Service providers’ perspectives on the quality of care of a new complex psycho-oncological care programme in Germany – mixed methods external evaluation results

BACKGROUND: In Germany, the guideline-compliant provision of psycho-oncological care is challenging. To improve care structures, a newly developed psycho-oncological care programme 'integrated cross-sectoral Psycho-oncology' (isPO) was implemented in four psycho-oncological care networks and externally evaluated for quality of care (QoC) and effectiveness. The psycho-oncological service providers' (SP) perspective was assessed as part of the QoC evaluation. METHODS: A mixed methods design with quantitative and qualitative methods was used. SPs were surveyed twice after programme implementation. They rated their programme satisfaction and contextual and individual factors that might affect its implementation. Medical staff from oncological wards were surveyed once after implementation. Descriptive and correlation analyses were conducted. The independent samples t-test was used to compare programme assessment between medical staff and SPs. Semi-structured interviews were conducted with the head psycho-oncologists and two cross-network focus groups with SPs from different professions. One semi-structured interview was conducted for someone who could not attend the focus group. Purposeful sampling was used. All interviews and focus groups were audiotaped, transcribed, and analysed using content-structuring method. RESULTS: In the surveys, SPs rated their programme acceptance and the care concept positively. Most stated that QoC and cross-sectoral care had improved due to isPO. In the interviews and focus groups, patient benefits were described as the main factors facilitating programme acceptance. Therefore, needs orientation was crucial for structured diagnostics, care intensity, and flexibility in appointment frequencies. Having a fixed contact person across sectorial boundaries was identified as highly beneficial. Organisational workload determinants, such as documentation and bureaucracy, were critically reflected upon as hindering implementation and straining. Participation in quality management activities was perceived as helpful in discussing ways of tailoring the programme to the practice, thereby improving its feasibility. CONCLUSIONS: SPs' programme assessment and experience help indicate the programme's feasibility and possible fit for routine care. Including participatory elements in the implementation or development phase may support adapting the programme to an implementation site's needs. SPs' experience with the stepped and needs-centred care approach indicates that its underlying concept is recommendable for routine care. However, persistent programme optimisations should be enabled and further implemented within structured quality management. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30 October 2018.