Predictors of overall satisfaction of cancer patients undergoing radiation therapy

BC Cancer Radiation Therapists' perspective on the impact of COVID-19 precautions in clinical practice

INTRODUCTION

There were many policy and procedure (P&P) changes implemented in health care facilities to combat the spread of the coronavirus disease 2019 (COVID-19). Common changes included an increase in personal protective equipment usage, room occupancy limits, limitations in visitors/family members and the absence of volunteers. This study evaluated the current views and opinions of Radiation Therapists (RTs) in British Columbia relating to how COVID-19 P&P changes have impacted their clinical practice. The goal was to identify gaps in the areas of RT practice, allow for self-reflection among RTs and potentially guide future P&Ps with patient-centred care at the forefront.

METHODS

A 24-item cross-sectional questionnaire was created and sent via e-mail to all RTs working across the province. Key sections explored in the questionnaire were: 1) patient care delivery, 2) staff-work environment, and 3) work satisfaction. Descriptive analysis was performed on the questionnaire responses.

RESULTS

Of the approximate 300 invited participants, 107 responses were received from all areas of Radiation Therapy (Treatment units, CT simulation, Dosimetry, etc.) and from all cancer centres in the province. RT staff indicated that COVID-19 P&P negatively impacted patient care, including the ability to verbally and non-verbally communicate with patients (82 %), assess for side effects (85 %), and build rapport (62 %). A majority (79 %) of RT staff felt that communication with co-workers had been negatively impacted as well. When queried regarding the impact on staff environment, 51 % of RT staff agreed that the absence of volunteers increased their workload and the responses were polarized (46 % disagree, 35 % agree) when asked if RT staff have enough time for cleaning their clinical areas with new COVID-19 P&Ps in place. 78 % of RTs were aware of where to go with COVID-19 safety concerns and thought they received adequate education concerning COVID P&Ps. When asked to rank the factors that most impacted RT practice, RTs identified increased PPE usage (83 %), absence of volunteers (74 %), and room occupancy limits (70 %) as the leading P&P changes that negatively impacted their practice; while plexiglass barriers (39 %), re-arranged workspaces (37 %) and working remotely (12 %) were the least negatively impactful.

CONCLUSION

The majority of RTs across BC Cancer responding to the questionnaire indicated that their ability to provide patient care and their staff-work environment were negatively impacted by implemented COVID-19 P&Ps. Views regarding COVID-19 P&P training/education was positive, yet there was no consensus regarding whether the changes were implemented smoothly. This study can facilitate reflection among both clinical leadership and RTs on how P&Ps can be implemented in the future and can encourage further retrospective analyses in aiding the development of P&Ps regarding future public health outbreaks.

Satisfaction with radiotherapy care among cancer patients treated in Germany-secondary analysis of a large multicenter study

PURPOSE

Patient satisfaction with healthcare has been linked to clinical outcomes and regulatory agencies demand its regular assessment. Therefore, we aimed to investigate patient satisfaction with radiotherapy care and its determinants.

METHODS

This is a secondary analysis of a multicenter prospective cross-sectional study. Eligible cancer patients anonymously completed questionnaires at the end of a course of radiotherapy. The outcome variable was overall patient satisfaction with radiotherapy care measured with a 10-point Likert scaled single-item. Given patient satisfaction was defined for patients scoring ≥ 8 points. Determinants of given patient satisfaction were assessed by univariable and multivariable analyses. A p-value < 0.05 was considered statistically significant.

RESULTS

Out of 2341 eligible patients, 1075 participated (participation rate 46%). Data on patient satisfaction was provided by 1054 patients. There was a right-skewed distribution towards more patient satisfaction (mean = 8.8; SD = 1.68). Given patient satisfaction was reported by 85% (899/1054) of the patients. Univariable analyses revealed significant associations of lower patient satisfaction with tumor entity (rectal cancer), concomitant chemotherapy, inpatient care, treating center, lower income, higher costs, and lower quality of life. Rectal cancer as tumor entity, treating center, and higher quality of life remained significant determinants of patient satisfaction in a multivariable logistic regression.

CONCLUSION

Overall patient satisfaction with radiotherapy care was high across 11 centers in Germany. Determinants of patient satisfaction were tumor entity, treating center, and quality of life. Although these data are exploratory, they may inform other centers and future efforts to maintain high levels of patient satisfaction with radiotherapy care.

Patient-reported perspectives of therapeutic radiographers when undergoing radiotherapy: A European multi-centre study

INTRODUCTION

Radiotherapy is delivered almost exclusively by therapeutic radiographers/radiation therapist (RTTs). Patient's perspectives of RTTs affect levels of trust and confidence in the profession and can have a significant impact on overall radiotherapy experience. The study reports patients' perspectives of RTTs from their experience of undergoing radiotherapy. Four partner sites collaborated in this research and included Malta, Poland, Portugal, and the UK (lead site).

METHODS

A survey was developed to gather information from patients receiving radiotherapy or who had had radiotherapy within the previous 24 months. Participants ranked their responses to 23 statements relating to person-centred care on a 5-point scale of 1 (strongly disagree) to 5 (strongly agree). Mann-Whitney or Kruskal Wallis tests were applied to test differences in responses to 5 key statements for patient characteristics including gender, age group, diagnosis, country, time spent with RTTs and number of fractions remaining at survey completion.

RESULTS

Three hundred and forty-seven surveys are included. Patients report a positive perception of RTTs (95.4% agree with 'I feel cared for'). Statistically significant differences in responses were found between gender, diagnosis, country, time spent with RTTs and fractions of radiotherapy remaining. Patients who had more time with RTTs and completed their surveys during radiotherapy had a more positive perception of RTTs.

CONCLUSION

This study suggests that sufficient time with RTTs is key to ensuring a positive radiotherapy patient experience. RTTs being attentive, understanding, and informative are most predictive of a positive overall patient experience. Timing of survey completion can influence responses.

IMPLICATIONS FOR PRACTICE

RTT education programmes should incorporate training on person-centred care at all levels. Further research into patient experience of RTTs is warranted.

Patient engagement with radiation therapists: Patient perspectives, challenges, and opportunities. A systematic review

INTRODUCTION

Radiotherapy is a major component of cancer care and treatment is delivered almost exclusively by therapeutic radiographers/radiation therapists (RTTs). Numerous government and professional guidance publications have recommended a person-centred approach to healthcare through communication and collaboration between professionals, agencies, and users. With approximately half of patients undergoing radical radiotherapy experiencing some degree of anxiety and distress, RTTs are uniquely placed as frontline cancer professionals to engage with patients regarding their experience. This review seeks to map the available evidence of patient reported views of their experience of being treated by RTTs and any impact, this treatment had on the patient's frame of mind or perception of treatment.

METHODS

In line with the principles of the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) systematic review methodology, a review of relevant literature was conducted. Electronic databases MEDLINE, PROQUEST, EMBASE and CINAHL were searched.

RESULTS

Nine hundred and eighty-eight articles were identified. Twelve papers were included in the final review.

CONCLUSION

Increased time with, and continuity of RTTs during treatment has a positive influence on patients' perspectives of RTTs. A positive patient perspective of their engagement with RTTs can be a strong predictor of overall satisfaction in radiotherapy.

IMPLICATIONS FOR PRACTICE

RTTs should not underestimate the impact of their supportive role in guiding patients through treatment. A standardised method for integrating patients' experience and engagement with RTTs is lacking. Further RTT led research is required in this area.

Shared Decision-Making Among Adolescent and Young Adult Cancer Survivors and Noncancer Adults: Associated Medical Expenditures and Health Care Utilization

Purpose: Engagement of patients in their care can lead to better health outcomes, especially for adolescent and young adult (AYA) cancer survivors who experience mental and physical illnesses more often than noncancer adults. We examined how patient engagement in care influences health care expenses and use. Methods: AYA cancer survivors (n = 1162) and a comparison group of matched adults with no history of cancer (n = 2954) were identified from the 2011 to 2016 Medical Expenditure Panel Survey (MEPS) data. Medical expenditures and health care utilization associated with shared decision-making (SDM) measured by a self-administered questionnaire adapted from the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CAHPS-CG) survey were evaluated using multivariable regression models. Results: AYA cancer survivors were more likely to report poor SDM compared with adults with no history of cancer (odds ratio = 1.31, 95% confidence interval [CI]): 1.06 to 1.62). AYA cancer survivors with poor SDM were more likely to report poor mental and physical health compared with AYAs with good SDM. AYA cancer survivors with poor SDM had $3037 (CI: $110 to $7032) in additional annual medical expenses and 4.86 (CI: 2.00 to 8.52) in additional office visits compared with AYA cancer survivors with optimal SDM, even after adjusting for chronic conditions and psychological distress. Conclusion: Our results highlight the substantial economic burden associated with poor SDM in AYA cancer survivors. Our research suggests that interventions to improve SDM in AYA cancer survivors may contribute to patients' positive perception of their health and result in AYAs seeking fewer medical services resulting in lower medical expenses.

Psychosocial and Clinical Predictors of Patient Satisfaction with Cancer Care

Purpose

Patient satisfaction with healthcare was recognized as an indispensable component of healthcare quality assurance programs for decades. Limited research has explored psychosocial variables impacting patient satisfaction with cancer care. The objective of our study was to identify the level of patient satisfaction with cancer care in Riyadh, Saudi Arabia and determine the psychosocial and clinical predictors of patient satisfaction.

Methods

A cross-sectional observational study was carried out in 2018–2019 with patients with cancer at the Outpatient Oncology Clinic at King Saud University Medical City in Riyadh, Saudi Arabia. The questionnaire contained a visual analog scale (VAS) of satisfaction with cancer care, a VAS of satisfaction with social support, the Patient Health Questionnaire-9 Depression scale, and the Generalized Anxiety Disorder 7-item scale.

Results

Out of the 400 patients approached, 280 agreed to participate in the study. Of the 280 patients participating in the study, 65% were satisfied with cancer care. Higher satisfaction was associated with being non-Saudi, being employed, having fewer household residents (≤4), being satisfied with social support, not receiving radiotherapy, and receiving hormonal or biological therapy. Having anxiety or depression was also associated with lower satisfaction. After adjustment for sociodemographic and clinical characteristics, being satisfied with social support, having ≤ 4 household residents, receiving hormonal therapy, and receiving biological therapy rather than radiotherapy were all independent predictors of higher satisfaction with cancer care.

Conclusion

This study found an inadequate level of patient satisfaction with cancer care. Higher levels of satisfaction were associated with being satisfied with social support, using biological and hormonal therapy, while lower satisfaction was associated with a larger number of household residents (>4), depression, anxiety and using radiotherapy.

Evaluation of cancer patient satisfaction during COVID-19 pandemic: A survey conducted at a tertiary care center in India

Purpose

Coronavirus disease (COVID-19) pandemic has affected the entire health-care system and has led to a sense of fear and anxiety in the minds of patients. Patient's perceptions in this scenario of the pandemic are unknown. Providing continued care for cancer patients during the lockdown has been challenging. Measures are needed to improve patient safety and satisfaction during these challenging times and hence the importance of measuring the degree of satisfaction for the quality of care provided. The aim of the study was to evaluate the factors related to patients' satisfaction and also understand their apprehensions, fears, and anxieties they face as they receive radiotherapy treatment amid COVID-19 pandemic. The study's objective was to explore other aspects such as logistic issues, patient-staff communication, and also perceptions of the patients toward the outbreak.

Materials and Methods

This study was conducted from April to September 2020. A questionnaire was created for which the patients were asked to provide answers. Parameters assessed included general information such as mode of transport used, frame of mind during treatment, awareness about pandemic, satisfaction toward care provided by health-care staff, and also documenting the suggestions to improve the quality of care.

Results

During this period, we interviewed 108 patients: 56 males (51.9%) and 52 females (48.1%). 90.7% of the participants were satisfied with the condition and safety measures employed in waiting area and billing section. Majority (88.9%) were found to be aware about COVID-19. 74.1% of the participants were very satisfied with the services provided to them in the department of radiation oncology.

Conclusion

The survey was useful in measuring the patient satisfaction, in understanding their fears and anxieties, and also in determining their awareness about the pandemic. The survey was also useful to get the patients' opinion and ideas for improvement in the health-care services.

The Role Of Effective Radiation Therapist-Patient Communication In Alleviating Treatment-Related Pain And Procedural Discomfort During Radiotherapy

PURPOSE

Managing radiotherapy (RT)-induced pain is essential for reducing the likelihood of treatment interruption and improving the chance of tumor control. The current study aimed to examine the role of radiation therapist (RTTs) interaction and effective information communication in modulating patients' experiences of pain and discomfort during RT.

METHODS

Participants were 91 cancer patients undergoing RT for the first time referred to the Radiotherapy Unit of Sant'Orsola-Malpighi Hospital in Bologna, Italy. Patient-reported outcome measures included patient satisfaction with the quality of the relationship and the information received by the RTTs, assessed by the Communication with RTTs - Shortened, scale, and pain and discomfort experienced during RT, assessed through two VAS scales. Attitudes toward RT were also assessed. All measures were collected as patients were approximately halfway through the overall RT duration (on average at the end of the 12th session).

RESULTS

Patient satisfaction with RTT relationships and treatment-information communication was significantly related to RT-induced pain intensity and patient attitudes toward RT. The more satisfied patients were with RTT interactions and communication, the more positive their attitudes were toward RT and the lower the pain intensity experienced during treatment.

CONCLUSION

Clinical implications can be drawn in terms of highlighting the need for RTTs to be mindful of their technical and supportive role in delivery of patient care and in structuring treatment information content in a way that contrasts potential nocebo effects related to patients' negative expectations about RT. The findings support the idea that RTTs may benefit from training interventions and structured education sessions with a focus on interpersonal skills and patient-centered communication.

Association of shared decision-making on patient-reported health outcomes and healthcare utilization

BACKGROUND

Shared decision-making (SDM) is a process that respects the rights of patients to be fully involved in decisions about their care. By evaluating all available healthcare options and weighing patients' personal values and preferences against available unbiased evidence, patients and healthcare professionals can make health-related decisions together, as partners. We sought to evaluate the impact of perceived SDM on patient-reported outcomes, healthcare quality, and healthcare utilization.

METHODS

Patients were identified from the 2010-2014 Medical Expenditure Panel Survey (MEPS) cohort. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey was levied to create a weighted composite score of satisfaction with SDM on a 12-point scale, and then categorized as optimal, average or poor SDM based on weighted scores. Weighting and variance techniques were applied to assure results were representative of the U.S. civilian population. Chi-square analysis was used to estimate differences across SDM groupings and multivariate logistic regression was performed to generate odds ratios (OR) and confidence intervals (CI).

RESULTS

The study cohort included 63,931 responses to the survey tool. Results of SDM satisfaction across the three categories were skewed, with 46.6% (n = 29,807) of the respondents reporting optimal SDM, 42.1% (n = 26,887) reporting average scores and only 11.3% (n = 7237) reporting poor perceived SDM. Non-white race, lower educational level, low socioeconomic status, non-married status, and uninsured or underinsured status were all associated with higher incidence of poor perceived SDM (p < .05). Poor SDM was associated with increased odds of poor physical health scores (OR: 1.17; 95% CI 1.01-1.36) and poor mental health scores (OR: 1.53; 95% CI 1.25-1.86). Poor SDM was associated with lower use of statins (OR: 0.77; 95% CI 0.68-0.87) and aspirin (OR: 0.86; 95% CI 0.77-0.95), both of which are established quality of care metrics. Poor SDM was also associated with increased emergency department (ED) utilization, with an increased likelihood of 2 or more ED visits associated with poor SDM (OR: 1.25; 95% CI 1.06-1.49).

CONCLUSIONS

Poor SDM was associated with worse patient-reported health outcomes, worse established quality indicators, and higher healthcare utilization. While increasing physician education may help optimize SDM, differences in patient-perceived SDM were also strongly driven by inherent patient characteristics.

Patients' Experiences of Preparation for Radiation Therapy: A Qualitative Study

PURPOSE/OBJECTIVES

To explore patients' experiences of and preferences for preparation for radiation therapy.
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RESEARCH APPROACH

Qualitative study. 
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PARTICIPANTS

26 individuals who recently received radiation therapy for cancer. 
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SETTING

One Australian radiation oncology clinic located within a tertiary referral hospital in New South Wales.
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METHODOLOGIC APPROACH

Semistructured interviews were conducted and analyzed based on a qualitative descriptive approach and content analysis of the transcribed interviews.
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FINDINGS

Four main themes related to preparation techniques were identified.

CONCLUSIONS

The information gained in this study indicates what strategies may best prepare patients for radiation therapy. 
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INTERPRETATION

Providing patients with information that creates a realistic expectation of what radiation therapy involves both before and after treatment seems particularly important in helping them feel prepared.

Physician Courtesy and Patient Satisfaction in a Pediatric Plastic and Oral Surgery Department

EXECUTIVE SUMMARY

Hospitals in the United States have started collecting information related to the patient experience with the objective of improving overall patient satisfaction. Between 2012 and 2015, the authors collected data from 2,875 patient satisfaction surveys. The purpose of this study was to analyze the effects of several variables-wait time, physician courtesy, administrative staff courtesy, patients' opportunity to ask questions, and patients' understanding of the answers-on a patient satisfaction score. A linear regression model was used to analyze the effects of these variables on patient satisfaction. All variables but one were significantly associated with patient satisfaction in the multivariable model. Healthcare provider courtesy was the strongest predictor of patient satisfaction; a score of "excellent" was associated with a 2.63-point (95% confidence interval [2.36, 2.90]) increase on a 5-point scale for patient satisfaction compared with a courtesy score of "poor." These findings suggest that patients had a positive experience when physicians and staff members were courteous.