Assessing physician performance at contextualizing care in patients with advanced lung cancer

Contextualization of care has been well documented as an important process for optimizing health care outcomes. Yet there has been little research on attention to patient life context in care planning in the setting of life-threatening disease. We sought to explore how care is contextualized during medical visits in advanced lung cancer treatment in Norway.

We conducted an exploratory observational study using data from physician-patient dialogues about treatment decisions. The material consisted of consultations with patients receiving treatment for advanced lung cancer from several hospitals in Western Norway. Transcripts and audio recordings were analyzed using the Content Coding for Contextualization of Care (4 C) system. Physician attention to patient context was defined by whether clinicians (a) probed contextual red flags to elicit contextual factors and (b) incorporated contextual factors into care plans. Contextual factors were categorized into their twelve domains.

Across 17 medical encounters, clinicians probed 19 of 30 contextual red flags (63%) and formulated contextualized care plans for 21 of 29 contextual factors, a contextualizing care rate of 72%. The most common contextual domains were Skills, Abilities and Knowledge (10 contextual domain assignments), followed by Access to Care (4) and Social Support (4). One contextual factor was assigned to two domains, yielding 30 contextual domain assignments across 29 contextual factors.

This exploratory observational study suggests that inattention to contextual factors may hinder effective care for patients with advanced lung cancer.

The findings support greater emphasis on contextualization of care in clinical training, assessment, and care planning.