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Why the Patient Concerns Inventory?

Learn about Patient Concerns Inventory (PCI) that helps reveal patients' concerns in healthcare settings. Explore how identifying concerns positively impacts communication, satisfaction, coping, and overall quality of life.

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Why the Patient Concerns Inventory?

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  1. Why the Patient Concerns Inventory?

  2. Outline ? • Communication • Patient agenda • Quality of care • Self management • Cost-efficient multiprofessional team working • Holistic needs assessment

  3. Patients are amazing Adaptation 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, Hamlet Act 3 Scene 1 Soliloquy

  4. HRQOL questionnaires Many different questionnaires Pale reflection of what is really going on

  5. HRQOL questionnaires • 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

  6. Patients and Carers fail to express their concerns Male High proportion of age 16 school leavers Lower social class Low self esteem Tend not to complain Clinical setting is intimidating

  7. Identifying appearance issues • 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 Lynne Millsopp et al BJOMS 2006; 44: 358-363

  8. Identifying concerns has positive benefit Better communication Improved satisfaction Better coping Quicker adaptation Improved HRQOL

  9. How are concerns identified • Majority were CNS • Really important • Key role and better placed that the doctors • Informally in clinic based on communication skills

  10. Touchscreen

  11. Screening in clinic 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.

  12. Screening in clinic UW-QOL v4 Domain scores Better, stable, worse Importance Freetext

  13. Patient 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.

  14. Patient Concerns Inventory Item generation HRQOL Head and Neck team National Associations Patients Carers Evolving list

  15. Patient Concerns Inventory e-health-insider: Best use of IT in patient and citizen involvement in healthcare

  16. PCI – H&N : New platform

  17. PCI: results • The overall median time for completing the TST was 8 minutes (IQR 6 to 11), range 3 to 27) • 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

  18. PCI: results • 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’

  19. Consultations 1st June 2013

  20. Consultations 1st June 2013 Invest in more focused consultations

  21. PCI: Four groups of patients • No issues • Two specific issues • Scary issues • Multiple issues

  22. Patient Concerns Inventory Sign posting the patient and carers / family in their cancer journey awareness

  23. Patient Concerns Inventory

  24. Patient Concerns Inventory Positive affirmation

  25. PCI evaluation • Papers thus far • Initial Assessment • Concept • Methodological •   Impact on clinic • Validation • Fear of recurrence • Other conditions

  26. PCI evaluation PCI across sites and stage

  27. Screening in clinic

  28. Royal College Surgeons England

  29. Patient Concerns Inventory 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.

  30. 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).

  31. Patient Concerns Inventory intervention support Sign posting the patient and carers / family in their cancer journey Anxiety / depression Fears of recurrence Appearance Intimacy Self-esteem awareness

  32. Patient Concerns Inventory : Clinical research Patient experience

  33. Patient Concerns Inventory : Clinical research Patient experience Relevant research

  34. Patient Concerns Inventory : Clinical research Patient experience Improved services / care Relevant research

  35. Patient Concerns Inventory : Issues they wish to discuss

  36. PCI at Aintree Development one clinic

  37. PCI at Aintree Development one clinic Development two clinics

  38. PCI at Aintree Development one clinic Development two clinics Development four clinics

  39. PCI at Aintree Development one clinic Development two clinics Development four clinics Development network

  40. PCI at Aintree Development one clinic Development two clinics What next? Development four clinics Development network

  41. Questions and comments Other chronic diseases Theoretical framework ? Consultation - communication Health economics Outcome measure Web-based Concern severity Holistic assessment Patient experience Intervention Training A lot still to find out about how best to use this tool

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