Background:
The need for better coordinated cancer care is internationally recognized as a priority for health service improvement. Good care coordination contributes to patient-centered, high-quality care. Understanding which factors impact care coordination is crucial to underpin service improvement.
Aim:
This study investigated patient- and system- related predictors of poorly coordinated care, and identified patient preferences for resources to assist care coordination.
Methods:
This population-based cross-sectional survey recruited patients with newly diagnosed colorectal cancer, notified to the NSW Central Cancer Registry between 29 November 2012 and 31 May 2013. Care coordination was assessed using the Patient Experience of Cancer Care Coordination questionnaire 6 months post diagnosis. Multivariate regression models were constructed to identify significant, independent predictors of poor care coordination.
Results:
Of 1027 patients contacted, 560 participated (55%). Respondents had a mean age of 68.18 years, 60% male and 24% rectal cancer. Mean care coordination was 76.1(SD10.9). Preliminary results suggest that patients who had little or no understanding of the health system (β-4.4,95% CI:-6.26,-2.57,p=<0.001,), had more than 2 comorbid conditions (β-3.7,95%CI:-6.69,-0.67,p=0.04), didn’t attend a regular GP clinic/practice (β-4.4,95% CI:-8.54,-0.31,p=0.04), didn’t receive a written plan prior to treatment (β-4.10,95% CI:-5.98,-2.22,p=<0.001) and didn’t see a cancer care coordinator or specialist cancer nurse (β-3.17,95% CI:-5.20,-1.13,p=0.002) experienced poorer care coordination. There were no significant associations with age, sex or cancer site. The most preferred resources amongst patients were, written plans before and after treatment (90%), access to a cancer care coordinator in hospital (82%) and by phone post discharge (87%), and copies of their medical records (electronic 90%, paper 87%).
Conclusions:
These findings suggest patients would benefit from more timely and targeted education and information prior to treatment, together with greater access to cancer care coordinators and nurse specialists. This information will provide a focus for the development of targeted strategies to improve care coordination.