Explaining variation in patient-centredness between breast cancer centres taking into account structure, leadership and organizational culture of the hospitals

• Applicant: Privatdozent Dr. Christoph Kowalski
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine
• Term: from 2013 to 2014
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 236165672

The Institute of Medicine defines patient-centredness as one of the six aims for improvement in health care, with information provision being a key antecedent. Breast cancer patients are confronted with a serious diagnosis that requires the patients to make important decisions. Many of the decisions are once-in-a-lifetime decisions and require the patient to be informed about different options. There are numerous studies that have investigated breast cancer patients' needs for information both related and unrelated to their particular illness, including information on different treatment options, on the risks/side effects and impact on health-related quality of life of possible treatments, and on support measures. Previous studies have been consistent in their findings that breast cancer patients have a high desire for information, especially concerning the severity of their condition and their treatment options. Recent data consistently demonstrate substantial differences in the degree to which breast cancer patients in Germany feel that they receive sufficient and adequate information and involvement across hospitals, even though breast cancer centres are relatively standardized. There has been little research that investigates why information provision as one central aspect of patient-centredness varies across hospitals and what facilitates or hinders processes of information provision. Additionally, while there is a large body of research into the associations between sociodemographic aspects and information needs and deficits, there are relatively few investigations that show methods to identify which kinds of information are adequate for different patients. Not much effort has been made in Germany to connect information deficits of patients to their (impaired) ability to read and understand (written or verbally provided) health-care information and to what extent this could be tackled in the hospital.The proposed project aims to 1) assess the amount of variation between breast cancer centres in terms of patient-centredness with a special focus on the information provided using a patient survey; 2) survey breast cancer centres' key informants to characterize the hospitals' organizational culture, structure and leadership; 3) employ multilevel analysis to determine the extent to which the degree of patient-centredness is associated with cancer centres' organizational culture, structure and leadership, holding constant patients' attributes; and 4) investigate whether patients' information needs vary as a result of their ability to read and understand health information.The research will be conducted at the University of Michigan School of Public Health under the supervision of Prof. Lee and Prof. Jacobson.

• DFG Programme: Research Fellowships
• International Connection: USA
• Hosts: Professor Dr. Peter D. Jacobson; Professor Dr. Shoou-Yih Daniel Lee