“Quality Care”: What Does It Mean?

From the Editor's Desk
March 2, 2017
Lidia Schapira, MD, FASCO

Today marks the beginning of the American Society of Clinical Oncology’s (ASCO) Quality Care Symposium. The word “quality” is tossed around a lot when it comes to medical care, but what does it mean?

To a person with cancer, “quality cancer care” may mean a chance to be cured of their disease and to be treated with respect and compassion. To a hospital administrator, it may mean that staff follows the highest standards of professionalism. They are up to date on the latest information, provide treatment that is based on guidelines accepted by peers, and there is ample communication between members of the cancer team with different specialties. To oncologists, it may mean putting the patient front and center and working collaboratively with colleagues to achieve the best possible outcome.

Many years ago, I took care of a college student with leukemia. She was deeply loved by her family and had a brilliant future ahead of her. As a mother myself, I imagined her mom was feeling intolerable levels of anguish and stress. So I asked if she would like to have a cup of tea and talk. She looked me straight in the eye, thanked me, and reassured me that she would be fine if and when her daughter was cured. “I appreciate your offer,” she said, “but I’m comfortable knowing that you are doing everything possible to save my daughter’s life.” This young woman’s story has a happy ending, and I share it here only to emphasize the fact that “quality” has many dimensions and interpretations. For this mother, quality meant knowing that everybody was doing their best to help her child.

Over the past couple of decades, the oncology community has made many strides in defining what comprises excellent cancer care. Research has shown that better treatment results were associated with the health care team’s clinical experience and the number of patients treated. But research also showed that patients appreciated and valued good communication and well-coordinated care. Over the years, the topics used to analyze and measure “quality” grew to include palliative care, management of complex symptoms, how the care is delivered to patients, and the personalization of care plans and communication with patients. Many of these ideas may seem obvious, but it’s important to clearly define these elements and to show that they lead to better outcomes in patient care and treatment. Defining, analyzing, and measuring what constitutes quality care helps us determine the standards to which oncology professionals should be held.

One of the valuable lessons I’ve learned from talking to patients and reading personal stories of illness is the importance of feeling hopeful and accompanied during the illness. Trusting the cancer team, feeling known as a person, and having hope that the illness can be controlled (sometimes but not always cured) really matters to patients and caregivers. Providing hope has not been proposed as a metric for quality care, probably because it would be impossibly hard to measure. Regardless, hope is important to patients and may help them get through these challenging periods in their lives.

By setting high requirements for quality, we may also increase patients’ access to expert advice, especially for those living in small communities. This is where we hope technology will play an increasingly important role, by connecting oncology professionals and opening access to experts to help manage difficult diagnoses and treatment plans. We are in a time of great opportunity and change, both in scientific progress and in the way we care for patients.

For the community of oncology professionals, “quality” means that we need to prepare and train to work in collaborative teams—and this includes sharing information and data in real time—to standardize practices and be quick to change in response to the needs of our community of patients. Our ultimate goal is to deliver the best possible technical care with compassion and good judgment. share on twitter  This doesn’t just apply for oncologists; let’s not forget all of the nurses, nurse practitioners, physician assistants, and more who are often the first faces a patient sees, providing expert counsel with a human touch.

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