Patient-centered care is a hallmark of high-quality cancer care and has been shown to improve patient outcomes and hospital quality metrics. A key element of patient-centered care depends on oncology clinicians understanding patients’ values. But this information is often unknown and lacking within clinical documentation.
A recent article in the Journal of Clinical Oncology – Oncology Practice by Anjali Desai, MD, et al. attempts to address this gap by evaluating a Patient Values Tab within the electronic health record. This tab serves as a centralized location where clinicians can review, document, and honor key information about patients’ values. The research team conducted interviews with stakeholders at Memorial Sloan Kettering. The interview questions centered on understanding the most salient patient goals and values and how to integrate this knowledge into the electronic health record and clinical care. The team applied a mixture of rigorous qualitative methods to develop, conduct, and analyze these interviews.
The majority of the 110 stakeholder participants were white (69%) and female (61%). Most participants endorsed the Patient Values Tab as highly useful and meaningful. Qualitative themes identified that the Patient Values Tab would assist with understanding each patient’s personhood, social situation, social dynamics, communication preferences, illness understanding, future planning, and end of life planning. Stakeholders wanted the Patient Values Tab to be easily accessible with shared ownership, especially by the primary oncology team. Some participants, especially patients, voiced concerns about the privacy of information provided, noting that some patients may not want all members of the team to know certain things.
The strengths of this study are the large, diverse sample. The qualitative methods are robust, ensuring the results have high validity. Weaknesses of this study are its location at a single institution, although the authors note this institution is a regional network. The authors also note the need to transport the Patient Values Tab into alternate electronic health records. Future work should investigate the impact of the Patient Values Tab on clinical processes and patient outcomes to demonstrate its effect on promoting patient-centered care.
Oncology nurses looking to apply these findings to their practice can consider how their institution currently captures patients’ goals and values. Nurses know their patients’ unique needs and priorities, perhaps more than other clinicians. How do we share this and integrate it into patient care? Having a place within the medical record allows the oncology team to understand the patient as a person and hopefully integrate that knowledge into our care. Nurses may consider working within their institution to adopt similar practices that enhance patient-centered care.
Desai, A. V., Agarwal, R., Epstein, A. S., Kuperman, G. J., Michael, C. L., Mittelstaedt, H., … & Nelson, J. E. (2021). Needs and perspectives of cancer center stakeholders for access to patient values in the electronic health record. JCO Oncology Practice, OP-20.