Non-modifiable demographic, financial, and geographic factors impacted patient-reported satisfaction with the care women received at a gynecologic oncology clinic, a single-center study showed.
“This study agrees with previous work in other disciplines that patient satisfaction scores, at the initiation of care, are affected by non-modifiable patient and system factors such as the age of the patient or the size of the hospital,” lead study author Dr. Emma L. Barber said in an interview prior to the annual meeting of Society of Gynecologic Oncology where she was presenting the study.
“The study is unique in that it is the first to examine this question specifically in gynecologic cancer patients in the outpatient setting. Cancer patients, and specifically gynecologic cancer patients, may have different perspectives on satisfaction with care than broader groups of patients, such as general internal medicine patients,” she said.
Dr. Barber, a gynecologic oncology fellow in the department of obstetrics and gynecology at the University of North Carolina at Chapel Hill, and her associates administered the Patient Satisfaction Questionnaire (PSQ-18) to 208 women seeking surgical management at the university’s gynecology clinic. The tool measures patient satisfaction in seven health care domains: general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with physicians, and accessibility on a five-point Likert scale. The researchers converted scores to “satisfied” versus “unsatisfied/equivocal” based on a cutoff of 3.5.
The median age of respondents was 58 years, their median PSQ-18 score was 70.5, 78% were white, 32% had some college/trade school education, and 43% were college graduates or had other advanced degrees. The majority of respondents (84%) had some private insurance, 9% had Medicaid/Medicare alone, and 7% were uninsured.
White patients had higher levels of patient satisfaction, compared with other minorities (86% vs. 65%; P less than .01), while uninsured patients had lower scores in the following domains of patient satisfaction, compared with their insured counterparts: interpersonal (60% vs. 83%; P = .02), financial (27% vs. 61%; P = .01), and accessibility (33% vs. 67%; P = .01). Increasing education was also associated with higher scores in the interpersonal and accessibility domains of patient satisfaction (P of .03 and .01, respectively). Multivariate regression analysis revealed that the strongest predictors of patient satisfaction were white race (adjusted OR 2.7) and each 20 minutes less traveled (adjusted OR of 1.2).
“Tertiary care facilities that serve heterogeneous populations and have large catchment areas can use this information to target improvement projects at specific domains of patient satisfaction,” Dr. Barber said. “However, given the association between non-modifiable factors and satisfaction, performance measures that use patient satisfaction scores based only on summed domain scores may be penalizing clinics for patient mix differences. Financially penalizing clinics that care for underserved patients may exacerbate healthcare disparities. Instead, a system of incentives for improvement may be more appropriate.”
She acknowledged certain limitations of the study, including its prospective, single-center design. “The results may not be generalizable to other institutions or practice settings. Additionally, we tested multiple hypotheses to examine the effects of various factors on the different domains of patient satisfaction. Thus, these results should be considered hypothesis generating and need to be confirmed in additional studies.”