Patient- and family-centered care: a qualitative exploration of oncologist perspectives.
Increasingly, patient- and family-centered care (PFCC) is recognized as a valuable component of healthcare reform with rich opportunities for improvement within oncology. Shifting toward PFCC requires physician buy-in; however, research examining their perspectives on PFCC is lacking. We sought to explore oncologists' perspectives on PFCC to identify factors that influence their ability to practice PFCC.



We conducted semi-structured interviews with 18 oncologists (8 radiation, 4 medical, 4 surgical, 2 hematologist-oncologists) at a single Canadian academic cancer institution. Interview data were analyzed using thematic analysis and principles drawn from grounded theory. Subsequently, focus groups consisting of the interviewed participants were facilitated to confirm and elaborate on our findings. Constant comparisons were used to identify recurring themes.



Three dominant themes emerged. First, physicians displayed cautious engagement in their approach to PFCC. Collectively, participants understood the general principles of PFCC. However, there was a limited understanding of the value, implications, and motivation for improving PFCC which may create reluctance with physician buy-in. Second, both individual and system barriers to practicing PFCC were identified. A lack of physician acknowledgement and engagement and competing responsibilities emerged as provider-level challenges. System barriers included impaired clinic workflow, physical infrastructure constraints, and delays in access to care. Third, physicians were able to identify existing and potential PFCC behaviors that were feasible within existing system constraints.



Advancing PFCC will require continued physician education regarding the value of PFCC, acknowledgement and preservation of effective patient- and family-centered strategies, and creative solutions to address the system constraints to delivering PFCC.
Division of Radiation Oncology, Department of Oncology, Western University and London Health Sciences Centre, London, ON, Canada.
Timothy K
TK
Nguyen
Division of Radiation Oncology, Department of Oncology, Western University and London Health Sciences Centre, London, ON, Canada. glenn.bauman@lhsc.on.ca.
Glenn S
GS
Bauman
Department of Clinical Neurological Sciences and Oncology, Western University, London, ON, Canada.
Christopher J
CJ
Watling
Division of Medical Oncology, Department of Oncology, Western University and London Health Sciences Centre, London, ON, Canada.
Karin
K
Hahn
D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072103:Oncologists / Q000523:psychology*; D018802:Patient-Centered Care; D036301:Qualitative Research; D057188:Workflow
Barriers; Patient- and family-centered care; Patient-centered care; Physician; Strategies