A qualitative study of patient satisfaction with follow-up cancer care: the case of Hong Kong

Patient experience of follow-up after surgery for kidney cancer: a focus group study

OBJECTIVE

To explore patient experience of follow-up care after kidney cancer surgery and to develop recommendations for best practice.

METHODS

We conducted two focus groups, including 14 participants with experience of kidney cancer follow-up after surgery, to elicit patient views on current follow-up care. Thematic analysis was used to identify unifying themes to describe the patient experience of follow-up, and the results were then used to develop a set of recommendations for best practice.

RESULTS

We identified six themes (feelings of abandonment; uncertainty about the plan; anxiety about appointments; variation in care; a need for information; and a need for emotional support) that described current patient experience and areas in which current care could be improved. In particular, while most of the participants felt that their physical needs had been met, many had struggled with unmet emotional needs and a lack of information and resources. This was especially noted in the period immediately following surgery, when feelings of abandonment were common, and around follow-up scans and routine appointments, which were a source of anxiety. Our participants also described concerns about the lack of consistency between different hospitals and centres around the United Kingdom, with differences in the content and quality of follow-up care. Based on the results, we developed a list of recommendations to address some of the challenges described through relatively minor changes to the care pathway.

CONCLUSIONS

We identified gaps and variability in current follow-up care after kidney cancer surgery, and have developed a set of recommendations that, if implemented, would improve the follow-up care experience for these patients.

Exploring the factors that influence healthcare providers care quality in Jordanian hospitals: the perspectives of nurses, pharmacists and physicians

Objectives

The key point of this investigation is to explore factors that influence healthcare providers’ quality care in government hospitals in Jordan, from the perspective of nurses, pharmacists and physicians.

Method

A qualitative technique (case study) was executed in this project. Semi-structured interviews (face-to-face) were used. The thematic analysis was applied in this study. The interviews were conducted with five physicians, five pharmacists and five nurses at different levels, including different specialists from Jordanian government hospitals.

Key findings

Four vital factor influencing of nu healthcare providers’ quality care were recognised in the sampled hospitals: manager ability and leadership support of staff, adequate and qualified hospital nurses and physicians, building a trusting work environment and good salaries and incentive.

Conclusions

This examination attempted to offer an in-depth comprehending factor that impacts healthcare providers’ quality care. Furthermore, it contributes to healthcare theory and practice by developing a conceptual framework that offers policymakers and managers a practical understanding of factors that influence healthcare providers’ quality care.

Follow-up care in cancer: adjusting for referral targets and extending choice

BACKGROUND

Over recent years, several initiatives have impacted on the referral of patients to secondary care, most notably targets for urgent referral in suspected cancer and the patient choice agenda. At the same time, improved long-term survival in cancer has increased numbers attending follow-up, doubts about the effectiveness of specialist follow-up have emerged, and alternative models of follow-up have been tested.

AIM

The aim of the study was to explore patient and carer perspectives on the flexibility and responsiveness of cancer services. This article focuses on findings relating to referral, subsequent outpatient appointments and cessation of outpatient follow-up.

METHODS

Issues were explored in a qualitative study using face-to-face interviews with a purposive sample of 54 people affected by cancer. Data were analysed concurrently with data collection, using qualitative analysis software.

FINDINGS

The study gave rise to a number of salient themes. Links were identified between three of these: choice and responsiveness during referral; the flexibility and responsiveness of outpatient appointment systems; and negotiating cessation of follow-up. It appeared that policy on urgent referrals might be adversely affecting practice relating to appointment systems and the continuance of follow-up.

DISCUSSION AND CONCLUSIONS

Hospital-based cancer follow-up is being given decreasing priority because of doubts about effectiveness and a target-driven focus on referral. This is impacting on patients, who may value outpatient follow-up as a 'safety net' but have difficulties in obtaining appointments, and may be discharged without negotiation or adequate support. For these reasons, new forms of flexible/responsive aftercare are urgently needed.

Care-seeking behavior of Japanese gynecological cancer survivors suffering from adverse effects

Background

Post-treatment follow-up visits for gynecological cancer survivors should provide opportunities for management of adverse physical/psychological effects of therapy and early recurrence detection. However, the adequacy of such visits in Japan is poorly documented. We qualitatively explored care-seeking experiences of Japanese gynecological cancer survivors and deduced factors influencing care-seeking behaviors and treatment access.

Methods

We conducted 4 semi-structured focus groups comprising altogether 28 Japanese gynecological cancer survivors to collect a variety of participants’ post-treatment care-seeking behaviors through active interaction with participants. Factors influencing access to treatment for adverse effects were analyzed qualitatively.

Results

Survivors sought care through specialty clinic visits when regular post-treatment gynecological follow-ups were inadequate or when symptoms seemed to be non-treatment related. Information provided by hospital staff during initial treatment influenced patients’ understanding and response to adverse effects. Lack of knowledge and inaccurate symptom interpretation delayed help-seeking, exacerbating symptoms. Gynecologists’ attitudes during follow-ups frequently led survivors to cope with symptoms on their own. Information from mass media, Internet, and support groups helped patients understand symptoms and facilitated care seeking.

Conclusions

Post-treatment adverse effects are often untreated during follow-up visits. Awareness of possible post-treatment adverse effects is important for gynecological cancer survivors in order to obtain appropriate care if the need arises. Consultation during the follow-up visit is essential for continuity in care.

Patients' and healthcare professionals' views of cancer follow-up: systematic review

BACKGROUND

Cancer follow-up places a significant burden on hospital outpatient clinics. There are increasing calls to develop alternative models of provision.

AIM

To undertake a systematic review of qualitative studies examining patients' and healthcare professionals' views about cancer follow-up.

DESIGN OF STUDY

Systematic review.

SETTING

Primary and secondary care.

METHOD

Comprehensive literature searches included: 19 electronic databases, online trial registries, conference proceedings, and bibliographies of included studies. Eligible studies included qualitative studies examining patients' and healthcare professionals' views of cancer follow-up. Studies of patients with any type of cancer, considered free of active disease, or no longer receiving active treatment were included. Findings were synthesised using thematic analysis.

RESULTS

Nineteen studies were included; seven were linked to randomised controlled trials. Eight studies examined the views of healthcare professionals (four of which included GPs) and 16 examined the views of patients. Twelve descriptive themes were identified, from which 12 perceived implications for practice were derived. Most themes related to conventional follow-up in secondary care. Some views concerning other models of care were based on participants' ideas, rather than experiences.

CONCLUSION

Patients' main concern is recurrent disease, and they find regular follow-up, expertise of specialists, and quick access to tests reassuring. Information regarding the effectiveness of follow-up is not given to patients who also have unmet information needs, which would help them to cope and be more involved. Continuity of care, unhurried consultations, and psychosocial support are important, but sometimes lacking in secondary care. GPs are thought to be unwilling and to have insufficient time and expertise to conduct follow-up.

Cancer patients' satisfaction with care in traditional and innovative ambulatory oncology clinics

This study examined the effects of environmental changes, such as rearranging the seating area, playing soft music, and displaying scenes of nature, on aspects of patient satisfaction, ranging from satisfaction with the physical environment and wait times to continuity of care, confidentiality, and trust in providers. Patients receiving care in a new, innovative cancer center had significantly higher satisfaction scores on the physical environment and wait time subscales than the patients receiving care in an older, traditional center. However, the 2 centers did not differ on any of the other satisfaction subscales. Implications of these findings are discussed.

Clinical Encounter Experiences of Patients With Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is a commonly occurring cancer among Hong Kong Chinese, especially in the relatively young population group. Since the disease carries a favorable prognosis, sequelae following treatment have become an important concern for patients suffering from NPC, particularly because of the strong interplay of psychological, social, and biological issues during their rehabilitation. In this qualitative study, in-depth, semistructured audiotaped interviews were undertaken with 32 patients receiving rehabilitation at the physiotherapy department of a regional teaching hospital in Hong Kong. The objective of the study was to examine the rehabilitation experiences of NPC survivors to identify factors that contributed to a satisfying clinical encounter experience. During the study, data collection and analysis using a grounded theory approach were concurrently conducted. The 3 main themes that shaped the rehabilitation experiences of NPC survivors were the patient-clinician relationship, participation in therapeutic alliance, and quality rehabilitation service provision. These, together with the identified needs of the participants, contributed to the participants' perceived health-related quality of life. A constructive clinical experience was perceived when their needs were met. The findings highlight the importance of patient-centeredness in the treatment delivery and a multifaceted role of clinicians in meeting the needs of this group of cancer survivors.

Patient satisfaction: a descriptive study of a breast care clinic in Iran

A descriptive study was carried out to examine patient satisfaction among women attending the Iranian Centre for Breast Cancer. A specially designed patient satisfaction questionnaire was distributed to all attendees and they were asked to complete the questionnaire. The questionnaire contained items on satisfaction with care organization, physical environment, personnel communication skills, clinical care, and overall satisfaction. In all, 425 women participated in the study. The mean age of women was 40.4 years (SD = 11.6), most were married (81%) and housewives (69%). A vast majority of women were very satisfied or satisfied with physical environment, personnel communication skills, and clinical care received. Eighty-two per cent of respondents were very satisfied or satisfied with the clinic's overall performance. There was a significant agreement between patients' overall satisfaction and satisfaction with physical environment, personnel communication skills, and clinical care. There was greatest agreement between patients' overall satisfaction and satisfaction with examination room (Kappa = 0.21, P < 0.0001) and with physicians' consultation (Kappa = 0.20, P < 0.0001). None of the demographic variables showed any significant association with patients' overall satisfaction. The findings suggest that the physical environment and physicians' style of consultation contribute most to the patients' overall satisfaction.