Chest
Volume 128, Issue 5, November 2005, Pages 3475-3481
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Clinical Investigations: SURGERY
The Place of Patient Satisfaction in Quality Assessment of Lung Cancer Thoracic Surgery

https://doi.org/10.1378/chest.128.5.3475Get rights and content

Study objectives: To compare the quality of non-small cell lung cancer (NSCLC) surgical care with patient satisfaction.

Design: Prospective study.

Setting: Academic hospital departments of thoracic oncology and surgery.

Patients and methods: Patients presenting with recently diagnosed NSCLC and eligible for front-line thoracic surgery were eligible. Patient satisfaction was assessed using the Questionnaire of Satisfaction of Hospitalized Patients. Quality of surgical care was evaluated using an original score built accordingly to British Thoracic Society guidelines. Univariate analysis used parametric (Pearson correlation,t test) and nonparametric tests (Mann-WhitneyU test) according to test conditions. Probability of survival was estimated using the Kaplan-Meier method.

Results: Seventy patients (mean age, 63.7 years) were included. Lobectomy was performed in 62 cases, and pneumonectomy was performed in 8 cases. In all, 28 patients had a postoperative complication. One-year survival rates for patients with stage I-II and stage IIIA NSCLC were 84% and 58%, respectively. Mean patient satisfaction was 78 ± 13/100 and 69 ± 13/100 for global staff and structure index, respectively (± SD). Mean score for quality of surgical care was 88.7/100 (range, 51 to 100). The absence of postoperative complication was significantly related to a high level of satisfaction regarding the structure (r= 0.30, p < 0.05). Other features of patient satisfaction did not show a significant correlation with the quality of the preoperative selection process or the surgical procedure itself (r< 0.20).

Conclusions: Considering the lack of significant correlation, the present study does not support a shortcut between quality of care and patient satisfaction. Nonetheless, patient satisfaction should be integrated into rather than substituted for the quality of health-care assessment, which also needs further development.

Section snippets

Patients

This prospective study was conducted at a university hospital over a period of 24 months starting in May 2002. Patients > 18 years old and undergoing standard thoracic surgery as the sole treatment for a primary NSCLC were eligible to participate in the study. The study protocol was approved by institutional ethics review. All patients provided written informed consent.

Patient Satisfaction

Patient satisfaction was measured using the validated Questionnaire of Satisfaction of Hospitalized Patients (QSH) [Appendix].4

Patients

A total of 70 inpatients participated in this prospective study. Major sociodemographic characteristics are summarized inTable 1. Mean age of patients was 63.7 years (range, 31 to 80 years). Twenty-one patients (30%) were active smokers (median, 39 pack-years; range, 5 to 120 pack-years). Forty-nine patients (74%) were married or coupled. Twenty patients (31%) had completed high school or higher. Overall, 52 patients (78%) were not working: 44 patients (66%) were retired, and 8 patients (12%)

DISCUSSION

Health-care state agencies and professionals wish to improve the quality of health care. However, assessing quality of care integrates several dimensions, making global and indisputable evaluation really difficult to accomplish. Then, considering the legitimate place currently given to the patients' point of view, a shortcut has been insidiously introduced to assimilate quality of care and patient satisfaction. Conversely, the present study does not support such a link between quality of care

The QSH

Answer each question on a scale of 1 to 5: 1 = better than expected; 2 = as expected; 3 = little bit worse than expected; 4 = worse than expected; 5 = greatly worse than expected.

When arriving at the hospital, administrative staff:

  • Quickly registered me

  • Was helpful and kind

When arriving at the hospital:

  • I felt a good coordination between administrative wards

When arriving at the department, staff:

  • Quickly took me in

  • Heartily welcomed me

When arriving at the hospital, I:

  • Believed

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