Evaluation of the physician-patient communication assessment tool (CAT) in a hematology-oncology practice.

Abstract

14 Background: Interpersonal communication skills are critical for building physician-patient relationships. The usefulness of feedback instruments to assess communication in oncology is uncertain. The simple, 15-item, patient-oriented CAT (Makoul G, et al. Patient Educ Couns 2007;67:333) was previously validated in non-oncologic specialties, using 20-30 samples per physician. The mean proportion of “Excellent” scores (MPES) was recommended as a summary estimate (76% in the above study). We evaluated the usefulness of this survey in a hematology-oncology practice. Methods: We administered CAT anonymously to all consenting outpatients during visits in our center, from January to March 2013. The association of “Excellent” scoring with patient age, gender and type of visit (cancer-related or unrelated) was studied using random-effects logistic regression. Results: We obtained 144 surveys (23-52 per physician). Median patient age was 65 years (range, 19-93) with 67% women and 54% cancer-related visits. The MPES for each survey question varied between 86% and 96%. The average MPES per physician was 92.1% (range 88.5-95.8%). MPES was higher for patients >65 years old (94.9% vs. 90.4%), men (96.7% vs. 90.3%), and for cancer-related visits (94.8% vs. 89.7%). In a multivariable model, the association was significant for age>65 (odds ratio, OR 5.38, 95%CI 1.06-27.5, p=.043) and female sex (OR 0.12, 95%CI 0.02-0.76, p=.024). The physician score strongly correlated with satisfaction with office staff recorded as part of the CAT (odds ratio, OR, 28.5, p<.0001). Conclusions: In a hematology-oncology practice, CAT results were considerably more skewed towards “Excellent” scores than in other previously studied specialties. Patients’ age and gender significantly influence the scores, which may confound comparisons between physicians or practices in quality assessment projects. As the needs, concerns and problems of cancer patients may differ from other medical settings, further research is needed to establish if CAT can be used for performance improvement, and whether oncology-specific questions can provide more discriminating measures of patient satisfaction and physician communication skills.