Patient-centred care is defined as ’Care that is respectful and mindful of patient preferences, needs and values, and ensures that this is what guides clinical decision-making’. This type of care is closer to a partnership between the healthcare professional and the patient (and his/her close relatives) than to a paternalistic relationship. It requires good communication, listening, thought, and exchange between the patient and the caregiver.
Methods for measuring this aspect of quality of care are still emerging and are the subject of extensive research. It is about acknowledging the patient’s needs, wishes and preferences, about quality of communication with the healthcare professional (which implies a number of skills on the professional’s part, such as listening, the ability to provide explanations, courtesy), and about involving patients and their close relatives in their care (giving them the option of managing their own care and making informed decisions about their treatment options).
However, measuring whether or not care is focused on the patient represents a real challenge. In 2011, the OECD published a questionnaire containing certain questions on how patients perceive the quality of a visit. Sciensano included some of these questions in the questionnaire of its Health Survey; four of these questions are used here as indicators (QP-1 to QP-4).
The importance given to patient preferences can also be approached through the extent of implementation of new active cancer surveillance strategies with a low risk of progression, as such approaches can only be conceived with the patient’s full agreement and active cooperation (QP-5, QP-6).
Lastly, an indicator related to hospitalised patient experience has also been added. This is the proportion of hospitals that measure experiences reported by patients through questionnaires (Patient-Reported Experience Measures – PREMs) (QP-7).
(1) OECD Health Statistics - Health at a glance 2019 (2015 for QP-3), EU mean is based on 8-9 of the EU-15 countries.
These are 4 indicators measuring how patients perceived their relationship with the last physician they visited.
These indicators are derived from the Health Survey (Sciensano). They are responses to 4 questions asked in this survey: ‘The last time you visited a physician (a general practitioner or a specialist),
- Did this doctor spend enough time with you? (QP-1)
- Did this doctor explain things to you in a way that was easy to understand? (QP-2)
- Did this doctor give you an opportunity to ask questions or raise concerns about recommended treatment? (QP-3)
- Did this doctor involve you as much as you wanted to be in the decisions about your care and treatment?' (QP-4)
- Overall, patient satisfaction is high with regard to the four indicators derived from the Health Survey,, both for contacts with general practitioners (min: 96.5%; max: 98.2%) and with specialists (min: 92.0%; max: 95.9%).
- These results are above the EU-15 average for the four indicators on satisfaction with outpatient care.
- No significant difference was found concerning the education level (for the four indicators).
- Regional differences were most evident for the question about time spent by physicians (Flanders: 97.8% of satisfaction, Wallonia: 97.2% and Brussels: 95.9%).
Active surveillance strategies for certain types of cancer are relatively recent practices which give patients a real role as a partner in the choice of their treatment. This is only done for certain types of cancer with a low risk of progression. The aim is to postpone an immediate treatment whose potential side effects can be heavy by carefully monitoring the natural development of the disease through regular control examinations, and switching to a more aggressive treatment only if a progression is detected. The choice of an active surveillance strategy can only be made with the patient’s full agreement and total cooperation.
- Prostate cancer: This type of cancer most often has a slow progression and its treatments (surgery, radiotherapy) can cause major side effects (urinary incontinence, sexual impotency). If certain conditions are met (stage of cancer development, patient age and general health status), it is possible to suggest to the patient not to treat the tumour immediately and to monitor its progression through regular examinations. If the tumour shows any signs of progression, there will still be time to switch to a more aggressive treatment.
- Testicular cancer: Active surveillance can be suggested after surgical ablation of the affected testicle, instead of possible additional standard chemotherapy and/or radiotherapy treatments. The principle is the same: careful monitoring with the patient’s full cooperation, and a more energetic treatment applied only in cases where it becomes necessary.
- Fewer and fewer patients with low-risk prostate cancer are offered an active treatment: 58% of patients diagnosed in 2015 received no treatment, versus 21% in 2004 (Figure 1).
- The proportion was higher for older patients (Figure 2)
- In patients who have testicular cancer with a positive prognosis, a clear decrease in the proportion of adjuvant treatments can be observed since 2004, and particularly since 2013, the year of publication of new clinical recommendations (Figure 3).
Source: Belgian Cancer Registry
Source: Belgian Cancer Registry
Source: Belgian Cancer Registry
Measuring patient experiences (Patient-Reported Experience Measure - PREM) has become part of quality of care assessment practices in hospitals. In Flanders, in 2017, 50 hospitals voluntarily responded to the satisfaction questionnaire initiated by the Vlaams Patiënten Platform (VPP/Flemish Patient Platform). French-speaking hospitals measure patient satisfaction using questionnaires developed by BSM Management and Santhea. Lastly, a few hospitals measure patient experience through their own independent methods. Although this trend is a welcome one, the non-uniformity of the measurement methods is unfortunate as it prevents any overall assessment.
In July of 2018, a Pay for Performance project (P4P) was launched in Belgian hospitals as part of the hospital funding reform, for a total budget of 6 million euros. Each participating hospital will be rated out of 80 points, ten of which are related to measuring patient experiences.
- In 2018, 96 hospitals out of 102 (94%) participated in the P4P Project by organising PREM measurements.
- In the future, the P4P project will be extended to include more PREMs and also to PROMs (Patient-Reported Outcomes Measure).