The delivery of cancer care must focus on ensuring the best outcomes and experience for the patient by drawing on the wide range of skills of the multidisciplinary team (MDT). These are a combination of clinical and technical skills, together with good communication, empathy and involvement of the patient in all aspects of care planning and delivery. Patient-centred care necessitates excellence in the quality and speed of diagnostic work and in the delivery of treatment, follow-up and long-term support. It requires control of the tumour and the best possible patient survival. We must also optimize health-related quality of life (HRQOL), patient experience and patient satisfaction with care. The best clinical options should be identified, preferably by a specialized MDT. The options are then considered with the patient, the family and carers. Decisions must take into account the views of both the healthcare professionals and the patient. Delivering excellent patient-centred care requires good communication skills. Patient participation in shared decision making, patient empowerment, and patient engagement in individual care, service planning and research all contribute to driving excellent patient-centred care.
The terminology in this area is rightly constantly evolving. 'Patient-centred care' is widely used to describe these aspects of cancer care, and we have used the term in this book. We recognize, however, that as the field extends to include approaches to people who undergo screening tests and diagnostic investigations, and as cancer survivors take up the reins of their lives again, the term 'person-centred care' becomes increasingly appropriate. This book brings together colleagues from a wide range of healthcare disciplines to articulate their understanding of patient-centred care, how to deliver it and how to consolidate its position in cancer care systems. A key aspect of developing and delivering excellent patient-centred care is the collaboration between many professions and disciplines. Integration of care can improve outcomes for cancer patients and is especially important to ensure a patient-centred approach.
Commitments to patient-centred care have been in place for several decades. An early example in the UK lay in the 1995 Calman-Hine report,1 which said: 'The development of cancer services should be patient-centred and should take account of patients', families' and carers' views and preferences as well as those of professionals involved in cancer care. Individuals' perceptions of their needs may differ from those of the professional. Good communication between professionals and patients is especially important.' These concepts are brought up to date and elegantly expressed by Abrahams et al.2 (Figure 1.1).
A model for patient-centred care (adapted from Abrahams et al.2).
Excellence in patient-centred care has many challenges. Patient outcomes have many aspects, and assessing them requires increasingly complex outcome measures, often patient-reported outcome measures (PROMs) (see Chapter 2). Psychological and social factors are key ...