient-recommended changes made a difference and to obtain any new recommendations from the patients.

References

1. Stress and Breast Cancer, Cleveland Clinic: Managing Stress and Breast Cancer. https://clevelandclinic.org/health/treatments/17208-managing-stress-breast-cancer. Accessed May 30, 2019.
2. American Cancer Society. Living as a Breast Cancer Survivor. www.cancer.org/cancer/breast-cancer/living-as-a-breast-cancer-survivor. Accessed May 30, 2019.
3. breastcancer.org. Day-to-Day Matters. www.breastcancer.org/tips. Accessed May 30, 2019.
4. The Becker’s Hospital Review. Women make 80 percent of healthcare decisions. www.beckershospitalreview.com/hospital-management-administration/women-make-80-percent-of-healthcare-decisions.html. Accessed May 30, 2019.
5. Andersen BL, Yang H, Farrar WB, et al. Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer. 2008;113:3450-3458.
6. McFarlane ME, Sony SD. Women, breast lump discovery, and associated stress. Health Care Women Int. 1992;13:23-32.