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Quality Improvement Reports

Improving the quality of palliative care for ambulatory patients with lung cancer

BMJ 2005; 330 doi: (Published 02 June 2005) Cite this as: BMJ 2005;330:1309
  1. Christian von Plessen, head of lung cancer unit (christian.von.plessen{at},
  2. Aslak Aslaksen, head of department2
  1. 1 Department of Thoracic Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
  2. 2 Department of Radiology, Haukeland University Hospital
  1. Correspondence to: C von Plessen
  • Accepted 2 March 2005


Problem Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time and energy in organisational aspects of care that could be better used in direct interaction with patients.

Design Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding satisfaction with working conditions.

Setting Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care.

Key measures for improvement Waiting time and time wasted during consultations; calmer working situation at the clinic; satisfaction among patients.

Strategies for change Rescheduled patients' appointments, automated retrieval of blood test results, systematic reporting in patients' files, design of an information leaflet, and refurnishing of the waiting area at the clinic.

Effects of change Interventions resulted in increased satisfaction for patients and staff, reduced waiting time, and reduced variability of waiting time.

Lessons learnt Direct observation, focus groups, questionnaires on patients' satisfaction, and measurement of process time were useful in systematically improving care in this outpatient clinic. The description of this experience can serve as an example for the improvement of a microsystem, particularly in other settings with similar problems.


  • Funding The project was supported by the Quality Improvement Fund of the Norwegian Medical Association. The Norwegian Heart and Lung Foundation sponsored new furniture for the waiting area at the clinic.

  • Competing interests Astra-Zeneca, GlaxoSmithKline, and Boehringer have supported CvP to attend conferences on thoracic medicine. He is currently investigator in clinical studies initiated by AstraZeneca and ElyLilly. AA has received funding from the Norwegian Cancer Society and Medirad.

  • Ethical approval The protocol was presented to the local ethical research committee and a formal review was not deemed necessary

  • Accepted 2 March 2005
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