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Assessment of satisfaction with cancer care: development, cross-cultural
psychometric analysis and application of a comprehensive instrument
Bredart, A.
Publication date
2001
Link to publication
Citation for published version (APA):
Bredart, A. (2001). Assessment of satisfaction with cancer care: development, cross-cultural
psychometric analysis and application of a comprehensive instrument.
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Preface e
Thee present thesis deals with the measurement of cancer patient satisfaction with the care received in hospital.. It consists in the elaboration of a questionnaire, its testing and application in different cultural contexts. .
Patientt satisfaction is not easily defined and interpreted. Simply stated, it corresponds to a patient's personall subjective evaluation of the care received. This is both a reflection of care realities and of patientt characteristics. Among the latter, expectations seem to play a major role; patient's care expectationss refer to his/her anticipation that a specific care event is appropriate.
Acrosss health care systems, patient satisfaction has become an increasing concern over the past decades.. Initially, research on the doctor-patient interaction highlighted a relationship between patient satisfactionn and compliance with treatment. Since treatment compliance affects the outcome of care, patientt satisfaction became a prerequisite for quality of care. More recently, with the widespread implementationn of health care reforms, the consideration and monitoring of patient satisfaction has emergedd as a political request in many countries [1-4]. Patient satisfaction has become recognised as essentiall in the definition of quality in health care. With the implementation of concepts such as total qualityy management, continuous quality improvement, the utilisation of patient satisfaction data has beenn more clearly specified.
Withinn and across health care institutions, purposes of patient satisfaction assessment consist in the identificationn of sources of patients' dissatisfaction, the determination of care improvement priorities, thee monitoring of care improvement initiatives, and the establishment of satisfaction ratings database forr benchmarking and comparative assessment. In clinical research, the measurement of patient satisfactionn may help to determine the superiority of a treatment over another.
Patientt satisfaction surveys are now widely diffused across health care settings; however these surveyss often rest on ill-considered methodologies, raising caution on the accuracy of their results. Effortss to develop psychometrically robust patient satisfaction instruments are recent, and mainly performedd in Anglo-Saxon countries. Few patient satisfaction questionnaires have been validated acrosss countries [5,6].
Mostt published patient satisfaction tools are designed for assessing the outpatient visit; others addresss consultations in general practice or in out-of-hours primary medical care. Several patient satisfactionn questionnaires have been developed for the inpatient setting. Satisfaction with care questionnairess designed for a particular patient population are mainly study-specific.
Inn the oncology hospital setting, although the issue of patient satisfaction is particularly salient, we couldd not find a standardised comprehensive patient satisfaction questionnaire elaborated for this context.. Such a comprehensive questionnaire should include an evaluation of major aspects of the care providedd in oncology hospitals. A standardised questionnaire may be applied widely, allowing for comparativee assessment across care settings. It requires psychometric evaluation in populations where itt will be used.
Thee main objective of this work is to develop and validate across different cultural contexts a satisfactionn with care questionnaire for cancer patients. Additional issues covered by this thesis includee the implications of satisfaction ratings in terms of desire for care improvement across cultural backgrounds;; the testing of the feasibility of assessing patient satisfaction in the oncology hospital; andd the examination of the optimal time lapse to the experience of care for performing this assessment.
Structuree of this thesis
Inn chapter 1, a review of the rationale, purposes, definition and components of patient satisfaction will bee presented. Beforehand, the concept of patient satisfaction will be situated with regard to quality of caree and quality of life evaluation. Chapter 2 will describe the development of a Comprehensive Assessmentt of Satisfaction with Care for cancer patients (CASC). The CASC development process involvedd interviews of cancer patients and of oncology specialists from different European countries. Chapterr 3 will report on the psychometric analyses of the CASC in an oncology institute in Italy. Factorr analysis, multi-trait scaling analysis and reliability testing were performed. Chapter 4 will presentt results of these analyses in three culturally different European countries : France, Poland and Sweden.. The results obtained in these countries were compared with the previous Italian findings. Chapterr 5 will further examine the cross-cultural comparability of the CASC ratings. A wide range of determinantss underlies patient satisfaction ratings. Among these, cross-cultural variations in terms of caree experience or expectations may play a role. We assessed whether the relationship between levels off satisfaction and desire for care improvement were similar across cultural backgrounds. Chapter 6 willl present a study aimed at assessing the feasibility of conducting a patient satisfaction survey in an oncologyy hospital setting. This study also explored predictors of patients' satisfaction, according to socio-demographic,, clinical and treatment data. In chapter 7, a methodological question will be addressed.. A number of methodological issues remain unclear in the assessment of patient satisfaction. Onee of them relates to the appropriate timing for assessing satisfaction with care. Through a randomisedd design, the optimal timing of questionnaire application was examined in terms of questionnairee acceptability, completeness of data, reliability and variability of scores. Chapter 8 will includee a summary and a general discussion of the study results. This final chapter will be followed by aa summary in Dutch.
References s
1.. Department of Health and Social Security. NHS management inquiry (1983). Report. London: DHSS. .
2.. World Health Organisation (WHO). Measuring consumer satisfaction with health care (1990). W.H.O.. Regional Office for Europe, Copenhagen.
3.. Netherlands Health Research Council. Advies kwaliteit van zorg. Terreinverkenning en prioriteitenn voor wetenschappelijk onderzoek (1990). 's-Gravenhage.
4.. Ministry of Work and Social Affairs. Ordinance n°96-346 of the 24th of April 1996 bearing on the
reformm of public and private hospitals. Official Journal of the French Republic , 25 April 1996 : 6324-5. .
5.. Gasquet I. Satisfaction des patients et performance hospitalière. La Presse Médicale 1999, 28: 1610-16. .
6.. Calnan M, Katsouyiannopoulos V, Ovcharov VK, Prokhorskas R, Ramie H, Williams S. Major determinantss of consumer satisfaction with primary care in different health systems. Family Practicee 1994, 11:468-78.
