NSW cancer patient survey 2007–2008
From 2007 the Cancer Institute NSW partnered with NSW Health to undertake the NSW Patient Survey project with the aim to identify patients' unmet needs.
Background
The Survey is one of several strategies being used by the Cancer
Institute NSW to understand patient experiences and levels of
satisfaction and to identify opportunities to improve cancer
care.
Method
In 2007 and 2008, cancer patient satisfaction surveys (employing
Picker tools), were posted to a random sample of NSW cancer
inpatients and outpatients who attended one of 19 public or private
health care facilities.
The inpatient survey focussed on one encounter while the
outpatient survey gathered feedback about the cancer journey across
six months.
Dimensions of care
The surveys measured satisfaction across dimensions of
care
 |
Positive scores and correlations were calculated to identify
areas of strength and opportunities for improvement. Results
were disseminated to participating health care facilities
encouraging them to own, review and action their results.
In 2007, a roadshow was conducted to facilitate discussions
about how priority areas can be addressed, what the next steps
forward might look like and how change can be influenced.
A stakeholder forum of cancer health professionals was held in
2008 to elicit views about initiatives that could be put in place
to address patients' unmet needs.
Results: Cancer inpatients
A sample of 578 cancer inpatients participated in 2008, compared
with a sample of 616 in 2007. Care satisfaction was high in 2008
with 92.9 per cent of cancer inpatients reporting good, very good
or excellent care. A total of 69.4 per cent of cancer
inpatients would definitely recommend the hospital to their family
and friends. These results were similar in 2007.
Performance across dimensions of care - cancer
inpatients
Performance across the dimensions of care was comparable
in 2008 and 2007. The best performing dimensions were 'Physical
Comfort' and 'Respect for Patient Preferences' while the worst
performing dimensions were 'Continuity and Transition' and 'Family
and Friends'.
 |
Areas of strength - cancer inpatients
Similar areas of strength were identified in 2008 and 2007
with ratings significantly improving for five questions, three of
which related to nurses in 2008.
| Question |
2008 Positive Score |
Identified in 2007 |
2007 Positive Score |
| Patients rated how well doctors and nurses worked together as
good, very good or excellent |
91.6% |
Yes |
90.4% |
| Staff treated patients with dignity and respect |
84.8% |
Yes |
82.7% |
| Patients rated the availability of nurses as good, very good or
excellent |
85.6%* |
Yes |
79.7% |
| Patients rated the courtesy of nurses as good, very good or
excellent |
94.8%* |
Yes |
92.2% |
| Staff did everything to control pain |
78.1%* |
No |
73.9% |
| Patients had confidence and trust in nurses |
79.6%* |
No |
73.8% |
| Patients had confidence and trust in doctors |
84.9% |
No |
86.8% |
| Patients rated the availability of doctors as good, very good
or excellent |
87.2%* |
No |
84.7% |
| *denotes that the 2008 result is statistically
significantly different from the 2007 result |
Areas for improvement - cancer inpatients
Of the seven 2008 areas for improvement four were reported
in 2007.
Performance on measures classified as areas for improvement in
2007 and 2008 was similar,
with the exception of 'nurses responded quickly to call button'
which statistically
significantly improved from 50.1 per cent in 2007 to 54.8 per cent
in 2008.
| Question |
2008 Positive Score |
Identified in 2007 |
2007 Positive Score |
| It was easy finding someone to talk regarding concerns |
63.6% |
Yes |
61.1% |
| Nurses discussed anxieties and fears |
54.3% |
Yes |
54.0% |
| Nurses responded quickly to call button |
54.8%* |
Yes |
50.1% |
| Care provider understood condition completely |
72.0% |
Yes |
73.0% |
| Family was given information to help recovery |
66.7% |
No |
65.3% |
| Staff explained the reason for delay in going to room/ward |
67.0% |
No |
68.3% |
| Care received in the emergency department was very
organised |
71.9%* |
No |
77.2% |
|
* denotes that the 2008 result is statistically
significantly different from the 2007 result
|
Questions with low positive score ratings (<60%)
- cancer inpatients
Those questions for which patient satisfaction was low
(positive score <60%).
The same measures were identified in 2007 and 2008.
| Question |
2008 Positive Score |
2007 Positive Score |
| Patients were given a choice of admission dates |
29.2% |
28.9% |
| Nurses discussed anxieties and fears |
54.3% |
54.0% |
| Nurses responded quickly to call button |
54.8%* |
50.1% |
| Patients were given enough information in the ED about their
medical condition/treatment |
59.5% |
58.6% |
|
* denotes that the 2008 result is statistically
significantly different from the 2007 result.
|
Results: Cancer Outpatients
A response rate of 53.4 per cent was achieved in 2008 (n=3793),
compared to 57.8 per cent in 2007 (n=3780). Care satisfaction
was high in 2008 with 97.4 per cent of cancer outpatients reporting
good, very good or excellent care. A total of 81.6 per cent
of cancer outpatients would definitely recommend the hospital to
their family and friends. These results were similar in
2007.
Performance across dimensions of care - cancer
outpatients
In both 2007 and 2008 the best performing dimensions were
Respect for Patient Preferences
and Coordination of Care while the worst were Information and
Education, Emotional Support
and Family and Friends
 |
Areas of strength - cancer outpatients
Five areas of strength were identified in 2008 of which
four were reported in 2007.
Positive score ratings across the two years were
comparable
| Question |
2008 Positive Score |
Identified in 2007 |
2007 Positive Score |
| Patients received the services they needed in past 6
months |
76.2% |
Yes |
75.5% |
| Staff did everything to treat the cancer |
83.5% |
Yes |
83.2% |
| Patients trusted staff with confidential information |
80.5% |
Yes |
80.6% |
| Patients were treated with dignity and respect |
86.8% |
Yes |
86.3% |
| Staff did everything to help with chemotherapy side
effects |
78.0% |
No |
77.1% |
Areas for improvement - cancer outpatients
Areas for improvement in 2008 and 2007 were similar,
as were the positive score ratings across the two years
|
Question
|
2008 Positive Score |
Identified in 2007 |
2007 Positive Score |
| Staff went out of way to help |
56.8% |
Yes |
57.1% |
| Patients received enough information on their
rights/responsibilities |
65.5% |
Yes |
67.3% |
| Staff did everything to control pain/discomfort |
70.6% |
Yes |
71.1% |
| Staff told patients how to manage chemotherapy side
effects |
73.4% |
No |
75.0% |
Questions with low positive score ratings (<
50%) - cancer outpatients
All those questions which patients rated low (positive
score < 50%).
The same measures were identified in 2007 and 2008.
| Question |
2008 Positive Score |
2007 Positive Score |
| Patients received enough information on nutritional needs |
49.7% |
50.3% |
| Patients felt comfortable talking regarding alternate
therapy |
48.7% |
47.5% |
| Staff considered living situation in treatment |
47.4% |
47.7% |
| Patients were offered counselling/support regarding
concerns/coping |
45.4% |
46.3% |
| Patients received enough information on emotional changes |
43.0% |
42.9% |
| When first told of illness put in touch with staff to help with
anxieties/fears |
41.2%* |
44.5% |
| Patients never waited longer than expected for radiation
treatment |
40.3% |
39.2% |
| Patients received enough information on sexual activity
changes |
36.6% |
35.6% |
| Patients received enough information on relationship
changes |
35.3% |
36.6% |
| In past six months after diagnosis put in touch with staff to
help with anxieties/fears |
29.5%* |
33.2% |
| *denotes that the 2008 result is substantially
different from the 2007 result |
Conclusion
The results clearly highlight low satisfaction and unmet patient
needs at diagnosis, treatment and follow-up. The opportunities for
improvement fall into four main categories:
- recognition and management of distress and pain;
- effective communication between clinicians and patients;
- timely provision of relevant information to patients and their
carers;
- timely provision of basic care e.g. call button
requests/bathroom needs.
No major changes in patient satisfaction were identified when
the survey was repeated in 2008. The lack of measurable change
through time could be related to the survey's sensitivity, survey
timing, with inadequate time for system change, or lack of
system-wide strategies to drive change.
Forum participants felt strongly that to address patients'
emotional and physical needs initiatives cannot rely on ad hoc
strategies that are implemented in isolation but that a system-wide
approach is required.
System-wide supportive care interventions including standardised
distress/pain screening/referral and staff communication training
are required. The Cancer Institute NSW is developing a program that
aims to implement system-wide evidence based supportive care
practice for cancer patients in NSW.
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