Do we deliver patient-centred care for cancer patients? Exploring care delivery in Australian medical oncology treatment centres

A cancer diagnosis poses a number of physical, emotional and practical challenges to patients and their families as they traverse an unfamiliar cancer care system. A patient-centred approach to care delivery is one of the key criteria for enabling a high-quality health care experience during this challenging time. Outpatient medical oncology treatment centres are visited by one-third of all new cancer patients in Australia, and chemotherapy, the primary treatment modality of medical oncology, is the most common treatment recorded for same-day cancer-related hospitalisations. This underscores the importance of ensuring the delivery of high-quality patient-centred care within medical oncology services. There is a paucity of research focused on patient-centred care delivery in outpatient medical oncology treatment centres, including whether care varies across centres. Such data can help to highlight aspects of care that need to be improved, and determine whether problems are limited to one site or are more systemic. Such data allow for tailoring quality improvement interventions within medical oncology centres to enhance the delivery of patient-centred care. This thesis by publication contains an introduction, five papers and a discussion. The published papers review how the quality of patient-centred care provided by treatment centres is measured, and discuss approaches for generating credible data (Paper 1); explore aspects of medical oncology outpatients’ experiences of cancer care across domains of patient-centred care endorsed by the United States of America (USA) Institute of Medicine (IOM) (Papers 2–5); and explore whether variation exists in the delivery of aspects of patient-centred care across medical oncology treatment centres (Papers 3–5). Data-based papers are based on data collected from a large multicentre cross-sectional survey of medical oncology outpatients’ perceptions of patient-centred care. The discussion draws together the six principal findings of the thesis and considers future research and implications, including rigorous methodological evaluation of the effectiveness of potential system-oriented interventions for care delivery.