How do you know if you or someone you love is getting the best quality care for their cancer?
The sad truth is that you don’t. It is difficult to impossible for most people to understand what really constitutes quality medical care. In fact, I suspect it is also difficult for many medical professionals to measure quality cancer care.
The good news is that most health care professionals and the hospitals where they work want to do the best they can for their patients. We are fortunate in that regard.
But despite good intentions, those of us who have seen the research which measures quality medical care know that many of those intentions fall short of the mark.
To address these concerns, the Cancer Quality Alliance (CQA) has written an article in the current issue of the American Cancer Society’s journal CA: A Cancer Journal for Clinicians which tries to give medical professionals and patients an understanding of what in fact constitutes high-quality cancer care. (The Alliance is a collaboration of many different types of organizations which is committed to improving the quality of cancer care.)
By comparing five scenarios which outline best case and worse case scenarios, the article gives you a glimpse into the arcane world of the medical management of cancer. In so doing, the authors show how much difference it can make when things are done right compared to what happens when they are done wrong.
The authors emphasize the importance of the six aims for a new health system for the 21st century, as outlined in a report from the Institute of Medicine (IOM) entitled, “Crossing The Quality Chasm: A New Health System For The 21st Century.” Those aims are that the health care system should be safe, effective, patient-centered, timely, efficient, and equitable.
As noted in the IOM report:
“Redesigning the health care delivery system to achieve these aims will require changing the structures and processes of the environment in which health professionals and organizations function, especially in 4 areas: applying evidence to health care delivery, using information technology, aligning payment policies with quality improvement, and preparing the workforce.”
The CQA article shows how meeting these objectives can improve the quality of care we receive for the treatment of cancer.
Examples include making certain that patients are treated in specialized regional cancer centers with experience in evaluating and treating uncommon cancers such as sarcomas; providing culturally sensitive, language-proficient care to allay fear and anxieties; educating patients to the sometimes unfortunate realities of their circumstances and then providing the support they and their families need; and avoiding unnecessary and potentially damaging tests and procedures which can impair the quality of life after treatment.
The article isn’t designed to provide information that is specific to everyone’s cancer. Yet I suspect that a lot of people will be able to relate to these best and worse case scenarios based on their own experiences.
We have a lot to learn in the United States about how to deliver higher quality medical care across the spectrum of wellness and illness, not just in the treatment of cancer.
The data shows that we spend substantially more per person on medical care in the United States than any other developed country on this planet. Yet our fundamental measure of outcome—the number of years lived by the typical American—falls far short of what has been achieved elsewhere.
The result, in my personal opinion, is that we can say we have the best technological health care in the world, but unfortunately the evidence doesn’t suggest that we deliver the best care across the board.
Yes, we have a lot of fancy machines, and we can do a lot to sustain life once we become ill. But that has not translated into a longer life span.
I believe that medicine needs to take a first step on a multi-step journey and admit that we have a problem. Then we need to actively address that problem, and demonstrate that we can indeed embrace quality health care as a worthy and sustainable goal.
I think it is important to point out that not all of the fault lies at the feet of the health care system. There are a lot of things we do to ourselves—and don’t do for ourselves—that complicate the situation quite a bit. Medicine can’t fix everything, and it can’t deliver everything that every person would want or hope for.
That said, we certainly could do a much better job when it comes to improving the consistency and effectiveness of what we do for our patients.
We could improve the way we communicate with our patients. We could create systems of care that would bring the best care to the local communities where many people work and live. We could make certain that our treatments are consistent with the latest guidelines, which in turn are based on the best evidence and expert opinion that we have. We could support those who practice evidence-based medicine by assuring them that one more test simply isn’t needed to avoid a malpractice suit. We could make certain that the care we provide is the right care—not too little, not too much—for the situation at hand.
The scenarios in the CA article are a step to help all of us understand the problems we face, how they relate to the Institute of Medicine’s goals for the health care system of the 21st century, and help set expectations for patients and their families as to how they would want to be treated—and expect to be treated—if they were diagnosed with cancer.
As I say here often, it is good to have knowledge and hope.
My hope is that we will all embrace these principles, and move forward together to make them more than just some words on a journal page.
We owe every patient and their family the opportunity to recognize that the care they received for their cancer—no matter the outcome—was indeed the “best scenario” for them.
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