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The remainder of this chapter is organized around the following five questions:
What is the state of the cancer care "system"?
What is quality cancer care and how is it measured?
What cancer care quality problems are evident and what steps can be taken to improve care?
How can we improve what we know about the quality of cancer care?
What steps can be taken to overcome barriers to access to quality cancer care?
What is The State of The Cancer Care "System"?
Health care in the United States is superb at its best, but there is a growing recognition that for many people in many situations, it is not at its best (Chassin et al., 1998). Observers have noted serious and extensive problems in health care quality and have called for urgent action. Although a few health plans, hospitals, and integrated delivery systems have made impressive efforts to improve their quality of care, and some success has been achieved, there are in general no clear models of exemplary delivery systems in this country (Chassin et al., 1998). The IOM National Roundtable on Health Care Quality concluded that current attempts to improve quality will not succeed unless major, systemic efforts are undertaken to overhaul the way in which health care services are delivered, physicians are educated and trained, and quality is assessed (Chassin et al., 1998).
The National Cancer Policy Board began its deliberations on quality by trying to describe what an ideal cancer care system would look and feel like from the vantage point of an individual receiving cancer care. The NCPB suggested that, for many, excellence in cancer care would be achieved if individuals had:
access to comprehensive and coordinated services;
confidence in the experience and training of their providers;
a feeling that providers respected them, listened to them, and advocated on their behalf;
an ability to ask questions and voice opinions comfortably, to be full participants in all decisions regarding care;
a clear understanding of their diagnosis and access to information to aid this understanding;
awareness of all treatment options and of the risks and benefits associated with each;
confidence that recommended treatments are appropriate, offering the best chance of a good outcome consistent with personal preferences;
a prospective plan for treatment and palliation;
a health care professional responsible (and accountable) for organizing this plan in partnership with each individual; and
assurances that agreed-upon national standards of quality care are met at their site of care.