Factors associated with elderly patients' perception of cancer services responsiveness

Abstract

Purpose of the study: To report on elderly cancer patients' ratings of Cancer Services Responsiveness (CSR) and to identify individual and organizational factors associated with patients' perception of care. Methods: A secondary analysis of data from a cross-sectional survey of 1379 adult patients' perceptions of their care experience (response rate: 80%) in nine outpatient cancer clinics in Quebec (Canada) was conducted in 2011. The sample for this study consisted of elderly patients, defined as aged 70 years and over (N=312). Responsiveness was measured using an adapted version of the WHO's Health Services Responsiveness questionnaire, the Cancer Services Responsiveness tool (CSR-T) [1]. The CSR-T has 19 items and four dimensions: 1) prompt access to care (ACC), 2) communication (COM), 3) person-centered response (PCR) and 4) quality of care environment (QENV). Responses ranged from 1 to 4 on a Likert-type scale. Descriptive statistics (mean (x ), standard deviation (SD)) were used to report on patients' ratings of Overall-CSR and each of its dimensions. Multiple logistic regression (MLR) analysis was performed to identify individual and organizational determinants of perceived responsiveness of cancer services (odds ratio (OR), [Confidence interval (CI) 95%]). Results: Elderly patients had a very positive rating of the Overall-CSR (x =3.87, SD=0.14) and its four dimensions: ACC (x =3.53, SD=0.66), COM (x =3.94, SD=0.17), PCR (x =3.95, SD=0.14) and QENV (x=3.91, SD=0.19). Regarding individual characteristics, MLR indicated a significant (pb0.05) and positive association between better self-assessed health status and Overall-CSR (OR=2.00, [1.28; 3.13]), COM (OR=1.87, [1.19; 2.92]), PCR (OR=2.30, [1.40; 3.79]) and QENV (OR=1.79, [1.05; 3.07]). Low education level was positively associated with COM (OR=2.06, [1.35; 3.15]) and PCR (OR=1.75, [1.10; 2.78]). Men had a more positive rating of ACC (OR=1.56, [1.06; 2.37]) and PCR (OR=1.61, [1.03; 2.51]) than did women. Emotional well-being was related to ACC (OR=1.53; [0.98; 2.39]). Presence of comorbidity was negatively associated with COM (OR=1.61, [0.93; 2.78]) and PCR (OR=1.73, [0.91; 3.28]) but not significant (p=0.09). Regarding organizational characteristics, rural location was associated with ACC (OR=1.93, [1.01; 3.68]) and Overall-CSR (OR=1.98, [1.12; 3.50]). Finally, cancer teams with eight professionals or less were associated with QENV (OR=0.34, [0.15; 0.80]). Conclusions: CSR appears to be a relevant patient-reported outcome measure to monitor non-medical aspects of quality of care. Our findings indicate that cancer services responsiveness in outpatient clinics is highly rated by elderly cancer patients. Nevertheless, variations exist and may be explained by both patient and organizational characteristics. Information regarding the influence of these characteristics may be helpful in interpreting patients' perceptions of care when comparing outpatient clinics.