Measuring the Quality of Personal Care in Prostate Cancer Radiation Therapy: What Aspects of Care Are Important to Patients?

Abstract

Quality of care is a multidimensional construct that includes elements of technical and non-technical care. We previously developed technical quality indicators for prostate cancer radiation therapy. The objective of this study was to identify the aspects of non-technical or “personal care” that are most important to patients undergoing radiation therapy for prostate cancer. Over a two-year period, patients undergoing definitive radiation therapy for early-stage prostate cancer at one cancer center in Ontario were invited to complete a self-administered questionnaire in which they were asked to rate the importance of various aspects of the quality of their care during radiation therapy. The questionnaire included 147 items relating to the patient’s experience from the time of his diagnosis through to his first return visit after treatment. Patients were asked to rate the importance of each item as: not important, somewhat important, important, or very important. The questionnaire was divided into three sections, which were administered sequentially: at the beginning of treatment; at the end of treatment; and at first follow-up visit. The importance of each item was measured by the percentage of patients who rated it as very important, and the items were then ranked on this basis. For each item, all possible pairs of patients were compared to determine the percentage of pairs assigning the same importance rating. A total of 113 patients gave their informed consent to participate in the study, and 89 patients completed all three sections of the questionnaire (response rate 79%). The mean percentage of patients rating an item as very important was 58%, and ranged widely from 93% for “the radiation oncologist is knowledgeable and experienced in dealing with prostate cancer”, to 9% for “waiting areas are decorated nicely”. The mean percentage of ratings of very important assigned to items belonging to particular quality domains varied as follows: ‘perceived competence of caregivers’, 77%; ‘empathy and respectfulness of caregivers’, 65%; ‘adequacy of information sharing’, 63%; ‘patient centeredness’, 56%; ‘accessibility of caregivers’, 54%; ‘privacy’, 47%; ‘continuity of care’, 46%; ‘convenience’, 42%; ‘comprehensiveness’, 39%; and ‘acceptability of the treatment environment’, 29%. However, importance ratings also varied among items within each domain. The percentage of patients who gave the same rating to a given item ranged from 25% to 87% (mean 49%). Many different aspects of care are important to patients undergoing radiation therapy for prostate cancer, and different aspects of care are important to different people. However, the three aspects of care that are most important to most patients are: the perceived competence of their caregivers; the empathy and respectfulness of their caregivers; and the adequacy of information sharing.