Surveys quantify cancer patient's perspective
Docs learn about communication, quality of life
You can't measure success in breast cancer care without considering the patient perspective. While survival is clearly the most critical issue, treatment also impacts the patient's quality of life, emotional coping, and ability to continue with daily activities.
Two cancer patient surveys are available to help clinicians monitor individual care or gauge the outcomes of a cancer treatment program: the Cancer Rehabilitation Evaluation Survey (CARES) and the Functional Living Index-Cancer (FLIC).
Using a patient survey such as CARES can help doctors focus their attention on the patients' most pressing needs, says Anne Coscarelli, PhD, a research psychologist at the University of California at Los Angeles (UCLA) and a co-developer of CARES.
"It's a systematic approach to assessing needs," says Coscarelli, who is also director of the Rhonda Fleming Mann Resource Center for Women with Cancer at UCLA. "It allows you prioritize and understand what a patient is going through." (For sample questions, see survey, above.)
At UCLA, women fill out the CARES before they join a support group or to assess their needs during treatment. The survey also can be used to measure the impact of treatment or the strength of the doctor-patient relationship.
Sutter Health in Sacramento, CA, is using the FLIC, developed by researchers at the Manitoba Cancer Treatment and Research Foundation in Winnipeg, Canada, as a part of its breast cancer outcomes project.
As a pilot project, the Mills Peninsula Medical Group in San Francisco mailed quarterly FLIC and patient satisfaction surveys to 60 patients who had been diagnosed with breast cancer in 1997. The satisfaction survey, developed by The Foundation for Accountability (FACCT) based on focus groups with patients, specifically addresses patients' feelings about their breast cancer diagnosis and treatment.
Although the sample size was not statistically significant as a measure of the overall population of breast cancer patients, the results were gratifying, says Gale Katterhagen, MD, medical director of the Mills Peninsula Medical Center Cancer Program and Breast Center in San Mateo, CA, and Sutter's medical director for quality. "The physicians did very well," he says. "The patients were very satisfied."
FACCT bases several of its measures on patient surveys, recommending CARES. The survey is long, but it's comprehensive, says Ted von Glahn, MSPH, a consultant with FACCT who helps medical groups, hospitals, and health systems implement the measurement sets. (See related story, p. 65.)
CARES provides information on five domains: physical (pain and activities of daily living); psychosocial (body image, anxiety, and communicating with friends and family); medical interaction (relationship between patients and health professionals); sexual; and marital. "Part of good quality care is the experience of care itself," says von Glahn.
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