Patient-expressed perceptions of wait-time causes and wait-related satisfaction

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PERCEPTIONS OF WAIT-TIME CAUSES

105

urrent

lume

22,

umber

2, A

pril

2015

Current Oncology

, the full text of each article is available immediately and archived in PubMed Central (PMC).

ORIGINAL ARTICLE

Patient-expressed perceptions

of wait-time causes and

wait-related satisfaction

M. Mathews

,* D. Ryan

and D. Bulman

underlying reasons for wait-related satisfaction or

dissatisfaction. Although our findings shed light

on patient experiences with the health system and

identify where interventions could help to inform the

expectations of patients and the public with respect

to wait time, more research is needed to understand

wait-related satisfaction among cancer patients.

KEY WORDS

Wait times, patient satisfaction, breast cancer, pros

–

tate cancer, colorectal cancer, lung cancer

BACKGROUND

ìPatient satisfactionî refers to personal evaluations

by patients about whether their lived health care ex

–

periences measure up to their expectations

. Patient

satisfaction is generally accepted as a dimension of

quality of care

and patient-centred care

. A num

–

ber of studies have examined patient satisfaction in

cancer care and have highlighted communication

between the physician (and other members of the

team) and the patient

3,4

. Nonetheless, wait times for

care are frequently cited as a cause of patient dis

–

satisfaction with the health care system

Studies examining wait times for cancer care and

wait-related satisfaction have a number of limitations.

First, some studies examine the length of time spent

in a waiting room preceding a single visit; few stud

–

ies have looked at waits as patients progress from

symptoms, to testing, and to diagnosis and treatment.

Second, some researchers have described wait times

for the various intervals from symptoms to treat

–

ment, but we found only one Canadian study that

considered patient satisfaction with those waits. In

a study of colorectal cancer patients in Nova Scotia,

researchers found only a modest correlation between

length of wait and wait-related satisfaction

Does patient satisfaction vary based on the cause

of the wait? Wait times along the pathway from

symptoms to treatment are commonly described in

ABSTRACT

Background

This study set out to identify patterns in the causes of

waits and wait-related satisfaction.

Methods

We conducted qualitative interviews with urban,

semi-urban, and rural patients (

= 60) to explore

their perceptions of the waits they experienced in the

detection and treatment of their breast, prostate, lung,

or colorectal cancer. We asked participants to de

–

scribe their experiences from the onset of symptoms

to the start of treatment at the cancer clinic and their

satisfaction with waits at various intervals. Interview

transcripts were coded using a thematic approach.

Results

Patients identified five groups of wait-time causes:

Patient-related (beliefs, preferences, and non-cancer

health issues)

Treatment-related (natural consequences of treatment)

System-related (the organization or functioning

of groups, workforce, institution, or infrastructure

in the health care system)

Physician-related (a single physician responsible

for a specific element in the patientís care)

Other causes (disruptions to normal operations

of a city or community as a whole)

With the limited exception of physician-related

absences, the nature of the cause was not linked to

overall satisfaction or dissatisfaction with waits.

Conclusions

Causes in themselves do not explain wait-related

satisfaction. Further work is needed to explore the

Curr Oncol

, Vol. 22, pp. 105-112; doi: http://dx.doi.org/10.3747/co.22.2243

MATHEWS

et al.

106

urrent

lume

22,

umber

2, A

pril

2015

Current Oncology

, the full text of each article is available immediately and archived in PubMed Central (PMC).

the literature as resulting from patient and provider

delay. ìPatient delayî refers to the interval from the

onset of symptoms to the first medical consultation,

usually with the patientís regular physician

7ñ9

. ìPro

–

vider delayî refers to the period after the first visit to

a health care provider (in Canada, usually the general

practitioner or family physician)

6,10,11

. The terminol

–

ogy suggests that waits during those periods result

from the provider or the patient. For example, a lengthy

wait to see a physician about symptoms is attributed to

the patient, and delays occurring after the initial visit

are attributed to physician- or health systemñrelated

issues. Although some studies have described patient

and provider delays, we were unable to find studies that

examined the relationship between patient satisfaction

and wait time causes. The purpose of the present study

was therefore to identify patterns in causes of waits

and wait-related satisfaction.

Using qualitative interviews, we asked patients

from Newfoundland and Labrador to describe their

experiences from the onset of symptoms to the start

of treatment at the cancer clinic. As in other provinces

in Canada, Newfoundland and Labrador has invested

resources in improving wait times for cancer care

By examining the care-seeking process, we adopt a

patient-centred approach and aim to better understand

the patientís experience of cancer and interactions with

the health care system. The study contributes to the

understanding of public perceptions of wait times and

efforts to improve timely access to cancer care.

METHODS

Memorial Universityís Human Investigations Com

–

mittee approved the study. We conducted semis

–

tructured qualitative interviews with breast, lung,

colorectal, and prostate cancer patients who, in an

earlier survey, had expressed satisfaction or dis

–

satisfaction with their wait times while seeking care

for their cancer.

Eligible study participants were residents of New

–

foundland and Labrador who were 19 years of age or

older and who had been diagnosed between January

2009 and August 2011. We excluded participants with

previous or multiple cancer diagnoses because their

wait-time experiences might differ from those of

patients who are diagnosed with one type of cancer

for the first time. For the initial survey, we recruited

cancer patients from regional cancer clinics across the

province and mailed invitations to individuals identi

–

fied through the provincial cancer registry. The survey

gathered information about dates in the care-seeking

process, satisfaction with interval-specific wait times

(for example, from symptoms to first visit with a health

care provider, from first visit to diagnosis, and so on),

and clinical and personal characteristics. A fuller

description of the survey procedures are provided

elsewhere

. At the end of the survey, respondents were

invited to take part in the qualitative interview, and

willing respondents were later contacted to complete

consent forms and schedule interviews.

Patients were selected for an interview based

on their responses to survey questions about com

–

munity of residence and satisfaction with various

waits. From among the survey respondents, we

identified urban (population =100,000), semi-urban

(population 10,001ñ99,999), and rural (population

=10,000) residents who were satisfied or dissatisfied

with their overall wait time from onset of symptoms

to care at the cancer clinic. Because patients were

overwhelmingly satisfied with the overall wait time,

we then amended our recruitment to patients who had

expressed dissatisfaction with any wait interval. For

each cancer type and community size, we recruited

a minimum of 3 patients who were satisfied or dis

–

satisfied with their wait time experiences. The final

number of interviews was determined when satura

–

tion of ideas and concepts was reached

The interviews were conducted in person or by

telephone and ranged in length from 8 minutes to

82 minutes. We asked participants about their wait

times and causes of waits from onset of symptoms

to receiving treatment for their cancer, their level of

satisfaction with those wait times, any barriers to

receiving care in their community, factors that might

make cancer care accessible in their area, and what

could have been done to improve their wait times or

the quality of care that they received. Each interview

was tape-recorded and later transcribed verbatim.

Using a thematic approach, three members of the

research team each independently read 4 transcripts

to identify key themes and concepts. We then devel

–

oped a template to code the remaining transcripts.

To ensure consistency in coding, we defined and

described each code. Each transcript was then read

and coded by two members of the team (one research

assistant read and coded all transcripts). Throughout

this process, data from previous interviews were con

–

tinuously compared to identify concepts, categories,

clusters, and themes

14,15

. Disagreements in coding

were resolved by consensus. Where disagreements

arose, members of the research team re-examined

the descriptions of individual themes to determine

the source of disagreement. Those discussions led, as

needed, to clarification of code and theme definitions,

the creation of new themes, or the integration of new

ideas within a theme. The NVivo

9 qualitative data

analysis software (version

9, 2010: QSR International,

Doncaster, Australia) was then used to re-code all

transcripts using the final coding template.

In the present article, we focus on the causes

of disruptions in timely care. Numbers are used to

identify individual participants.

RESULTS

Of 128 invited patients, 60 (46.9%) participated in an

interview. Table

shows participant characteristics

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