Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt.

BACKGROUND: The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated. PURPOSE: The purpose of this study was to determine the impact of different patient characteristics on the following outcomes: (1) patients' wishes for or against CPR, (2) assessments made by physicians of the indication for CPR, and (3) the probability of discordance between patients' wishes and physicians' assessments. METHODS: In this survey, 1,128 of 1,408 cancer patients received a questionnaire concerning their wish for CPR. In total, 904 patients responded. A total of 61 treating physicians assessed the medical indication for resuscitation. Different predefined patient characteristics were analyzed using both univariate and multivariate analyses. RESULTS: Ninety percent of responding patients wished to receive CPR. The physicians found indications supporting CPR in 89 % of patients. Age ≥70 years, increasing line of treatment, poor prognosis, living alone, and poor self-rated physical and mental health enhanced both patients' wishes and physicians' assessments to withhold CPR. However, only age ≥70 years, poor prognosis, and poor self-rated physical health significantly predicted rejection of CPR in multivariate analyses. The likelihood of discordance between patients and physicians was significantly higher when the patient was ≥70 years and when the expected 5-year survival was <25 %. CONCLUSIONS: Factors associated with the imminence of dying influenced both patients and physicians to refrain from CPR, and perhaps more surprisingly, the probability of discordance between patients and physicians increased.

Patients' experience of choosing an outpatient clinic in one county in Denmark: results of a patient survey.

BACKGROUND: Research on patients' choice of hospital has focused on inpatients' rather than outpatients' choice of provider. We have investigated Danish outpatients' awareness and utilisation of freedom of choice of provider; which factors influence outpatients' choice of hospital, and how socio-demographic variables influence these factors in a single uptake area, where patients were free to choose any public hospital, where care was provided free at the point of delivery, and where distance to the closest hospitals were short by international standards. METHODS: Retrospective questionnaire study of 4,232 outpatients referred to examination, treatment, or follow-up at one of nine somatic outpatient clinics in Roskilde County in two months of 2002, who had not been hospitalised within the latest 12 months. The patients were asked, whether they were aware of and utilised freedom of choice of hospital. RESULTS: Fifty-four percent (2,272 patients) filled in and returned the questionnaire. Forty-one percent of respondents were aware of their right to choose, and 53% of those patients utilised their right to choose. Awareness of freedom of choice of provider was reported to be especially high in female outpatients, patients with longer education, salaried employees in the public sector, and in patients referred to surgical specialties. Female outpatients and students were especially likely to report that they utilised their right to choose the provider. Short distance was the most important reason for outpatients' choice, followed by the GP's recommendations, short waiting time, and the patient's previous experience with the hospital. CONCLUSIONS: Outpatients' awareness and utilisation of free choice of health care provider was low. Awareness of freedom of choice of provider differed significantly by specialty and patient's gender, education and employment. Female patients and students were especially likely to choose the clinic by themselves. Most outpatients chose the clinic closest to their home, the GP's recommendation and short waiting time being the second and third most important factors behind choice.

[Patient evaluation of health care]. / Patientevaluering af sundhedsvaesenet.

Quality improvement in health care should include patient evaluations. Patient evaluation is a relevant instrument for assessing those aspects of care which are significant for the patient's experience of quality and for assessing courses of treatment. The striving for 100% satisfaction should be balanced by the regard for quality viewed from a professional and an organizational perspective. Patient evaluations must be integrated in a learning process in order to produce quality improvement in the evaluated organization. Scientific development of instruments for evaluation by patients with specific diagnoses and evaluations of courses of treatment will contribute to future quality improvement of health care.

[Patients' attitude towards the hospital system in eastern and western Denmark. Patient involvement, patient orthodoxy and information gathering]. / Patienters indstilling til sygehusvaesenet i Østdanmark og Vestdanmark. Medinddraegelse, autoritetstro og informationssogning.

INTRODUCTION: Based on results from the Danish National Patient Satisfaction Survey (2000, 2002), which showed that patients treated in hospitals in western Denmark (West) had more positive experiences than patients treated in hospitals in eastern Denmark (East), the Unit of Patient Evaluation examined what factors may be creating the regional differences in patients' experiences. MATERIALS AND METHODS: This research is based on qualitative research methods and has decoded the sense ascribed by each patient, based on his or her own understanding, norms and values, to phenomena and experiences during hospitalisation. The research was carried out in four orthopaedic departments, and hip patients were chosen as the target group. In all, 16 interviews with patients, 9 interviews with medical personnel and 4 observations were carried out. RESULTS: All the patients preferred to be informed about their treatment possibilities. Nevertheless, compared to patients in the West, patients in the East had more specific expectations of being involved in their hospitalisation, they had more often tried to get involved and they were less orthodox and more engaged in obtaining information. DISCUSSION: This research indicates that the difference in patients' experiences between eastern and western Denmark may be caused by their different expectations of involvement. An individual patient's evaluation of hospitalisation may be more positive if the patient does not have a high expectation of having his or her individual needs fulfilled.

[Clinical leaders' and staff's assessment of the current quality related to the patient pathways and expectations of and knowledge about accreditation--a baseline evaluation in Copenhagen County]. / Lederes og medarbejderes vurdering, forventninger og kendskab til akkreditering--en førmåling på sygehuse i Københavns Amt.

INTRODUCTION: In the preparation for accreditation in Copenhagen County the commitment of clinical leaders and staff members is crucial. The objectives of these surveys are to examine the leaders' and the staff's assessment of quality improvement and their expectations and knowledge about accreditation, as well as the staff's advice concerning the further planning. MATERIALS AND METHODS: Two surveys among clinical leaders and staff members were carried out. RESULTS: Statistically, significant differences between staff and leaders were found in many areas concerning quality improvement and knowledge about accreditation. Leaders and staff both had high expectations of the use of accreditation as a tool for quality improvement, thus no statistically significant difference between expectations were found. CONCLUSION: The overall positive expectation for accreditation as a tool for quality improvement is an excellent basis for the accreditation process. The different assessments in quality among leaders/staff and positions show the need to involve all personnel in the organization. A survey about patient experiences includes the same subjects as the survey among staff and leaders. A striking discrepancy between the evaluation of quality by patients and by the leaders and staff in specific areas was found; therefore further investigations will be carried out.

[Patient-experienced quality assessed in two national surveys]. / Patientoplevet kvalitet belyst ved to nationale undersøgelser.

INTRODUCTION: Surveys of patients' experiences can be used for other purposes than to disclose patients' overall satisfaction. They can, for example, also be used to select focus areas in the health care sector. In this article two large national surveys of patient-experienced quality are compared. The advantages and disadvantages of the applied methods and various applications of the surveys are discussed. MATERIALS AND METHODS: The Danish National Patient Satisfaction Survey was based on a questionnaire with questions about patients' experiences. The questionnaires were sent to the patients after discharge. All 62 public Danish hospitals were included. The Patient Reports Survey was based on a questionnaire with questions about whether the patient had received certain services. The questionnaire was given to each patient on the day of discharge and returned before the patient left the hospital. All medical wards were invited to participate in the survey. RESULTS: Despite differences in questions, design and methods, the two surveys showed agreement in the areas where patients experienced flaws in the quality of services. CONCLUSION: In future surveys the advantages and disadvantages of data feedback, inclusion on the basis of data registers, sample sizes and the possibility of being supplied with ward-specific data should be taken into consideration. The advantages and disadvantages of involving employees should be counterbalanced in each survey. The Danish National Patient Satisfaction Survey is suitable for external evaluation and benchmarking between hospitals, while the applied methods in the Patient Reports Survey are best suited to internal self-evaluation and quality improvement within hospital departments.