Differences in the Cancer Patient Experience Across Practice Settings

The majority of cancer patients are treated in community cancer centers or private oncology practices, not at comprehensive and academic cancer centers; yet, little is known about the differences in patient experience across these practice settings with respect to patient engagement around treatment decision-making.  To explore these differences and understand where there may be gaps in patient-centered care, we surveyed cancer patients and survivors who registered in the Cancer Experience Registry, an online initiative designed to track their psychosocial needs.  In 2013, 788 registrants answered questions about their experience in getting support around treatment decision-making.  The sample was 86.4% female and 90.9% Caucasian with median age 57; 70.0% had a college degree.  41.4% received treatment at an academic or comprehensive cancer center (A/CCC); 32.1% at a community hospital or cancer center; 26.5% at a private oncology practice.  Respondents who received treatment at an A/CCC reported being more knowledgeable about treatment options (p=0.001) and more involved in the treatment decision making process (p<0.001).  They also received more treatment decision support (p=0.024), were more likely to speak to their healthcare team about clinical trials (p<0.001) and were more satisfied with how much they participated in making the treatment decision (p=0.014).  Findings suggest that cancer survivors who receive treatment at an A/CCC feel more involved, knowledgeable, and satisfied with the treatment decision making process than those who receive care elsewhere.  Future efforts should target the development of innovative, patient-centered decision support programs that link patients to resources treated in community practice settings.