Table 2.

Patient Care Experience from the Framework for Outcomes of Clinical commUnication Services (FOCUS)

Patient Care Experience Categoriesa	Description	Example measures	Hypothesized to influence other outcomes
bSatisfaction with support personnel and logistics of care	Appointment and registration personnel were courteous, respectful, and helpful. Facilities/amenities were perceived favorably (comfortable, clean, etc). Wait times to be seen in clinic were reasonable to the patient.	Proportion of patients who report the amenities were clean. Proportion of patients who report that the wait time to be seen for an appointment was not too long.	Patient satisfaction with these and other aspects of care is one indicator of patient-centered care and therefore considered quality care.
bMeeting patient needs & expectations [1]	Patient’s perception that expectations are met, needs are addressed, and provider spent enough time with them.	Proportion of persons who report that their health care providers always spent enough time with them. Several of these concepts are captured as part of the Genetic Counseling Satisfaction Scale Patient satisfaction with cancer genetic counseling [2] Satisfaction with genetic counseling: dimensions and measurement [3]	Meeting patient needs may influence patient empowerment and adherence/self-management.
Perceptions of provider communication	Patient reports their provider communicated well. Patient recalls discussion of certain topics such as: available options (including risks and benefits) or who in the family may also be at risk for the genetic condition. Patient recalls provider asked about patient's preferences, values and opinions. Patient feels that the provider involved them in the interaction. Patient recalls provider followed up with patient as planned (e.g., called out test results, verified insurance, communicated with other providers) Patient’s perceptions of degree to which clinical providers worked together	Proportion of persons who report their health care provider always asked them to describe how they will follow the instructions. Proportion of persons who report that their health care providers always involved them in decisions about their health care as much as they wanted, Perceived involvement in Care Scale (patient involvement subscale) [4]	Improved recall is expected to increase how informed patients feel and their perceptions of both the information received and the patient-provider relationship. If patients don't recall what occurred, it may hinder their ability to make quality health decisions or negatively impact self-efficacy to take action. Patients’ perceptions that staff worked together for their health care is strongly correlated with overall evaluations of care.
bPerceptions of patient-provider relationship [2–4]	Feeling understood and respected Perceptions of trust and confidence in the provider Perceptions of emotional support from the provider Perceptions of autonomy support from provider	Captured as part of the Genetic Counseling Satisfaction Scale Patient satisfaction with cancer genetic counseling [2] Satisfaction with genetic counseling: dimensions and measurement [3] Patient Reactions Assessment subscale “affective communication” measures patient perceptions of physician's respect and concern for the patient [8] Proportion of persons who report that their health care providers always listened carefully to them. Health Care Climate – patient feels provider supports autonomy [9]	Patients who positively perceive their relationship with their provider are more likely to make quality health decisions and adhere to health recommendations.
bPerceptions of information	Although “experts” can evaluate whether the information is accurate, the patient is perhaps the best person to evaluate information clarity, amount, appropriateness, and relevance for themselves.	Patient Reactions Assessment (PRA) subscale, “information”-- measures patient's perception of physicians' information-giving [8] Proportion of persons who report their health care provider always gave them easy to understand instructions [or information] about their health condition	Perceptions that information is appropriate and relevant indicate patient-centered care. Positive perceptions about information may improve how informed patients feel, quality health decision, adherence/self-management, and communication with family.

^aPatient experience measures reflect patient-centeredness which is one of the six quality health domains

^bAlthough more specific, these categories may encompass some aspects of what people have referred to as “patient satisfaction”.

References

^[1]C. Wang, R. Gonzalez, and S. D. S. D. Merajver, “Assessment of genetic testing and related counseling services: current research and future directions.,” Soc. Sci. Med., vol. 58, no. 7, pp. 1427–42, Apr. 2004. http://www.ncbi.nlm.nih.gov/pubmed/14759687

^[2]T. A. DeMarco, B. N. Peshkin, B. D. Mars, and K. P. Tercyak, “Patient satisfaction with cancer genetic counseling: a psychometric analysis of the Genetic Counseling Satisfaction Scale.,” J. Genet. Couns., vol. 13, no. 4, pp. 293–304, Aug. 2004. http://www.ncbi.nlm.nih.gov/pubmed/19736695

^[3]S. Shiloh, O. Avdor, and R. M. Goodman, “Satisfaction with genetic counseling: Dimensions and measurement,” Am. J. Med. Genet., vol. 37, no. 4, pp. 522–529, Dec. 1990. http://onlinelibrary.wiley.com/doi/10.1002/ajmg.1320370419/abstract;jsessionid=0D869F79210E85EC865859AE4B3F00A8.f03t02

^[4]C. E. Lerman, D. S. Brody, G. C. Caputo, D. G. Smith, C. G. Lazaro, and H. G. Wolfson, “Patients’ Perceived Involvement in Care Scale: relationship to attitudes about illness and medical care.,” J. Gen. Intern. Med., vol. 5, no. 1, pp. 29–33. http://www.ncbi.nlm.nih.gov/pubmed/2299426

^[5]R. L. Street, G. Makoul, N. K. Arora, and R. M. Epstein, “How does communication heal? Pathways linking clinician-patient communication to health outcomes.,” Patient Educ. Couns., vol. 74, no. 3, pp. 295–301, Mar. 2009. http://www.ncbi.nlm.nih.gov/pubmed/19150199

^[6]R. L. Street, “How clinician-patient communication contributes to health improvement: modeling pathways from talk to outcome.,” Patient Educ. Couns., vol. 92, no. 3, pp. 286–91, Sep. 2013. http://www.ncbi.nlm.nih.gov/pubmed/23746769

^[7]R. L. Street and R. M. Epstein, Patient-Centered Communication in Cancer Care: Promoting Healing & Reducing Suffering. Bethesda, MD: NIH publication, 2007. http://appliedresearch.cancer.gov/areas/pcc/communication/pcc_monograph.pdf

^[8]J. P. Galassi, R. Schanberg, and W. B. Ware, “The Patient Reactions Assessment: A brief measure of the quality of the patient-provider medical relationship.,” Psychol. Assess., vol. 4, no. 3, pp. 346–351, 1992. http://doi.apa.org/getdoi.cfm?doi=10.1037/1040-3590.4.3.346

^[9]D. Zohar, Y. Livne, O. Tenne-Gazit, H. Admi, and Y. Donchin, “Healthcare climate: a framework for measuring and improving patient safety.,” Crit. Care Med., vol. 35, no. 5, pp. 1312–7, May 2007. http://www.ncbi.nlm.nih.gov/pubmed/17414090