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

Disclosures

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

In This Article

Results

Response Rate

A total of 1429 returning NSCLC patients were contacted at all three hospitals combined to participate in the survey between July 2007 and December 2010. However, only 986 patients responded. As a result, the response rate for this study was 69%.

Baseline Patient Characteristics

Table 1 displays baseline patient characteristics across the entire study population (n = 986). At the time of this analysis (June 2012), 630 (63.9%) patients had expired. The median time duration between the date first seen at CTCA and the date of patient satisfaction survey was 103 days.

Service Quality Items

Table 2 describes patient satisfaction with service quality items pertaining to CTCA's operations and services. Table 3 describes patient satisfaction with service quality items pertaining to CTCA's multidisciplinary patient care team. Seven hundred and sixty-two (77.3%) patients were 'completely satisfied' with the overall service quality they received. The highest levels of dissatisfaction were observed for the following individual service quality items: team helping you understand your medical condition, the timeliness with which your care was delivered and team explaining your treatment options. Table 4 displays the patient characteristics and patient satisfaction with service quality stratified by the three CTCA hospitals.

Univariate Analysis: Predictors of Patient Survival

On Kaplan–Meier analysis, the median overall survival for the entire patient cohort was 12.1 months (95% CI: 10.9–13.2 months). The median survival for 'completely satisfied' patients and 'not completely satisfied' patients was 12.9 and 8.7 months, respectively, log-rank P < 0.001. As shown in Table 5, individual service quality items that were significantly predictive of survival on univariate analysis were 'the ease of the registration process', 'the speed of the registration process', 'the timeliness with which care was delivered', 'team helping you understand your medical condition', 'team explaining your treatment options', 'the amount of time spent with you', 'team calling you by your name', 'team genuinely caring for you as an individual' and 'team providing you with a sense of well-being'. In addition, 'overall patient satisfaction with service quality' was also significantly predictive of survival. Among the patient characteristics, prior treatment history, stage at diagnosis and gender were significant predictors of survival. Finally, the CTCA hospital variable was also found to be significantly associated with survival.

Multivariate Analysis: Predictors of Patient Survival

Before proceeding with multivariate analysis, we checked the bivariate Kendall's tau b correlation among the service quality predictors in order to screen for observable multicollinearity. 'Ease of the registration process' and 'speed of the registration process' were highly correlated (tau b = 0.77). Of these two, 'speed of the registration process' was chosen to be included in multivariate analysis because it is a more straightforward concept to understand from the patient's point of view. Similarly, 'team explaining your treatment options' was highly correlated with 'team helping you understand your medical condition' (tau b = 0.78). Of these two, 'team helping you understand your medical condition' was considered for multivariate analysis because it represents the primary point of beginning for a patient with cancer. Table 6 displays the results of the multivariate Cox regression for the following two models: 'Model I' investigated six service quality items controlling for stage at diagnosis, prior treatment history, gender and CTCA hospital. 'Model II' investigated the overall service quality item controlling for stage at diagnosis, prior treatment history, gender and CTCA hospital. In 'Model I', only one service quality item 'team providing you with a sense of well-being' reached marginal statistical significance. Other service quality items were non-significant. Stage at diagnosis, prior treatment history, gender and CTCA hospital were also found to be statistically significant. In 'Model II', the item pertaining to overall service quality was found to be significant along with stage at diagnosis, prior treatment history, gender and CTCA hospital. The results of both models were confirmed using the forward stepwise approach. VIF values for the service quality measures ranged from 1.3 to 2.4, none of which indicates a significant problem with multicollinearity.[26,27] There was no evidence of non-proportional hazards in the multivariate models presented.

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