Feeling Heard and Understood in the Hospital Environment: Benchmarking Communication Quality Among Patients With Advanced Cancer Before and After Palliative Care Consultation

Luke T Ingersoll; Fahad Saeed; Susan Ladwig; Sally A Norton; Wendy Anderson; Stewart C Alexander; Robert Gramling

doi:10.1016/j.jpainsymman.2018.04.013

Feeling Heard and Understood in the Hospital Environment: Benchmarking Communication Quality Among Patients With Advanced Cancer Before and After Palliative Care Consultation

J Pain Symptom Manage. 2018 Aug;56(2):239-244. doi: 10.1016/j.jpainsymman.2018.04.013. Epub 2018 May 2.

Authors

Luke T Ingersoll¹, Fahad Saeed², Susan Ladwig³, Sally A Norton⁴, Wendy Anderson⁵, Stewart C Alexander⁶, Robert Gramling⁷

Affiliations

¹ Department of Consumer Science, Purdue University, West Lafayette, Indiana. Electronic address: lingerso@purdue.edu.
² Division of Nephrology, Department of Medicine, University of Rochester, Rochester, New York.
³ Public Health Sciences, University of Rochester, Rochester, New York, USA.
⁴ Department of Medicine, University of Rochester, Rochester, New York.
⁵ Department of Medicine, University of California San Francisco, San Francisco, California.
⁶ Department of Consumer Science, Purdue University, West Lafayette, Indiana.
⁷ Division of Palliative Medicine, Department of Family Medicine, University of Vermont, Burlington, Vermont.

PMID: 29729348
DOI: 10.1016/j.jpainsymman.2018.04.013

Abstract

Context: Maximizing value in palliative care requires continued development and standardization of communication quality indicators.

Objectives: To describe the basic epidemiology of a newly adopted patient-centered communication quality indicator for hospitalized palliative care patients with advanced cancer.

Methods: Cross-sectional analysis of 207 advanced cancer patients who received palliative care consultation at two medical centers in the U.S. Participants completed the Heard & Understood quality indicator immediately before and the day after the initial palliative care consultation: Over the past two days ["24 hours" for the post-consultation version], how much have you felt heard and understood by the doctors, nurses, and hospital staff?-completely/quite a bit/moderately/slightly/not at all. We categorized completely as indicating ideal quality.

Results: Approximately one-third indicated ideal Heard & Understood quality before palliative care consultation. Age, financial security, emotional distress, preferences for comfort-longevity tradeoffs at the end of life, and prognosis expectations were associated with preconsultation quality. Among those with less-than-ideal quality at baseline, 56% rated feeling more Heard & Understood the day after palliative care consultation. The greatest prepost improvement was among people who had unformed end-of-life treatment preferences or who reported having no idea about their prognosis at baseline.

Conclusion: Most patients felt incompletely heard and understood at the time of referral to palliative care consultation, and more than half of the patients improved after consultation. Feeling heard and understood is an important quality indicator sensitive to interventions to improve care and key variations in the patient experience.

Keywords: Palliative care; communication; heard and understood; quality measure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Benchmarking
Communication*
Cross-Sectional Studies
Emotions / physiology*
Female
Humans
Male
Middle Aged
Neoplasms / psychology*
Palliative Care / psychology*
Professional-Patient Relations*
Referral and Consultation*
Surveys and Questionnaires