Introduction
Patient satisfaction (PS) is a critical metric for evaluating the quality of cancer care, and it stands as a primary outcome within the National Cancer Institute (NCI)-sponsored Patient Navigation Research Program (PNRP), designed to mitigate disparities in cancer care across diverse racial and ethnic groups. Despite the significance of patient satisfaction, a comprehensive tool to measure satisfaction across the entire spectrum of cancer-related care—from initial screening through treatment—was notably absent. This gap highlighted the urgent need for a new instrument capable of assessing patient satisfaction throughout the cancer care journey.
Recognizing this unmet need, researchers embarked on a mission to develop the Patient Satisfaction with Cancer Care (PSCC) measure. This initiative aimed to create a tool that could effectively gauge patient satisfaction across all phases of cancer-related care, addressing a significant void in existing measurement instruments. The development of the PSCC tool was driven by the necessity for a measure that was not only broad in scope but also particularly relevant to underserved populations and applicable in diverse healthcare settings.
The PSCC tool was conceived to fill a critical gap in cancer care assessment. Existing patient satisfaction measures often focused on specific aspects of care, such as inpatient experiences or advanced cancer care, lacking the breadth to evaluate the entire continuum of cancer-related services. The development of the PSCC was therefore a direct response to the need for a more holistic and inclusive measure. This initiative was especially crucial for programs like the PNRP, which sought to improve cancer care experiences and outcomes for individuals from racial/ethnic minorities and lower socioeconomic backgrounds. The creation of the PSCC tool marked a significant step forward in patient-centered cancer care assessment, providing a means to evaluate and enhance the quality of care across diverse patient populations and healthcare settings.
Objective
The primary objective was to develop a Patient Satisfaction with Cancer Care (PSCC) measure specifically designed for patients undergoing diagnostic and therapeutic cancer-related care. This initiative was in direct response to the lack of a comprehensive tool capable of assessing patient satisfaction across the entire spectrum of cancer care, from screening to treatment.
Methods
Conceptual Framework and Item Pool Development
The development of the Patient Satisfaction with Cancer-related Care (PSCC) tool was a meticulous process grounded in a robust conceptual framework and operational definition of patient satisfaction with cancer care. The initial phase involved an extensive literature review to identify existing patient satisfaction measures and key domains relevant to cancer care. Expert feedback was then solicited from healthcare professionals and researchers with expertise in cancer care, patient experience, and psychometrics. Group discussions and consensus meetings were conducted to refine the conceptual framework and operational definition, ensuring the PSCC tool would be comprehensive and relevant across diverse patient populations and care settings.
Based on the insights gathered, an initial item pool was generated, encompassing various facets of patient satisfaction, including access to care, interpersonal interactions, communication, information provision, and care coordination. This comprehensive item pool was carefully reviewed and refined to ensure clarity, relevance, and comprehensiveness, forming the foundation of the 35-item PSCC measure.
Participants and Data Collection
The 35-item PSCC measure was administered to a diverse cohort of 891 participants enrolled in the multi-site NCI-sponsored PNRP. These participants were drawn from various locations across the United States, representing a wide range of racial, ethnic, and socioeconomic backgrounds. Data collection was conducted as part of the larger PNRP initiative, which aimed to evaluate the impact of patient navigation on cancer care outcomes. Participants completed the PSCC measure as part of a broader survey assessing their experiences with cancer-related care. To ensure inclusivity and minimize literacy barriers, surveys were administered orally in English.
Psychometric Evaluation
To rigorously evaluate the psychometric properties of the PSCC measure, a series of statistical analyses were conducted. Principal components analysis (PCA) was employed to explore the underlying structure of the PSCC and identify latent factors. Internal consistency was assessed using Cronbach’s coefficient alpha (α) to determine the reliability of the measure. Divergent validity was examined through correlation analyses between the PSCC, the Communication and Attitudinal Self-Efficacy (CASE-Cancer) measure, and demographic variables. These analyses aimed to establish the validity and reliability of the PSCC as a robust tool for measuring patient satisfaction in cancer-related care.
Results
Dimensionality and Reliability of the PSCC Tool
Principal components analysis (PCA) revealed that the PSCC is essentially a one-dimensional measure. This means that the items within the PSCC tool collectively measure a single, coherent construct: patient satisfaction with cancer-related care. This single component effectively explained a substantial 62% of the variance in patient satisfaction, indicating that the PSCC items form a cohesive set capturing the core aspects of patient experience.
Reliability assessment further underscored the strength of the PSCC tool. The Cronbach’s coefficient alpha (α), a key indicator of internal consistency, ranged from 0.95 to 0.96. These exceptionally high alpha values demonstrate a high degree of internal consistency, confirming that the items within the PSCC tool are closely related and reliably measure the same underlying construct of patient satisfaction.
Validity of the PSCC Tool
The PSCC tool demonstrated robust validity across different dimensions. In terms of face validity, experts in the field reviewed the PSCC items and confirmed that they appeared to accurately reflect the construct of patient satisfaction with cancer-related care. Convergent validity was supported by moderate correlations observed between the PSCC and subscales of the CASE-Cancer measure. These correlations, all statistically significant (ps < 0.05), indicated that the PSCC tool aligns with other measures assessing related constructs, such as communication and self-efficacy in cancer care. Divergent validity was also established, as the PSCC showed no significant correlations with demographic variables like age, primary language, and marital status, suggesting that the PSCC tool measures patient satisfaction independently of these demographic factors.
These comprehensive validity assessments confirm that the PSCC tool is a valid and reliable instrument for measuring patient satisfaction within the context of cancer-related care. The psychometric properties of the PSCC tool, including its dimensionality, reliability, and validity, support its use in research and clinical practice to assess and improve patient experiences in cancer care settings.
Table 1. Demographic and Clinical Characteristics of 891 Participants
| n | Mean (Std) |
|---|---|
| Age | 843 |
| n | Percent |
| Cancer Site | |
| Breast | 572 |
| Cervix | 96 |
| Colorectal | 107 |
| Prostate | 112 |
| Multiple concurrent cancer sites | 4 |
| Gender | |
| Female | 686 |
| Male | 158 |
| Race/Ethnicity | |
| White | 360 |
| Black/African American | 266 |
| Asian | 9 |
| American Indian/Alaska Native | 4 |
| Hispanic or Latino | 190 |
| Other | 4 |
| Primary Language | |
| English | 740 |
| Spanish | 87 |
| Other | 16 |
| Birth Country | |
| US | 647 |
| Other | 139 |
| Marital Status | |
| Single/Never married | 256 |
| Married/living as married | 339 |
| Divorced/separated | 190 |
| Widowed | 54 |
| Education | |
| 8th grade or less | 69 |
| Some high school | 106 |
| High school diploma (including equivalency) | 196 |
| Some college/vocational after high school | 182 |
| Associate degree | 58 |
| College graduate | 100 |
| Graduate or professional degree | 62 |
| Household Income | |
| Less than $10,000 | 219 |
| $10,000 to $19,999 | 134 |
| $20,000 to $29,999 | 88 |
| $30,000 to $39,999 | 69 |
| $40,000 to $49,999 | 38 |
| $50,000 or more | 162 |
| Employment Status | |
| No current employment | 443 |
| Part-time employment | 106 |
| Full-time employment | 234 |
| Health Insurance Coverage | |
| Yes | 681 |
| No | 138 |
Table 2. Component Loadings for Sample 1 (N1 = 453) and Sample 2 (N2 = 438): Correlations between Individual items and the Underlying Component.
| Patient satisfaction with Cancer Care | Component Loadings |
|---|---|
| Scale Items | Eigenvalue (λ) 14.58 Sample 1 |
| 1. I felt that my health concerns were understood. | .782 |
| 2. I felt that I was treated with courtesy and respect. | .762 |
| 3. I felt included in decisions about my health. | .816 |
| 4. I was told how to take care of myself. | .741 |
| 5. I felt encouraged to talk about my personal health concerns. | .758 |
| 6. I felt I had enough time with my doctor. | .774 |
| 7. My questions were answered to my satisfaction. | .805 |
| 8. Making an appointment was easy. | .549 |
| 9. I knew what the next step in my care would be. | .670 |
| 10. I feel confident in how I deal with the health care system. | .744 |
| 11. I was able to get the advice I needed about my health issues. | .817 |
| 12. I knew who to contact when I had a question. | .695 |
| 13. I received all the services I needed. | .798 |
| 14. I am satisfied with the care I received. | .855 |
| 15. The doctors seemed to communicate well about my care. | .830 |
| 16. I received high quality care from my regular doctor. | .723 |
| 17. I received high quality care from my specialists. | .811 |
| 18. My regular doctor was informed about the results of the tests I got. | .541 |
Extraction Method: Principal Components Analysis
Discussion
The Patient Satisfaction with Cancer Care (PSCC) tool was developed as a concise and easily administered instrument to evaluate satisfaction with cancer-related care, particularly for individuals from diverse cultural and socioeconomic backgrounds. A key objective in creating the PSCC was to ensure its applicability to all patients, irrespective of whether they received patient navigation services. This approach aimed to produce a broadly relevant measure for diverse populations facing various barriers to cancer care.
Psychometric evaluation of the PSCC revealed a robust and reliable one-component structure. This unidimensionality simplifies the interpretation of scores, making it a practical tool for assessing overall patient satisfaction. The high construct validity of the PSCC is evidenced by its strong internal consistency and reliability, confirming that the items effectively measure the intended construct of patient satisfaction with cancer care.
A distinctive feature of the PSCC is its focus on satisfaction with cancer-related care across the entire spectrum, from diagnostic testing to treatment. This contrasts with previous scales that often target narrower aspects of care, such as specific cancer types, treatment stages, or care settings (inpatient or outpatient). By addressing the broader domain of cancer care, the PSCC offers a more comprehensive assessment of patient experiences.
Despite the strengths of the PSCC, certain limitations should be considered. Cognitive interviewing was not conducted during item development, which could have provided further insights into item interpretation and relevance. However, a pilot study did not identify any issues that would necessitate item modification. Additionally, the oral administration of the PSCC to mitigate low literacy concerns may limit generalizability to self-administered settings.
The observed skewness towards higher satisfaction ratings, consistent with other satisfaction measures, warrants further investigation. It remains unclear whether this reflects genuinely positive experiences or potentially lowered expectations or social desirability bias. Future research could explore patient expectations and the impact of anonymous responses on satisfaction scores.
The study sample predominantly comprised women (approximately 80%), indicating a need for further research to confirm the PSCC’s generalizability to men. Furthermore, while the PSCC accounted for a substantial portion (60%) of the variance in patient satisfaction, future studies could explore additional factors contributing to patient satisfaction to provide a more complete understanding. Finally, the responsiveness of the PSCC to changes in care and its alignment with clinical impressions remain to be assessed in future research.
Despite these limitations, the PSCC offers significant strengths, including its psychometric validation in medically underserved and underrepresented populations across diverse healthcare settings. The development of the PSCC represents a valuable contribution to the field, providing a context-specific, patient-centered measure of satisfaction with cancer-related care.
Conclusion
In conclusion, the Patient Satisfaction with Cancer Care (PSCC) tool stands as a validated and reliable instrument for assessing patient satisfaction across the continuum of cancer-related care. Developed to address the need for a comprehensive satisfaction measure applicable to diverse populations, the PSCC demonstrates strong psychometric properties and offers a valuable tool for researchers and healthcare providers. While the original research article does not explicitly state the exact date of creation, the development of the PSCC tool was integral to the Patient Navigation Research Program, aimed at improving cancer care outcomes, particularly for underserved communities. Its development can be understood as occurring within the timeframe of this significant research initiative. The PSCC holds promise for evaluating and enhancing patient-centered cancer care, particularly within patient navigation programs and diverse healthcare settings. Further research should continue to explore its predictive validity and responsiveness to change, solidifying its role in improving the quality of cancer care.
Acknowledgments
Supported by grants from the National Cancer Institute (3U01CA116924-03S1, U01 CA11692401, 1R25CA10261801A1, U01CA116892, U01CA 117281, U01CA116903, U01CA116937, U01CA116885, U01CA116875, and U01CA116925) and the American Cancer Society (SIRSG-05-253-01). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the Center to Reduce Cancer Health Disparities, NCI.
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