Cancer Patient Assessment and Reports of Excellence: Reliability and Validity of Advanced Cancer Patient Perceptions of the Quality of Care

Abstract

A B S T R A C T PurposeConsumer perceptions are important measures of the quality of cancer care. This article describes the validation of new measures of the quality of cancer care at the time of diagnosis and treatment for advanced cancer with life-limiting prognosis. MethodsFocus groups, review of guidelines, and an expert panel were used to construct two surveys of the quality of cancer care. A prospective cohort study examined the reliability and validity of three problem scores (ie, counts of the opportunities to improve the quality of care) that examine care at the time of diagnosis and initial treatment. ResultsAt the first interview, 58% of 206 cancer patients (54.9% females; 27.5% with lung cancer; 5.4% with pancreatic cancer; 30.4% with colorectal cancer; 18.6% with breast cancer; mean age, 66.6 years) identified one or more concerns with communication about being diagnosed with advanced cancer. At the second interview, 57.0% of the respondents voiced one or more concerns about treatment communication, and 30.2% expressed one or more concerns about the experience of treatment. Each of the problem scores demonstrated both internal consistency with Cronbach's ␣ Ͼ .75 and short-term stability of responses in a subsample that had the survey administered twice in 72 hours. Factor analysis largely confirmed the proposed scale structure. All three measures demonstrated moderate correlations suggesting evidence of construct validity. ConclusionThe three proposed problem scores demonstrate evidence of reliability and validity that warrants further testing to examine their responsiveness and discriminate validity in larger, more generalizable samples.

Measuring patient satisfaction in oncology palliative care: psychometric properties of the FAMCARE-patient scale

“…Although several measures exist for measuring patient quality of life [25,26] and quality of death [27] in palliative care settings, these constructs are distinct from the construct of patient satisfaction with care [4,5]. As well, although there are existing instruments for measurement of satisfaction with oncology inpatient and outpatient care [28][29][30][31], and for care in intensive care unit settings [32], these are not suitable for use by palliative care physicians in palliative care clinic settings. Similar to the FAMCARE, the FAMCARE-P is specifically indicated for measurement of satisfaction with palliative cancer care and includes items that are considered to be important for measuring patient satisfaction, including accessibility, coordination of care, symptom management, communication and education, and support of decision making [5].…”

Patient satisfaction instruments for cancer clinical research or practice

“…Some questionnaires use response scales with various verbal descriptors [13,37,40,46]. Visual analogue scales [46] or dichotomous items (e.g., yes/no) [40] can also be found.…”

“…Different instruments use an evaluative rating scale, generally on a five-level scale, to assess degree of satisfaction, agreement regarding an aspect of care [13][14][15]26,32,34,36,41,42,44], care frequency (e.g., 'never' to 'always') [13,33,40,41] or amount options (e.g., 'not at all' to 'very much' or 'extremely') [39,45]. Some questionnaires use response scales with various verbal descriptors [13,37,40,46].…”

“…Some instruments only include items referring to the interpersonal or communicational aspects of the interaction with providers, reflecting particular attention to patient-centered care requirements [34,37,[39][40][41]. Others also involve satisfaction with technical skills or physical care [14,15,26,[31][32][33]36,42,44,46].…”

“…Most patient satisfaction instruments validated in oncology address components of the structure or process of the overall care [14,15,26,[31][32][33][34][35][36][37][38][39][40][41][42]. Only three questionnaires specifically evaluate treatment, either intravenous and/or oral chemotherapy, biological or hormonal therapy [13,43] or breast [44] or head and neck surgery [45] considering both the process of care and treatment outcomes.…”