Exploring Transitions in Care Among Patients with Head and Neck Cancer: A Multimethod Study
Creators: name: Kersen, Jaling Kathleen
Publisher: name: Graduate Studies
Year: 2023
Subjects: subject: Care Transitions
subject: Oncology
subject: Transitions of Care
subject: Cancer
subject: Alberta
subject: Education--Health
subject: Public Health
subject: Oncology

description: Introduction: Head and Neck Cancers (HNC) are the 6th most common cancer worldwide. Due to the complex nature of HNC, treatments are multifaceted and focus on diverse anatomical structures. As such, patients with HNC experience many Transitions in Care (TiC), which occur when patients transfer between healthcare providers, institutions, and settings. Although a necessary component of patient care, TiC represent a vulnerable point in the journey and are associated with compromised patient safety, decreased patient satisfaction, and increased healthcare costs. However, our understanding of TiC among patients with HNC is lacking. The objective of this multimethod study was to understand TiC among patients with HNC and identify opportunities to improve care for patients with HNC. Methods: This multimethod study consisted of two phases: a retrospective cohort study and qualitative description. Phase I was a retrospective population-based cohort study that characterized the number and type of TiC that patients with HNC experienced using routinely collected populations-based administrative health databases including the Alberta Cancer Registry, Discharge Abstract Database, the National Ambulatory Care Reporting System, and Physician Claims between January 1, 2012, to December 1, 2019. Both patient demographic and TiC variables were dichotomously coded and described using descriptive statistics. In Phase II, semi-structured interviews were used to explore the lived experiences of patients with HNC and their healthcare providers during TiC. Two independent reviewers used an inductive approach to thematically analyze the semi-structured interview transcripts. Results: In Phase I, there were 2,208 patients with HNC who were mostly male (71.1%), classified as Stage IV HNC at diagnosis (62.4%) and had two or more tumours (91.3%). Patients with HNC often underwent multiple treatment modalities (average: 1.5), with the most common treatment transitions being from surgery to radiotherapy (29.7%). Many patients with HNC were admitted to the hospital and emergency department during the study period, averaging 2.0 hospital admissions and 13.2 emergency departments per patient during the study period. Patients with HNC also experienced many TiC between healthcare providers, with the highest number of physician visits being to general practitioners (average= 62.24 per patient). In Phase II, there were 16 semi-structured interviews conducted with ten patients with HNC and six healthcare providers. The experiences of patients with HNC and their healthcare providers revealed three interconnected themes related to TiC: 1) Navigating the Healthcare System (subthemes include: Head and Neck Cancer Care Complexities, Disrupted Continuity of Head and Neck Cancer Care, and Healthcare System Pressures), 2) Relational Head and Neck Cancer Care (subthemes include: Patient Expectations during Transitions in Care, Feeling Valued as a Head and Neck Cancer Patient and Healthcare Provider Roles and Responsibilities) and 3) System and Individual Impact of Transitions in Care (subthemes include: Impact of Resource-intensive Nature of TiC and the Impact of Transitions in Care on Quality of Care). Conclusions: In sum, this study identifies the challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within HNC. This study suggests TiC may have an impact on the quality of care and provides crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of care during TiC within this patient population. These findings also identified potentially feasible interventions for further exploration, such as shared decision-making, telehealth, or a patient navigator within HNC care.