Methodological considerations in hospital patient opinion surveys

Assessing Patient Satisfaction: Using the Radiation Oncology Patient Satisfaction [ROPS] Questionnaire in a Private Practice Setting

A new patient satisfaction measure called the Radiation Oncology Patient Satisfaction (ROPS) questionnaire is used in this study to measure satisfaction data for radiation oncology in private practice. Limitations of existing literature on patient satisfaction demonstrated a need to develop a questionnaire that was more tailored to analyze patient satisfaction among those utilizing private oncology centers within the U.S. healthcare system. This need was met by this study’s development of the ROPS questionnaire, which was a variation of 2 existing constructs that are presented in the text. The questionnaire was fielded among patients at a private cancer radiation treatment clinic in Florida (n = 950). Data analysis tested the psychometric properties of our revised construct and its predictive validity for 2 patient satisfaction outcomes: (1) likelihood of recommending this treatment center to family members/close friends and (2) overall satisfaction with treatment. Each of the ROPS variables were found to make a legitimate contribution to evaluating patients’ overall satisfaction with radiation treatment. Findings indicated organizational setting was of vital importance when conducting patient- centered research on satisfaction. Treatment factors in ROPS can be adjusted to measure satisfaction with chemotherapy or other modalities in addition to radiation treatment. Authors recommend radiation oncology clinics regularly monitor patient satisfaction, especially if/when they experience organizational changes, such as when a new physician joins the practice or if/when the national or local landscape undergoes significant shifts in norms and expectations like we have seen happen with COVID-19.

Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey of women in Switzerland

Background

In many countries, the increase in facility births is accompanied by a high rate of obstetric interventions. Lower birthrates or elevated risk factors such as women’s higher age at childbirth and an increased need for control and security cannot entirely explain this rise in obstetric interventions. Another possible factor is that women are coerced to agree to interventions, but the prevalence of coercive interventions in Switzerland is unknown.

Methods

In a nationwide cross-sectional online survey, we assessed the prevalence of informal coercion during childbirth, women’s satisfaction with childbirth, and the prevalence of women at risk of postpartum depression. Women aged 18 years or older who had given birth in Switzerland within the previous 12 months were recruited online through Facebook ads or through various offline channels. We used multivariable logistic regression to estimate the risk ratios associated with multiple individual and contextual factors.

Results

In total, 6054 women completed the questionnaire (a dropout rate of 16.2%). An estimated 26.7% of women experienced some form of informal coercion during childbirth. As compared to vaginal delivery, cesarean section (CS) and instrumental vaginal birth were associated with an increased risk of informal coercion (planned CS risk ratio [RR]: 1.52, 95% confidence interval [1.18,1.96]; unplanned CS RR: 1.92 [1.61,2.28]; emergency CS RR: 2.10 [1.71,2.58]; instrumental vaginal birth RR: 2.17 [1.85,2.55]). Additionally, migrant women (RR: 1.45 [1.26,1.66]) and women for whom a self-determined vaginal birth was more important (RR: 1.15 [1.06,1.24]) more often reported informal coercion. Emergency cesarean section (RR: 1.32 [1.08,1.62]), being transferred to hospital (RR: 1.33 [1.11,1.60]), and experiencing informal coercion (RR: 1.35 [1.19,1.54]) were all associated with a higher risk of postpartum depression. Finally, women who had a non-instrumental vaginal birth reported higher satisfaction with childbirth while women who experienced informal coercion reported lower satisfaction.

Conclusions

One in four women experience informal coercion during childbirth, and this experience is associated with a higher risk of postpartum depression and lower satisfaction with childbirth. To prevent traumatic after-effects, health care professionals should make every effort to prevent informal coercion and to ensure sensitive aftercare for all new mothers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03826-1.

Routine patient surveys: Patients' preferences and information gained by healthcare providers

BACKGROUND

Patient feedback after contact with a hospital is regarded as an important source of information for the improvement of local healthcare services. Routine patient surveys are in widespread use to obtain such feedback. While general principles for the composition of this kind of surveys have been described in the literature, it is unknown which method of contact and topics of feedback are important to patients in postcontact healthcare surveys.

MATERIAL AND METHODS

We invited 2931 consecutive patients who had in- or outpatient contact with the Department of Orthopaedics and Traumatology at the University Hospital Basel to an anonymous survey. They were asked whether they were generally in favor of feedback surveys. They also had the opportunity to state their preferred form of contact (text message, app, email, online or letter) and provide up to three topics that they regarded as specifically important in patient surveys.

RESULTS

A total of 745 patients participated in the survey (25.4%), of these 61.9% expressed the preference to be surveyed, and 69.1% selected `letter' as one of the preferred forms of contact. Favoring only `letter' contact increased substantially with age. Overall 54.6% of patients stated at least one topic that they wished to give feedback on. The most frequent topics were related to treatment and rather general aspects regarding staff and overall impression. The wish to include suggestions for improvements was rarely mentioned as specific topic.

CONCLUSIONS

The majority of patients seem to be rather indifferent to the existence and content of patient surveys. They mention a wide range of topics from general to specific ones, but do not express interest in the opportunity to suggest changes. There is a need to effectively engage patients in healthcare planning using new approaches to obtain valuable feedback on patients' hospital stay and contact experiences. These new approaches should ideally be more informative and cost-effective than the current practice.

Factors associated with participation and completion of a survey-based study

PURPOSE

The Healthy Work Place (HWP) study investigated methods to improve clinicians' dissatisfaction and burnout. The purpose of this paper is to identify factors that influenced study enrollment and completion and assess effects of initial clinic site enrollment rates on clinician outcomes, including satisfaction, burnout, stress and intent to leave practice.

DESIGN/METHODOLOGY/APPROACH

In total, 144 primary care clinicians (general internists, family physicians, nurse practitioners and physician assistants) at 14 primary care clinics were analyzed.

FINDINGS

In total, 72 clinicians enrolled in the study and completed the first survey (50 percent enrollment rate). Of these, 10 did not complete the second survey (86 percent completion rate). Gender, type, burnout, stress and intervention did not significantly affect survey completion. Hence, widespread agreement about most moral/ethical issues (72 percent vs 22 percent; p=0.0060) and general agreement on treatment methods (81 percent vs 50 percent; p=0.0490) were reported by providers that completed both surveys as opposed to just the initial survey. Providers with high initial clinic site enrollment rates (=50 percent providers) obtained better outcomes, including improvements in or no worsening of satisfaction (odds ratio (OR)=19.16; p=0.0217) and burnout (OR=6.24; p=0.0418).

SOCIAL IMPLICATIONS

More providers experiencing workplace agreement completed the initial and final surveys, and providers at sites with higher initial enrollment rates obtained better outcomes including a higher rate of improvement or no worsening of job satisfaction and burnout.

ORIGINALITY/VALUE

There is limited research on clinicians' workplace and other factors that influence their participation in survey-based studies. The findings help us to understand how these factors may affect quality of data collecting and outcome. Thus, the study provides us insight for improvement of quality in primary care.

Patients’ Assessment of Quality of Care: A Survey of a Group of Breast Cancer Patients in Italy

Patients’ assessment of quality of care was investigated in 825 women with breast cancer treated in a group of specialized and non-specialized institutions in Italy. A 10-page mail questionnaire explored patients’ adjustment to the disease, satisfaction with care, and quality of the information on diagnosis and treatment. Most of the 428 (52 %) responders reported good or acceptable adjustment to the disease (as reflected by acceptable performance in some daily living activities), and favorable judgment about care providers, but many women complained of hospital organizational deficiencies. A contradictory picture emerged regarding the quality of information. Completeness and thoroughness appeared seriously deficient when examined objectively using a series of explicit predefined criteria, but patients’ assessments showed in most cases moderate or high satisfaction. The paper presents these results and discusses pros and cons in the use of patients’ opinions for evaluation of quality of care.

Factors associated with patients' satisfaction in Brazilian dental primary health care

Objective

To assess factors associated with patients’ satisfaction with the treatment by dentists in primary health care (PHC) in Brazil.

Materials and methods

The dataset was part of a nationwide cross-sectional survey for evaluating PHC teams conducted by the Brazilian Ministry of Health. Patients from each of 16,202 oral health teams were interviewed. In addition to sociodemographic information, the questionnaire included information about patient experience domains: access and booking of dental appointments, bonding and accountability, welcoming of the patient, and their perception of dental facilities.

Statistical analysis

The dependent variable was the answer to the question ‘From 0 to 10, how would you grade your satisfaction with treatment received from the dentist?’ Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios and corresponding 95% confidence interval.

Results

The mean patient satisfaction was 9.4 (±2.3). Higher patient satisfaction with PHC was associated with lower education and the patient’s perception of the clinic conditions. Moreover, higher satisfaction was associated with positive reception and hospitality, enough time for treatment, and instructions that met patients’ needs. Lower satisfaction with PHC was associated with patients who have jobs compared to those who do not work.

Conclusion

Patient satisfaction is increased with friendly and understanding PHC staff. Moreover, meeting patient expectations by taking time to understand the needs and giving the right instructions is associated with higher satisfaction.

Measuring client satisfaction with home-based respite services

This descriptive study investigates the validity and reliability of the home-based respite services tool (HBRST) which was developed to measure client satisfaction with home-based respite care (HBRC) and determine the degree to which caregivers were satisfied with the respite services they received in a newly-developed AmeriCorps home-based respite program. A convenience sample of 77 caregivers completed the HBRST. Reliability testing showed that the HBRST had high internal consistency (Chronbach's alpha = 0.82 and high stability (r = 0.92; p 0.001). Validity testing with a criterion measure also showed a significant positive correlation (r =.40, p < .01). Thus, the HBRST is a methodologically sound instrument that can be used to evaluate caregiver satisfaction with home-based respite services.

Patient education and quality assurance in nursing

Changes in healthcare provision introduced in the early 1990s raised awareness of the issue of quality in health care. Quality, currently a fashionable topic, is an abstract concept and attempts to define and measure its properties have proved controversial and challenging. An equally challenging aspect of nursing care is the satisfactory delivery of health education to patients. This paper focuses on patient education and quality assurance in nursing. The results of a study concerning 20 young adults with insulin-dependent diabetes mellitus (IDDM) are reported. The findings indicate deficiencies in their experiences of patient education at initial diagnosis, discharge home after first hospital admission and when needing further information. It is contended that patient education is an area which requires qualitative as well as quantitative measurements of quality in order to capture the unique experience of information needs.

Patient satisfaction in telemedicine

Recent improvements in technology and telecommunications have resulted in renewed interest in telemedicine [1]. The UK’s National Health Service (NHS) Executive has recently published an ‘Information for Health’ strategy which states that ‘telemedicine and telecare will undoubtedly come to the fore as a way of providing services in the future. They have a key role to play in the Government’s plans to modernize the NHS’ [2]. Within the current climate, the future success of telemedicine will depend on patient and provider acceptance of such technologies. It is, therefore, imperative that the views and experiences of the users and providers of healthcare services are sought to enable problems to be resolved and issues addressed before telemedicine is fully implemented: ‘Information about the patients’ experiences can be an important lever for change, both highlighting where, and what sort of quality improvements are needed’ [3].

This paper provides an overview of telemedicine and patient satisfaction and considers the satisfaction studies to date. It finally discusses some of the problems in assessing patient satisfaction within telemedicine and how future studies may be improved in light of the findings. It is based upon work that is presently being carried out at the School of Health and Related Research (ScHARR) at the University of Sheffield as part of a Randomized Controlled Trial of telemedicine in dermatology, funded by the NHS Executive Research and Development Programme.

Client Satisfaction With Community-Based Services in a Pilot Cost Share–Service Coordination Program

The purpose of this research was to measure client satisfaction with community-based services (CBS) in a pilot service coordination–shared cost program. Data were collected with telephone surveys from 307 clients. Instruments with demonstrated reliability and validity were used to measure satisfaction with each of the following CBS: homemaker, home-delivered meals, personal care, transportation, and handyman and/or chore services. Results indicated that on average, clients were satisfied with each of the CBS they received. Gender, income, and level of satisfaction with other CBS were shown to have some influence on satisfaction levels.

The Reliability of Big "Patient Satisfaction" Data

Big data in healthcare can bring significant clinical and cost benefits. Of equal but often overlooked importance is the role of patient satisfaction data in improving the quality of healthcare service and treatment, where satisfaction is measured through feedback by patients on their meetings with medical specialists and experts. One of the major problems in analyzing patient feedback data is the nonstandard research designs often used for gathering such data: the designs can be uncrossed, unbalanced, and fully nested. Traditional measures of data reliability are more difficult to calculate for such data. Also, patient data can contain significant proportions of missing values that further complicate the calculation of reliability. This paper describes a reliability approach that is robust in the face of nonstandard research designs and missing values for use with large-scale patient survey data. The dataset contains nearly 85,000 patient responses to over 2,000 healthcare practitioners in five different subtypes over a 15-year period in the United Kingdom. Reliability measures are calculated to provide benchmarks involving minimum numbers of patients and practitioners for deeper drill-down analysis. The paper concludes with a demonstration of how regression models generated from big patient feedback data can be assessed in terms of reliability at the total data level as well as drill-down levels.

Participant recruitment in sensitive surveys: a comparative trial of 'opt in' versus 'opt out' approaches

Background

Although in health services survey research we strive for a high response rate, this must be balanced against the need to recruit participants ethically and considerately, particularly in surveys with a sensitive nature. In survey research there are no established recommendations to guide recruitment approach and an ‘opt-in’ system that requires potential participants to request a copy of the questionnaire by returning a reply slip is frequently adopted. However, in observational research the risk to participants is lower than in clinical research and so some surveys have used an ‘opt-out’ system. The effect of this approach on response and distress is unknown. We sought to investigate this in a survey of end of life care completed by bereaved relatives.

Methods

Out of a sample of 1422 bereaved relatives we assigned potential participants to one of two study groups: an ‘opt in’ group (n=711) where a letter of invitation was issued with a reply slip to request a copy of the questionnaire; or an ‘opt out’ group (n=711) where the survey questionnaire was provided alongside the invitation letter. We assessed response and distress between groups.

Results

From a sample of 1422, 473 participants returned questionnaires. Response was higher in the ‘opt out’ group than in the ‘opt in’ group (40% compared to 26.4%: χ² =29.79, p-value<.01), there were no differences in distress or complaints about the survey between groups, and assignment to the ‘opt out’ group was an independent predictor of response (OR=1.84, 95% CI: 1.45-2.34). Moreover, the ‘opt in’ group were more likely to decline to participate (χ²=28.60, p-value<.01) and there was a difference in the pattern of questionnaire responses between study groups.

Conclusion

Given that the ‘opt out’ method of recruitment is associated with a higher response than the ‘opt in’ method, seems to have no impact on complaints or distress about the survey, and there are differences in the patterns of responses between groups, the ‘opt out’ method could be recommended as the most efficient way to recruit into surveys, even in those with a sensitive nature.

Quality of care indicators for the structure and organization of inpatient rehabilitation care of children with traumatic brain injury

OBJECTIVES

To develop evidence-based and expert-driven quality indicators for measuring variations in the structure and organization of acute inpatient rehabilitation for children after traumatic brain injury (TBI) and to survey centers across the United States to determine the degree of variation in care.

DESIGN

Quality indicators were developed using the RAND/UCLA modified Delphi method. Adherence to these indicators was determined from a survey of rehabilitation facilities.

SETTING

Inpatient rehabilitation units in the United States.

PARTICIPANTS

A sample of rehabilitation programs identified using data from the National Association of Children's Hospitals and Related Institutions, Uniform Data System for Medical Rehabilitation, and the Commission on Accreditation of Rehabilitation Facilities yielded 74 inpatient units treating children with TBI. Survey respondents comprised 31 pediatric and 28 all age units.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Variations in structure and organization of care among institutions providing acute inpatient rehabilitation for children with TBI.

RESULTS

Twelve indicators were developed. Pediatric inpatient rehabilitation units and units with higher volumes of children with TBI were more likely to have: a census of at least 1 child admitted with a TBI for at least 90% of the time; adequate specialized equipment; a classroom; a pediatric subspecialty trained medical director; and more than 75% of therapists with pediatric training.

CONCLUSIONS

There were clinically and statistically significant variations in the structure and organization of acute pediatric rehabilitation based on the pediatric focus of the unit and volume of children with TBI.

Quality of care from patients' perspective: impact of the combination of person-related and external objective care conditions

AIMS AND OBJECTIVES

To describe patients' perceptions of quality of care and to explore combinations of person-related and external objective care conditions as potential predictors of these perceptions.

BACKGROUND

Several studies have examined various single factors of person-related and external objective care conditions in relation to quality of care. None of these has included the effect of over-occupancy on patients' perception of quality of care. Furthermore, little is known about how combinations of different factors are related to each other and to the perception of quality of care using multivariate analysis.

DESIGN

A cross-sectional design.

METHOD

A total of 528 patients (83·7%) from 12 medical, surgical or medical-surgical wards in five hospitals in Norway participated. Perceptions of quality of care and person-related conditions were measured with the 'Quality from Patient's Perspective' instrument. Data on external objective care conditions was collected from ward statistics provided by head nurses. Multivariate general linear modelling was used (p < 0·05).

RESULTS

The combination of person-related and external objective care conditions revealed five factors that predict patients' perception of quality of care. Three of these are person-related conditions: sex, age and self-reported psychological well-being and two of them are external objective care conditions: RNs (headcount) on the wards and frequency of over-occupancy. These five factors explained 55% of the model. Patients rated the quality of care high.

CONCLUSIONS

Sex, age, psychological well-being, frequency of over-occupancy and the number of RNs are important factors that must be emphasised if patients are to perceive the quality of care as high. Relevance to clinical practice.  Head nurses and healthcare authorities must continually prepare the wards for over-occupancy and they must consider the number of RNs working on the wards.

Psychometric properties of the instrument quality in psychiatric care and descriptions of quality of care among in-patients

PURPOSE

The purpose of this paper is to test the psychometric properties and dimensionality of a new instrument, quality in psychiatric care (QPC), and to describe and compare quality of care among in-patients as measured by this instrument.

DESIGN/METHODOLOGY/APPROACH

The instrument quality in psychiatric care measures patients' experiences regarding quality of care. The instrument is based on a definition of quality of care from the patients' perspective. A sample of 265 in-patients at eight general psychiatric wards in Sweden was assessed.

FINDINGS

Exploratory factor analysis revealed that the original five-dimensional 69-item QPC was better with six dimensions and reduced to 30 items, hereinafter denoted quality in psychiatric care-in-patients (QPC-IP) with retained internal consistency. The patients' ratings of quality of care were generally high; the highest rating was for quality of encounter and the lowest for participation.

RESEARCH LIMITATIONS/IMPLICATIONS

Analysis of the dropouts was not possible because of incomplete registrations at the wards.

PRACTICAL IMPLICATIONS

QPC-IP is a simple, inexpensive and quick way to evaluate quality of care and thus contributes to health care improvement in the field of psychiatry.

ORIGINALITY/VALUE

The new 30 items instrument, QPC-IP includes important aspects of patients' perceptions of quality of care. The QPC-IP is psychometrically adequate and thus recommended for evaluating patients' experiences of the quality of psychiatric care.

Client and Responder Perceptions of a Personal Emergency Response System: Lifeline

A mixed methodology mail survey was used to gauge level of customer satisfaction with, and identify issues that may help improve, personal emergency response system service delivery. A total of 1,236 surveys were mailed out to subscribers of Victoria Lifeline (Canada; n = 618) and their designated responders (n = 618). Overall response rate was 50%. Significant predictors of subscriber and responder satisfaction were satisfaction with the service during an emergency and whether expectations of service were met. In addition, for responders, customer service also predicted satisfaction. Thematic analysis of subscriber and responder comments identified the need for improvement in several areas: equipment, cost of the service, training sessions for users, and communication between subscribers and service providers. Although more than 95% of subscribers and responders were satisfied with the service, the findings provide direction to personal emergency response service providers about ways in which their product and service delivery might be enhanced, and underscore the need for research examining the impacts of response systems on family caregivers and public policy regarding community care solutions.

Quality in psychiatric care: an instrument evaluating patients' expectations and experiences

PURPOSE

The principal aim of this paper is to develop an instrument to measure quality of care in the psychiatric setting from an in-patient perspective and to describe quality of care by means of this instrument. A further aim is to investigate the influence of background variables and expectations on the experience of care.

DESIGN/METHODOLOGY/APPROACH

The instrument "Quality in psychiatric care" consists of two parts: one for measuring the patient's expectations regarding quality of care, the other for measuring his or her experiences regarding it. The instrument was derived from an earlier interview study of patients' perceptions of the quality of psychiatric care. A sample of 116 patients from eight in-patient wards in Sweden participated in the present study.

FINDINGS

Results indicate a generally high quality of care. Experienced quality of care was significantly lower, however, than expectations in all the dimensions of the instrument: total dimension, dignity, security, participation, recovery and environment. Patients who perceived that the time of discharge was consistent with the stage of their illness experienced significantly higher Recovery; patients with good psychiatric health experienced this too, but also significantly higher participation.

RESEARCH LIMITATIONS/IMPLICATIONS

This new instrument needs to be further tested before the psychometric properties can be established.

ORIGINALITY/VALUE

The value of the research is that instruments for measuring the quality of in-patient psychiatric care from the patient's perspective and with a theoretical foundation are less common.

How Satisfied Are Parents Supported by Nurses With the NIDCAP® Model of Care for Their Preterm Infant?

The main purpose of implementing the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) in our neonatal intensive care unit from the perspective of quality of care was to bring about an improvement in the satisfaction of parents. This was measured by means of the NICU-Parent Satisfaction Form and the Nurse Parent Support Tool. Parents were significantly more satisfied with care given according to NIDCAP principles than they were with the traditional care for their premature born babies.

Development of an instrument to measure patient perception of the quality of nursing care

Although patient satisfaction has been given considerable attention in health care, analysis of the conceptual and measurement limitations of existing measures indicates that a more elemental approach to obtaining patients' perspectives is warranted. In this investigation we developed and evaluated the psychometric properties of an instrument designed to measure patients' perceptions of the degree to which their needs were met while hospitalized. This 15-item instrument, Patient Perception of Hospital Experience with Nursing (PPHEN), based on Swanson-Kauffman's framework of caring, is internally consistent and represents a single construct best described as feeling cared for. The relationship of PPHEN to other measures demonstrates concurrent validity; moreover, the scale is responsive to differences in care provided, as shown by differences in means for different hospitals. PPHEN offers a brief, theoretically oriented, internally consistent, and valid patient self-report measure of nursing care. It does not require patients to compare their expectations of care with the care received but only to evaluate whether their needs were met. It promises to be useful to clinical and health services researchers.

Impact of reminders and method of questionnaire distribution on patient response to mail-back satisfaction survey

Nonresponse and methods of data collection could affect satisfaction measurement. The goal of this study was to estimate the impact of (1) nonresponse and (2) distribution method on evaluation of patient satisfaction in a mail-back study measuring patient opinion of medical and nursing care. The study was conducted in an adult hospital. Patients were pseudo-randomized according to the initial mode of questionnaire distribution (given at hospital or sent by mail). Three reminders were made at 1-week intervals to nonrespondents, regardless of the method of initial questionnaire distribution. Groups were distinguished according to the delay of response: initial (before any reminder), middle (after one or two mailed reminders), and late respondents (after mailed reminders plus telephone contact). The study included consecutively discharged patients to obtain 300 patients per arm. 482 patients returned the questionnaire (248 in the group receiving the questionnaire at the hospital and 234 in the other group). Groups were compared for satisfaction scores and delay of response. Early respondents were compared with middle and late respondents for patient characteristics, modality of hospital care, and satisfaction scores. Multivariate analyses were performed. Participation rate before any reminder was higher when the questionnaire was mailed than when it was given at the hospital (45% versus 39.7%, p = 0.03). The initial method of distribution did not influence patient satisfaction level. Satisfaction did not differ between respondents with or without reminders. Distributing questionnaires by mail may be preferred to distribution at discharge to optimize response rate. Reminders do not seem necessary to estimate satisfaction of overall potential respondents.

Patients' perceptions of hospice day care: a phenomenological study

This study explored the perceptions of 12 patients attending a day care unit in June/July 1996, with the purpose of finding out what was important to these people about their day care experiences. It used a phenomenological methodology derived from Paterson and Zderad's Humanistic Nursing Theory. The patients described numerous aspects of the day care service that were important to them. All 12 people interviewed considered the service satisfactory, and a number considered it to be more than anyone could or should expect. Day care was found to help them feel comfortable, to feel of value and to feel less isolated. In addition, the participants were found to be living with cancer in two different ways. All 12 knew they had cancer and might be terminally ill. Yet some seemed to "tolerate" their life with cancer, whereas others saw it as requiring "adaptation". The day care service was supporting both these styles of managing life with cancer. The interpretation of the findings suggests that the reason patients expressed such satisfaction with the service offered was because the care was humanistic. It responded to individual opinions, feelings and understandings of health and well-being, by giving people time and responding to their individual concerns. In this way, it was flexible enough to support people in managing their illness using their own preferred style.

Client satisfaction with service coordinators' provision of home based long-term care services

This descriptive study investigates the reliability and validity of the Service Coordinator Satisfaction Measure (SCSM) which was developed to measure client satisfaction with service coordination in a pilot home based long-term care (LTC) program. The SCSM measures the subdimensions of service delivery and service sufficiency, as well as overall satisfaction with service coordination. Reliability testing with a sample of 213 clients indicated that the SCSM had high internal consistency (Cronbach's alpha = .86) and validity testing with the SCSM and a criterion measure also yielded significant positive correlations (r = .57, p < .01). Results showed that clients ranged between being unsure and satisfied with their service coordinator. Analysis of the subdimensions in the SCSM indicated clients were more satisfied with service delivery than they were with service sufficiency, suggesting that clients were somewhat ambiguous about assuming a greater role in managing their own home based LTC needs.

Patient satisfaction with nursing care in a colorectal surgical population

This paper describes one arm of a much larger, multi-site study whose hypothesis was that evidence-based nursing practice is more effective than routine nursing care in improving patient outcomes and health gain. This arm of the study investigated patient satisfaction as an outcome measure for those patients undergoing colorectal surgery. The study's relevance for nurses is in the potential feedback for reviewing nursing practice and health care delivery. Patient satisfaction with nursing care was measured through a validated questionnaire, the SERVQUAL, followed by interviews with a percentage of the study population. The results of this arm of the study confirm the importance of measuring patient satisfaction through a triangulated method which investigates thoroughly, providing feedback for continuous quality improvement. The in-depth interviews provided greater insight into the results of the questionnaire, enabling clear feedback to nursing staff at the different sites of the study. Results of the questionnaire revealed age, sex and education levels of patients as major influences on individual perceptions of nursing care. Patients whose surgery resulted in stomas were also less satisfied with health-care delivery.

Caring About Women and Cancer (CAWAC): a European survey of the perspectives and experiences of women with female cancers

This paper reports on the findings of the largest ever European survey of female patients' perceptions of their cancer treatment. It has provided clarification of what women consider important in relation to their management and has identified several areas where more research is needed. It has shown that women's knowledge about cancer before diagnosis is poor and the number undergoing regular screening could be improved. Women are not being adequately prepared and educated about what to expect from treatment and steps should be taken as a matter of urgency to redress this shortcoming. It was revealed that whilst families were the primary source of support to female cancer patients, women also derive considerable support from healthcare professionals, particularly senior doctors; more attention should be paid by specialists and nurses to developing psychological skills to cope with this. In this context, further research is needed into how support groups may best meet patient needs.

Measuring patient satisfaction with nursing care: experience of using the Newcastle Satisfaction with Nursing Scale

Patient satisfaction with care has frequently been used as a measurement of quality, especially in attempts to demonstrate the benefits of changes in nursing practice. Unfortunately such attempts have frequently failed as patient satisfaction ratings have lacked sensitivity, consistently achieving very high scores. They have also failed to isolate the nursing component from the whole health care experience. The Newcastle Satisfaction with Nursing Scale (NSNS) has been developed after extensive research work as an attempt to establish reliable and valid measures of patients' experiences of and satisfaction with nursing care. This study evaluated the use of the NSNS in practice and found that it was readily understood by patients and easily administered by clinical staff. However, several lessons were learnt which could help its administration. The results demonstrated a very high degree of satisfaction with nursing care which left the discriminatory ability of the scale open to question, although its potential benefits in standard setting were demonstrated. Further evaluative studies are needed if the potential benefits of the NSNS are to be fully realised.

Patient satisfaction: a key concept for evaluating and improving nursing services

AIMS

The main purpose of this review was to explore the meaning of patient satisfaction and present the theoretical background and the definitions which developed in nursing.

BACKGROUND

Today, there is an increasing interest in patient satisfaction which is considered a valid indicator of the quality of care.

ORIGINS OF INFORMATION

An extensive literature review was performed by using the MEDLINE database.

DATA ANALYSIS

Data was classified and analysed by using the content analysis approach.

KEY ISSUES

The principal finding of this review was the lack of attention to the meaning of patient satisfaction, the development of theoretical frameworks and the psychometric properties of the developed instruments.

CONCLUSIONS

Nurses need to develop valid and reliable instruments to measure patient satisfaction in order to improve the quality of care and make their work visible.

Investigating psychosocial aspects of participation in early anti-cancer drug trials: towards a choice of methodology

This paper presents the methodological approach and research methods chosen to explore psychosocial aspects of participation in early anti-cancer drug trials from the perspective of those actually involved. The paper describes how an appropriate methodology, or principles of reasoning behind the choice of research methods, emerged. The choice of methodology was based on three elements: first, an understanding of the competing philosophies about how research can be approached and conducted; second, the author's view of the subject area; and third, a consideration of previous research approaches which have investigated psychosocial aspects of cancer clinical trials. A qualitative methodology situated within an interpretative paradigm was eventually chosen as the most appropriate means of exploring trial participants' experiences and the aim and objectives of the research were developed within this methodological framework.

Using a nursing framework to measure client satisfaction at a nurse-managed clinic

There is considerable literature on nurse-managed clinics and client satisfaction with nurse practitioner care. However, the methodological weaknesses of satisfaction measures which are often used limits confidence in the study findings. Satisfaction measures typically lack reliability analysis and/or have limited validity testing. This descriptive, correlational study investigates the validity and reliability of a new measure, the Client Satisfaction Tool (CST) and determines the degree of satisfaction that clients at a newly established senior health clinic had with the primary care services they were receiving. The CST is based upon Cox's Interactional Model of Client Health Behavior and thus was explicitly developed to measure client satisfaction with a nurse practitioner model of care. A convenience sample of 38 clients completed the CST. Responses to the CST indicated that users of the senior health clinic were satisfied with the care they received. Reliability testing showed that the tool has high internal consistency (Chronbach's alpha was 0.956) and high stability (r = 0.974). Construct validity testing with measures of perceived health changes showed that the tool has both convergent (r = 0.599, P < 0.01) and divergent (r = 0.194, P > 0.10) validity. Thus, the CST is a methodologically sound measure of client satisfaction that can be used in future research that examines client satisfaction with nurse practitioner care.

Patient satisfaction in a nurse-led rheumatology clinic

Patient satisfaction with a nurse-led rheumatology clinic was tested using the Leeds Satisfaction Questionnaire (LSQ), which was specially developed and shown to be both reliable (Cronbach's alpha, 0.96) and stable (test-re-test r = 0.83). A total of 70 patients with rheumatoid arthritis, aged 22-75 years were randomly allocated to either a nurse's or a rheumatologist's clinic and seen on six occasions over a year. They completed the LSQ on entry and on completion of the study. At week 0 both groups were satisfied with their care and there were no significant differences between them. By week 48 the medical cohort showed significantly increased satisfaction with access and continuity (P < 0.05) but no change in overall satisfaction. The patients in the nurse-led clinic recorded significant increases in overall satisfaction and in all subscales (P < 0.0001). Between-group comparison at week 48 showed the nurse's patients to be significantly more satisfied than those of the rheumatologist.

Newcastle satisfaction with nursing scales: an instrument for quality assessments of nursing care

OBJECTIVES

To test the validity and reliability of scales for measuring patients' experiences of and satisfaction with nursing care; to test the ability of the scales to detect differences between hospitals and wards; and to investigate whether place of completion, hospital, or home influences response.

DESIGN

Sample survey.

SETTING

20 wards in five hospitals in the north east of England.

PATIENTS

2078 patients in general medical and surgical wards.

MAIN MEASURES

Experiences of and satisfaction with nursing care.

RESULTS

75% of patients approached to complete the questionnaires did so. Construct validity and internal consistency were both satisfactory. Both the experience and satisfaction scales were found to detect differences between randomly selected wards and hospitals. A sample of patients (102) were sent a further questionnaire to complete at home. 73% returned this; no significant differences were found in either experience or satisfaction scores between questionnaires given in hospital or at home.

CONCLUSION

Scales to measure patients' experiences of and satisfaction with nursing in acute care have been developed and found to be valid, reliable, and able to detect differences between hospitals and wards. Questionnaires can be given before patients leave hospital or at home without affecting scores, but those given at home have a lower response rate.

A new measure of parent satisfaction with medical care provided in the neonatal intensive care unit

The objective of this study was to develop a valid and reliable discriminative index that measures parent satisfaction with the medical care of their infant in the NICU. We developed an initial questionnaire (Item Reduction Questionnaire) by reviewing the literature, surveying 63 NICU clinicians, and interviewing 125 parents of infants in 2 tertiary level NICUs regarding what they liked and disliked about the medical care of their infants. We administered the Item Reduction Questionnaire, which included 154 items, to 60 parents, who rated the frequency and importance of these items. We included the items identified most frequently as sources of dissatisfaction and rated most important in a second, briefer instrument, the Neonatal Index of Parent Satisfaction (NIPS). To measure reliability we administered the NIPS to 47 parents twice, separated by a 1-week interval. We assessed validity by comparing actual to predicted correlations between NIPS scores and other measures: parent's global rating of satisfaction, medical caregiver ratings of mother's satisfaction, medical caregiver ratings of father's satisfaction, and parents' perception of their infant's health status. We also compared mean NIPS scores for parents who did and who did not report incidents when errors occurred in the medical care of the infant. Of 154 items generated, we included 27 in the NIPS. The intraclass correlation between two administrations of the NIPS to the same 47 parents was 0.71. As predicted, there was a high correlation (0.61) between the NIPS score and parent global rating of satisfaction, and much lower correlations with other variables. Mean NIPS scores for parents who did and who did not report errors differed significantly (difference, 14.6; 95% CI around difference, 5.8-23.5; p < 0.001). The NIPS is likely to be a useful measure for discriminating between parents who differ in terms of their satisfaction with the medical care of their infant in the NICU.

Quality and quality assurance in the health care setting: an equitable life?

Research studies alluding to quality and quality assurance within the health care arena are increasingly utilized to justify management initiatives, particularly in relation to the provision and resourcing of patient services, both within the institutional and community setting. The following paper considers the role and utility of quality indicators and presents a critical analysis of the literature pertaining to the concept of quality as it applies to the provision and organization of health care and the relationship between quality assurance and patient satisfaction per se. The paper concludes with a dual challenge not only to nurses to better understand and articulate the specific contribution of the discipline, particularly in relation to positive patient outcomes, but also to current, narrow focused interpretations of quality assurance and calls for definitions of quality to reflect an appreciation of the particular involvement and role of the patient in determining policy affecting care provision.

Assessing patient satisfaction. Part 1. The research process

The research reported in this article formed part of a project evaluating nursing developments in four demonstration wards in one health authority, and the article focuses on evaluation of patient satisfaction. The evaluation of patient satisfaction is a topic surrounded by much methodological debate and therefore it was necessary to clarify the issues involved at the planning stage of the study. The 'process' aspects of evaluating patient satisfaction will be discussed here, while the content of patient interviews will be the subject of Part 2.

Satisfying solutions? A review of some unresolved issues in the measurement of patient satisfaction

The measurement of patient satisfaction has been encouraged by a growing consumer orientation in health care, especially since it yields information about consumers' views in a form which can be used for comparison and monitoring. However, drawing on literature from a variety of sources, this paper suggests that there remain several unresolved issues relating to the measurement of satisfaction, and some serious questions about the validity of the concept. It is argued that current approaches to measuring satisfaction may not be grounded in the values and experiences of patients; therefore satisfaction surveys could be denying patients the opportunity to have their opinions included in the planning and evaluation of health care services.

Perceived occurrence and importance of caring behaviours among patients and staff in psychiatric, medical and surgical care

The present study identified, within psychiatric, medical and surgical care, patient and staff perceptions of the occurrence and importance of caring behaviours. A Swedish version of the 'CARE-Q' instrument, including 50 caring behaviours, was used for the assessment of importance, and the 'CARE-How often' questionnaire (containing the same behaviours) was used for the determination of occurrence. In psychiatric and medical care, but not in surgical care, staff considered several behaviours to occur more frequently than did patients. However, in each type of care, the groups agreed fairly well with respect to rankings of behaviours. 'Explains and facilitates' occurred rarely, and 'Monitors and follows through' occurred often, according to both patients and staff. Overall, patients and staff differed both with regard to perceived levels and rankings of the importance of behaviours. Psychiatric patients perceived 'Explains and facilitates' as most important, and somatic patients perceived 'Monitors and follows through' as most important, while staff in both somatic and psychiatric care considered 'Comforts' as the most important subscale. Neither patient nor staff perceptions of the occurrence of caring behaviours were well matched with their perceptions of the importance of these. Implications for nursing practice and for studying patient satisfaction with care are given.

User satisfaction with in-patient mental health services

Although a wealth of literature regarding lay evaluation or satisfaction with health services exists, a paucity of literature is available about satisfaction with mental health services. Much of this literature is fraught with methodological problems. The study described, using both quantitative and qualitative methodology, investigated how users of in-patient mental health services evaluated these services with particular reference to the areas of the admission process, treatment, ward environment and safety. The findings confirmed the broad outcomes reported in the literature, in that they demonstrated the mismatch between quantitative and qualitative data. Global satisfaction ratings were generally positive; however, more specific questions yielded less positive outcomes. Semi-structured interviews reported some important areas of dissatisfaction, including a lack of information regarding treatment and services. Fears relating to safety were expressed equally by male and female users. Further work in this area is required with larger samples, and with specific reference to the experience of ethnic minorities and those detained under the Mental Health Act.

Choice cuts: an exploratory study of patients' views about participation in decision-making in a day surgery unit

Patient participation is widely recognized as a principle of ethical health care and linked to benefits in treatment outcome. Even so there is evidence that patients do not recognise their participatory role. This exploratory study aimed to investigate patients' perspectives on choice in a day surgical unit. It involved non-participant observation of 12 patients in a pre-surgical assessment clinic and in depth interviews with 10 patients following surgery. Their expectations of participation can be summarised as "being told" and "going in to get it fixed". Patients had an instrumental model of involvement and considered themselves as the professional's "work object", which constrained scope for participation.