Patient Satisfaction With Service Quality in an Oncology Setting

Implications for Prognosis in Non-small Cell Lung Cancer

Digant Gupta; Mark Rodeghier; Christopher G. Lis


Int J Qual Health Care. 2013;25(6):696-703. 

In This Article

Abstract and Introduction


Objective To evaluate the relationship between self-reported satisfaction with service quality and overall survival in non-small cell lung cancer (NSCLC).

Design A prospective cohort study.

Setting Cancer Treatment Centers of America® from July 2007 and December 2010.

Participants Nine hundred and eighty-six returning NSCLC patients.

Intervention Overall patient experience 'considering everything, how satisfied are you with your overall experience' was measured on a 7-point Likert scale ranging from 'completely dissatisfied' to 'completely satisfied.'.

Main Outcome Measure Patient survival was the primary end point.

Results The response rate for this study was 69%. Six hundred patients were newly diagnosed, while 386 were previously treated. Four hundred sixty-nine were males, while 517 were females. 101, 59, 288 and 538 patients had stage I, II, III and IV disease, respectively. Mean age was 58.9 years. Six hundred and thirty (63.9%) patients had expired at the time of this analysis. Seven hundred and sixty-two (77.3%) patients were 'completely satisfied'. Median overall survival was 12.1 months (95% confidence interval (CI): 10.9–13.2 months). On univariate analysis, 'completely satisfied' patients had a significantly lower risk of mortality compared with those not 'completely satisfied' [hazard ratio (HR) = 0.70; 95% CI: 0.59–0.84; P < 0.001]. On multivariate analysis controlling for stage at diagnosis, prior treatment history, age and gender, 'completely satisfied' patients demonstrated significantly lower mortality (HR = 0.71; 95% CI: 0.60–0.85; P < 0.001) compared with those not 'completely satisfied'.

Conclusions Self-reported experience with service quality was an independent predictor of survival in NSCLC patients undergoing oncologic treatment, a novel finding in the literature. Based on these provocative findings, further exploration of this relationship is warranted in well-designed prospective studies.


Lung cancer is the most common cancer in the USA in terms of incidence and mortality with 219 440 new cases and 159 390 deaths in 2009.[1] Patients with lung cancer experience a variety of distressing symptoms, many of which begin prior to diagnosis and continue throughout the course of the disease and its treatment, adversely affecting functional status and quality of life.[2–5] While symptom burden in lung cancer is well known, there is little to no data on how the satisfaction with the quality of the services these patients receive at a healthcare institution[6,7] can affect their treatment outcomes.

Patient satisfaction with service quality is becoming an increasingly important tool for providers to demonstrate patient focus and differentiation in the healthcare community, as well as enhance patient experience. Furthermore, providers are using this information to make important decisions regarding operational and treatment plans.[8] Evaluations of service quality in an oncology setting provide important data concerning the patient satisfaction with the quality of care and treatment delivered by physicians, paramedical staff and the hospital as a whole.[9] Health providers can use data on service quality to design and track quality improvement over time and compare themselves with other health providers (when the same measures are used), as well as recognize and expeditiously resolve service problems in real time.[10,11]

Evaluation of service quality involves a diverse array of methodologies, including longitudinal surveys, in-depth interviews, focus-group discussions, patient panels, consultation of voluntary groups and analyses of patient feedback and concerns. Such evaluations, when followed by speedy improvements to hospital operations and protocol, can enhance current and future patient satisfaction during and after treatment. Patient-reported service quality survey is the most widely used method for objectively and systematically determining cancer patients' satisfaction with the health care received.[12]

There are several studies in the literature that have evaluated service quality in cancers like gastroesophageal,[13] breast,[10,14] colorectal,[15] lung,[16] prostate[16] and gynecological.[17,18] Collectively, these studies have found that satisfaction with the information provided by medical staff about a patient's illness and the course of treatment is important. This is followed closely by the time spent with the physician and the interpersonal skills of the physician. Other key factors are waiting time to get an appointment, empathy of staff with the patient, the continuity of care provided and satisfaction with the nursing staff.[12]

Patient satisfaction with their treatment and services from medical providers is often influenced by patient's overall well-being and health.[19,20] Similarly, patients who are responding more favorably to treatment will likely have greater survival and are also likely to have better current health and more positive feelings of well-being. Given the interrelationship among these characteristics, and because patient satisfaction is so commonly assessed in health care, we investigated the relationship between patient satisfaction with service quality and survival in non-small cell lung cancer (NSCLC) patients treated at a national network of oncology hospitals. The current study is a sequel to our recently published study evaluating this relationship in colorectal cancer.[21]