Why the Patient Concerns Inventory?. Communication Patient agenda Quality of care Self management...

Why the Patient Concerns Inventory?

•Communication

•Patient agenda

•Quality of care

•Self management

•Cost-efficient multiprofessional team working

•Holistic needs assessment

Outline

Patients are amazing

To be or not to be, that is the question;

Whether 'tis nobler in the mind to suffer

The slings and arrows of outrageous fortune,

Or to take arms against a sea of troubles,

Adaptation

Hamlet Act 3 Scene 1 Soliloquy

HRQOL questionnaires

Many different questionnaires

Pale reflection of what is really going on

•Patients experience a range of problems of different intensities, at different times

•HRQOL questionnaires are limited by their structure and interpretation

BUT

•HRQOL questionnaires can help identify patients doing badly

HRQOL questionnaires

Patients and Carers fail to express their concernsPatients and Carers fail to express their concerns

MaleMale

High proportion of age 16 High proportion of age 16 school leaversschool leavers

Lower social classLower social class

Low self esteemLow self esteem

Tend not to complainTend not to complain

Clinical setting is intimidatingClinical setting is intimidating

•278 oral and oropharyngeal SCC•Cross-sectional survey•Appearance question on UW-QOL•114 (41%) were concerned•7 was it mentioned in the casenotes•4 documented help -2 scar revision

-2 oral rehabilitation

Identifying appearance issuesIdentifying appearance issues

Lynne Millsopp et al BJOMS 2006; 44: 358-363

Identifying concerns has positive benefitIdentifying concerns has positive benefit

Better communicationBetter communication

Improved satisfactionImproved satisfaction

Better copingBetter coping

Quicker adaptationQuicker adaptation

Improved HRQOLImproved HRQOL

How are concerns identifiedHow are concerns identified

Majority were CNSMajority were CNS

Really importantReally important

Key role and better placed that the doctorsKey role and better placed that the doctors

Informally in clinic based on communication skillsInformally in clinic based on communication skills

Touchscreen

Rogers SN, Lowe D Screening for dysfunction to promote MDT intervention using the University of Washington Quality of Life questionnaire (UW-QOL) Archives of

Otolaryngology Head & Neck Surg. 2009; 135: 369-375.

Screening in clinic

Screening in clinic

Domain scores

Importance

Freetext

Better, stable, worse

UW-QOL v4

Patient Concerns Inventory : Issues they wish to discussPatient Concerns Inventory : Issues they wish to discuss

Rogers SN, El-Sheikha J, Lowe D. The development of a Patients Concerns Inventory (PCI) to help reveal patients concerns in the head and neck clinic.

Oral Oncol. 2009; 45: 555-561.

Item generationItem generation

HRQOLHRQOL

Head and Neck teamHead and Neck team

National AssociationsNational Associations

Patients Patients

CarersCarers

Evolving listEvolving list

Patient Concerns Inventory Patient Concerns Inventory

Patient Concerns Inventory Patient Concerns Inventory

e-health-insider: Best use of IT in patient and citizen involvement in healthcare

PCI – H&N : New platformPCI – H&N : New platform

•The overall median time for completing the TST was 8 minutes (IQR 6 to 11), range 3 to 27)

PCI: resultsPCI: results

•The length of the consultation with TST - median (IQR) 8 (5 to 10) minutes

•The length of the consultation without TST - median (IQR) 7 (4 to 14) minutes

The median number of issues: 3 IQR 1-6 range 0 to 21

82% selecting at least 1 issue

62% patients felt it made a very much /quite a bit difference to their consultation

•Patient comments:

-’it made it a bit more personal’

- ‘reminds me of the points I want discuss’

- ‘allows consultation to get straight to the point’

-’ encourages me to talk about things I would otherwise not discuss’

-’if it helps you its fine by me’

PCI: resultsPCI: results

Consultations 1st June 2013Consultations 1st June 2013

Consultations 1st June 2013Consultations 1st June 2013

Invest in

more

focused

consulta

tions

•No issues

•Two specific issues

•Scary issues

•Multiple issues

PCI: Four groups of patientsPCI: Four groups of patients

Sign posting the patient and carers / family in their cancer journey

awareness

Patient Concerns Inventory Patient Concerns Inventory

Patient Concerns Inventory Patient Concerns Inventory

Patient Concerns Inventory Patient Concerns Inventory

Positive affirmation

•Papers thus far

Initial Assessment 

Concept   Methodological

  Impact on clinic 

Validation

Fear of recurrence 

Other conditions

PCI evaluationPCI evaluation

PCI across sites and stage

PCI evaluationPCI evaluation

Screening in clinic

Royal College Surgeons England

A total of 106 patients were included, 52 before and 54 after the introduction of the PCI. Data collection included observational data made during the consultation about which issues were discussed and which multidisciplinary health professionals were referred to.

Patient Concerns Inventory

The PCI made little difference to the length of the consultations with a mean length of 5.4 minutes before and 5.6 minutes following its introduction.

There was a significant increase in the number of issues discussed in consultation from a mean 2.5 to 3.9 (p=0.07).

Patient Concerns Inventory

Sign posting the patient and carers / family in their cancer journey

awareness

Patient Concerns Inventory Patient Concerns Inventory

support intervention

Anxiety / depressionFears of recurrenceAppearanceIntimacySelf-esteem

Patient Concerns Inventory : Clinical researchPatient Concerns Inventory : Clinical research

Patient experiencePatient experience

Patient Concerns Inventory : Clinical researchPatient Concerns Inventory : Clinical research

Patient experiencePatient experience

Relevant researchRelevant research

Patient Concerns Inventory : Clinical researchPatient Concerns Inventory : Clinical research

Patient experiencePatient experience

Relevant researchRelevant research

Improved services / careImproved services / care

Patient Concerns Inventory : Issues they wish to discussPatient Concerns Inventory : Issues they wish to discuss

PCI at Aintree PCI at Aintree

Development one clinic

PCI at Aintree PCI at Aintree

Development one clinic

Development two clinics

PCI at Aintree PCI at Aintree

Development one clinic

Development two clinics

Development four clinics

PCI at Aintree PCI at Aintree

Development one clinic

Development two clinics

Development four clinics

Development network

PCI at Aintree PCI at Aintree

Development one clinic

Development two clinics

Development four clinics

Development network

Questions and commentsQuestions and comments

A lot still to find out about how best to use this tool