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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