An evaluation of patient satisfaction with breast cancer care

Abstract

Introduction: The approach and methods used to deliver care to breast cancer sufferers has wide ranging and far reaching consequences on the patient and also on her family. The incidence of breast cancer is on the increase world wide and to no less extent in the Maltese island. However, treatment is always improving and patients are living a longer and better quality of life. The incidence of breast cancer in women varies with age. Age is the single most important factor and it is projected that 32% of women will be aged more than 60 years by 2050.The greater number of elderly women means that breast cancer incidence will rise to one million breast cancers per year (Crosignani, 2004). Objectives: In view of this situation, the study aims at evaluating the level of patient satisfaction with the care being currently provided. The objectives of the research are 1. To identify areas where patients' level of satisfaction is lower than expected. 2. To make recommendations based on the results, which can improve and influence change in the practice of care management being currently delivered to breast cancer sufferers. 3. To analyse whether the perceptions of care providers are in tune with patients expectations. 4. To identify whether the management of care currently provided is reaching its main objectives: that of helping the patient cope with the situation they found themselves in through the provision of high quality streamlined care management. Thus in this study various essential key factors were reviewed in the literature, in particular the levels of patient satisfaction in the various stages of breast cancer care in various countries. Methodology: A mixed methodology approach was used. The data collected in the first part was through a structured questionnaire that the patients filled out themselves and sent it by post or left it at the respective clinics. In the second part, data was collected through individual face to face interviews with a representative sample of all the healthcare providers involved in breast cancer care. The main clinics that were involved in this study were the Radiotherapy Department, The chemotherapy department and the oncology out patients at the oncology hospital together with the Breast Care clinic at the acute Hospital. The target population in the first stage of the study included all those patients who attended for chemotherapy, radiotherapy or for a follow up visit over a period of three months. The target population in the second part of the study included a number of different healthcare providers involved in breast cancer care and treatment such as nurses, radiotherapists consultants, doctors, priests, psychologists, receptionists, and physiotherapists. Main findings: The most salient findings in this study were that continuity in care provided to breast cancer patients is sometimes lacking because when respondents were presented with the statement 'Care was coordinated and with a continuity approach' 56.2% 'Totally disagreed' or 'Disagreed'. A lack of communication between departments was also hypothesised. Many patients claimed that they do not get the information they expect. This study also concluded that in some aspects of care, a patient focused approach is not being adopted especially when 66.3% of patient participant express their dissatisfaction in this regard (Mean 2.37 P-value 0.001). In the qualitative section, it was expressed that there is not enough time for long explanations, and that time required for each patient is often based on each individual case especially the stage of her disease and her age. It was also concluded that certain support services were not being given the importance they deserved in the treatment and care for breast cancer. This study identified some gaps that exist within the journey that a breast cancer sufferer has to go through. The majority of the respondents 'Totally disagreed' or 'Disagreed' that 'Care is patient focused' (Mean 2.37, P-Value 0.001) and that 'The care provided reached their expectations' (Mean 2.54, P-Value 0.001). On aspects of care related to in patient care this study concluded that patients are quite satisfied. In fact several statements that were presented to patients in the quantitative section of this study achieved an overall tendency towards satisfaction. Amongst the statements were: 'The ward nurses were always there to help me' (Mean 3.36,P-Value 0.001).'1 was given a full explanation with regards to what I was consenting for' (Mean 3.79,P-Value 0.001), 'Breast cancer care in Malta compares well to that abroad' (Mean 3.28,P-value 0.002) and 'In Malta, access to information on breast cancer is adequate' (Mean 3.18, P-Value 0.071). Conclusion: In summary, it was concluded that continuity of care especially between departments was sometimes lacking. Communication and information giving was also felt to be lacking especially in the quantitative section of this study. However, in the qualitative part some participants acknowledged that there is not enough time for long explanations. This shortcoming was very often blamed on the lack of resources that is present in certain departments and the workload that is constantly increasing. Additionally it was concluded that patients showed high levels of satisfaction when presented with statements that were directly related to the treatment of their disease.