Patient experiences with case management
A qualitative study on the influence of case management towards patient centered care,
based on experiences by colorectal patients at the Maastricht University Medical Centre
M.C.J. Peters
I6074832
Maastricht University, Faculty of Health, Medicine and Life Sciences
Master Healthcare Policy, Innovation & Management
HPI4050 Placement and Thesis
First supervisor: M.H.C. Bleijlevens
Second supervisor: S. Zwakhalen
Period of placement: April 2018- June 2018
Maastricht University Medical Centre (MUMC+)
25 P. Debyelaan 25
6229 HX Maastricht
Date: 06-07-2018
,Abstract
Background: Due to the availability of modern treatment techniques, many stakeholders
are involved in het care process of cancer patients, making it important that everything
around the patient is well organized. Currently, each stakeholder often works in his/her
own department and nobody has full control over the patient’s care process. In addition to
these internal aspects, professional organizations and the Healthcare Inspectorate have
published standards for all tumor types to professionalize their care. One requirement
described for this is a person within the chain who maintains an overall overview of the
treatment process, called a case manager. The Maastricht University Medical Centre
(MUMC+) has appointed nurse practitioners to fulfill the role of case managers. This is
done on the tumor line which includes colorectal patients. Although this is a promising
development, case management is organized from the perspective of professional
organizations and the Healthcare Inspectorate. To further improve case management, the
experiences of colorectal patients will be investigated in this study.
Method: A qualitative, cross-sectional case design was chosen for this study to gain more
insight in the experiences towards case management. Semi-structured interviews were
conducted at the oncology centre in the MUMC+. Colorectal cancer patients who were
treated with chemotherapy or surgery and had at least three contact moments with the
case manager were questioned. The topics in the interviews were derived from the PPE-15
questionnaire. This questionnaire is based on the eight domains of the Picker Institute.
Furthermore, a directed content analysis was performed.
Results: In total, eight patients were interviewed. During the interviews it emerged that
the patients are positive about the domains: ‘‘respect for patients’ values, preferences and
expressed needs’’, ‘‘coordination and integration’’, ‘‘information, communication &
education’’ and ‘‘involvement family and friends’’. Additionally, patients are not satisfied,
while there is no role for the case manager about the following domains: ‘‘physical
support’’, ‘‘emotional support and alleviation of fear and anxiety’’ and ‘‘access to care’’.
Lastly, the patients are not satisfied, while there is a role for the case manager about the
domain ‘‘transition and continuity’’.
Conclusion: The case manager contributes to patient centeredness of care. However,
patients still see possibilities for improving patient centeredness, especially within the
domains concerning more practical activities, such as planning and logistics, compared to
the domains involving psychological and emotional support.
2
,Table of Contents
1. INTRODUCTION ............................................................................................................................. 5
2. THEORY AND CONCEPTUAL MODEL .............................................................................................. 8
2.1. THEORIES .................................................................................................................................. 8
2.1.1. Quality of care ................................................................................................................... 8
2.1.2. Care process and patient logistics ...................................................................................... 9
2.1.3. Case management........................................................................................................... 10
2.2. CONCEPT MODEL OF THE STUDY .................................................................................................... 12
3. METHODOLOGY .......................................................................................................................... 13
3.1. RESEARCH NATURE, TYPE AND DESIGN ............................................................................................ 13
3.2. SAMPLE .................................................................................................................................. 13
3.3. DATA COLLECTION ..................................................................................................................... 13
3.3.1. Semi-structured interviews .............................................................................................. 14
3.4. DATA ANALYSIS ........................................................................................................................ 15
3.5. TRUSTWORTHINESS ................................................................................................................... 15
3.6. ETHICAL CONSIDERATION ............................................................................................................ 15
4. RESULTS ...................................................................................................................................... 17
4.1. STUDY CHARACTERISTICS ............................................................................................................. 17
4.2. GENERAL REMARKS ABOUT THE ROLE OF THE CASE MANAGER ............................................................... 18
4.3. THE EIGHT DIFFERENT DOMAINS OF PATIENT CENTEREDNESS ................................................................ 18
4.3.1. Respect for patients’ values, preferences and expressed needs ......................................... 18
4.3.2. Coordination and integration of care ............................................................................... 19
4.3.3. Information, communication and education..................................................................... 20
4.3.4. Physical comfort .............................................................................................................. 22
4.3.5. Emotional support and alleviation of fear and anxiety ...................................................... 22
4.3.6. Involvement of family and friends .................................................................................... 23
4.3.7. Transition and continuity ................................................................................................. 24
4.3.8. Access to care.................................................................................................................. 25
4.4. RECOMMENDATIONS REGARDING THE EIGHT DIFFERENT DOMAINS ......................................................... 28
4.4.1. Coordination and integration of care ............................................................................... 28
4.4.2. Information, communication and education..................................................................... 28
4.4.3. Transition and continuity ................................................................................................. 28
4.4.4. General ........................................................................................................................... 28
5. DISCUSSION AND CONCLUSION................................................................................................... 29
3
, 5.1. THE MAIN FINDINGS ................................................................................................................... 29
5.2. STRENGTHS AND STUDY LIMITATIONS ............................................................................................. 30
5.2.1. Methodological considerations ........................................................................................ 30
5.2.2. Theoretical considerations ............................................................................................... 32
5.3. CONCLUSION ........................................................................................................................... 32
5.4. RECOMMENDATIONS FOR RESEARCH AND PRACTICE ........................................................................... 32
5.4.1. Research ......................................................................................................................... 33
5.4.2. Practice ........................................................................................................................... 33
6. REFERENCES ................................................................................................................................ 34
APPENDIX I .......................................................................................................................................... 37
APPENDIX II ......................................................................................................................................... 39
APPENDIX III ........................................................................................................................................ 40
4
A qualitative study on the influence of case management towards patient centered care,
based on experiences by colorectal patients at the Maastricht University Medical Centre
M.C.J. Peters
I6074832
Maastricht University, Faculty of Health, Medicine and Life Sciences
Master Healthcare Policy, Innovation & Management
HPI4050 Placement and Thesis
First supervisor: M.H.C. Bleijlevens
Second supervisor: S. Zwakhalen
Period of placement: April 2018- June 2018
Maastricht University Medical Centre (MUMC+)
25 P. Debyelaan 25
6229 HX Maastricht
Date: 06-07-2018
,Abstract
Background: Due to the availability of modern treatment techniques, many stakeholders
are involved in het care process of cancer patients, making it important that everything
around the patient is well organized. Currently, each stakeholder often works in his/her
own department and nobody has full control over the patient’s care process. In addition to
these internal aspects, professional organizations and the Healthcare Inspectorate have
published standards for all tumor types to professionalize their care. One requirement
described for this is a person within the chain who maintains an overall overview of the
treatment process, called a case manager. The Maastricht University Medical Centre
(MUMC+) has appointed nurse practitioners to fulfill the role of case managers. This is
done on the tumor line which includes colorectal patients. Although this is a promising
development, case management is organized from the perspective of professional
organizations and the Healthcare Inspectorate. To further improve case management, the
experiences of colorectal patients will be investigated in this study.
Method: A qualitative, cross-sectional case design was chosen for this study to gain more
insight in the experiences towards case management. Semi-structured interviews were
conducted at the oncology centre in the MUMC+. Colorectal cancer patients who were
treated with chemotherapy or surgery and had at least three contact moments with the
case manager were questioned. The topics in the interviews were derived from the PPE-15
questionnaire. This questionnaire is based on the eight domains of the Picker Institute.
Furthermore, a directed content analysis was performed.
Results: In total, eight patients were interviewed. During the interviews it emerged that
the patients are positive about the domains: ‘‘respect for patients’ values, preferences and
expressed needs’’, ‘‘coordination and integration’’, ‘‘information, communication &
education’’ and ‘‘involvement family and friends’’. Additionally, patients are not satisfied,
while there is no role for the case manager about the following domains: ‘‘physical
support’’, ‘‘emotional support and alleviation of fear and anxiety’’ and ‘‘access to care’’.
Lastly, the patients are not satisfied, while there is a role for the case manager about the
domain ‘‘transition and continuity’’.
Conclusion: The case manager contributes to patient centeredness of care. However,
patients still see possibilities for improving patient centeredness, especially within the
domains concerning more practical activities, such as planning and logistics, compared to
the domains involving psychological and emotional support.
2
,Table of Contents
1. INTRODUCTION ............................................................................................................................. 5
2. THEORY AND CONCEPTUAL MODEL .............................................................................................. 8
2.1. THEORIES .................................................................................................................................. 8
2.1.1. Quality of care ................................................................................................................... 8
2.1.2. Care process and patient logistics ...................................................................................... 9
2.1.3. Case management........................................................................................................... 10
2.2. CONCEPT MODEL OF THE STUDY .................................................................................................... 12
3. METHODOLOGY .......................................................................................................................... 13
3.1. RESEARCH NATURE, TYPE AND DESIGN ............................................................................................ 13
3.2. SAMPLE .................................................................................................................................. 13
3.3. DATA COLLECTION ..................................................................................................................... 13
3.3.1. Semi-structured interviews .............................................................................................. 14
3.4. DATA ANALYSIS ........................................................................................................................ 15
3.5. TRUSTWORTHINESS ................................................................................................................... 15
3.6. ETHICAL CONSIDERATION ............................................................................................................ 15
4. RESULTS ...................................................................................................................................... 17
4.1. STUDY CHARACTERISTICS ............................................................................................................. 17
4.2. GENERAL REMARKS ABOUT THE ROLE OF THE CASE MANAGER ............................................................... 18
4.3. THE EIGHT DIFFERENT DOMAINS OF PATIENT CENTEREDNESS ................................................................ 18
4.3.1. Respect for patients’ values, preferences and expressed needs ......................................... 18
4.3.2. Coordination and integration of care ............................................................................... 19
4.3.3. Information, communication and education..................................................................... 20
4.3.4. Physical comfort .............................................................................................................. 22
4.3.5. Emotional support and alleviation of fear and anxiety ...................................................... 22
4.3.6. Involvement of family and friends .................................................................................... 23
4.3.7. Transition and continuity ................................................................................................. 24
4.3.8. Access to care.................................................................................................................. 25
4.4. RECOMMENDATIONS REGARDING THE EIGHT DIFFERENT DOMAINS ......................................................... 28
4.4.1. Coordination and integration of care ............................................................................... 28
4.4.2. Information, communication and education..................................................................... 28
4.4.3. Transition and continuity ................................................................................................. 28
4.4.4. General ........................................................................................................................... 28
5. DISCUSSION AND CONCLUSION................................................................................................... 29
3
, 5.1. THE MAIN FINDINGS ................................................................................................................... 29
5.2. STRENGTHS AND STUDY LIMITATIONS ............................................................................................. 30
5.2.1. Methodological considerations ........................................................................................ 30
5.2.2. Theoretical considerations ............................................................................................... 32
5.3. CONCLUSION ........................................................................................................................... 32
5.4. RECOMMENDATIONS FOR RESEARCH AND PRACTICE ........................................................................... 32
5.4.1. Research ......................................................................................................................... 33
5.4.2. Practice ........................................................................................................................... 33
6. REFERENCES ................................................................................................................................ 34
APPENDIX I .......................................................................................................................................... 37
APPENDIX II ......................................................................................................................................... 39
APPENDIX III ........................................................................................................................................ 40
4
