There is evidence demonstrating that routinely assessed patient reported outcomes are associated with improved patient-centred care, quality of life, clinical and health service provision. Nevertheless, there is limited and conflicting evidence for routine assessment of patient-reported outcomes and patient experience of care to demonstrate improvements in quality of life.
The purpose of this study was to explore the relationship between selected demographic variables, patient-reported experience of care as measured by Picker Patient Experience (PPE) instrument, and quality of life as measured by the World Health Organisation Quality of Life – BREF (WHOQOL-BREF). This study was conducted in a cohort of ambulatory cancer patients who attended cancer services at a tertiary public hospital in Australia.
Methods:
Adults >18 years attending ambulatory chemotherapy or radiotherapy clinics at the tertiary hospital with a new or recurrent diagnosis of any cancer were recruited. Data was collected from patients using paper-based questionnaires by project officers during routine ambulatory clinics, from the third cycle of chemotherapy onwards, or nearing the end of a defined course of radiotherapy. A minimum sample size (n=260) was based on a minimum of 10 observations per variable for the largest questionnaire (WHOQOL-BREF; 26 questions). Four hundred and fourteen participants were recruited over 12 months.
Continuous variables were described using mean, standard deviation, median, minimum and maximum. Pearson correlation was used to describe the relationship between the four domains of WHOQOL and the PPE. Spearman's correlation was used for the two individual items of the WHOQOL-BREF. General linear models were used to analyse relationships between the four WHOQOL domains and PPE and demographic variables. Bivariate models for each domain with 95% confidence intervals were reported for all variables. Final multivariable models were developed using backwards selection. Model residuals were used to assess the assumptions of tests including histograms and scatterplots. Bootstrapping was used to provide robust estimates when assumptions were questionable; however, these were not reported as they produced similar results. Patterns of missing data across variables were examined using t-test and chi-square.
Results:
Of the 414 participants, 335 were included in the analysis. On average participants were 56.95 (sd: 14.81) years old. Most (65%) were married and were well educated, with 18.2% having a university education and 52.8% having completed technical and further education, trade or certificate. No relationships were found between the demographic variables and patient experience of care, or between demographic variables and quality of life. The median PPE score for the sample was 13.33 (range 0-93). Overall, 76% of the participants reported good or very good QOL; 19.4 % reported neither good nor poor QOL; and 4.2% reported poor QOL. In general, as Picker Patient Experience (problem score) increased, WHOQOL-BREF scores decreased (p = 0.001) in all QOL domains (Physical, Psychological, Social-relationships, Environment).
Conclusion:
The current study showed that high levels of patient experience of care (fewer problems) were associated with higher levels of quality of life in this ambulatory, adult cancer patient population. These results support the routine assessment of patient-reported outcomes, such as patient-reported experience of care in the clinical ambulatory setting. Assessment of patient-reported experience of care could support organisations to identify and manage any shortfalls in patient care. Timely assessment of patient-reported outcomes in cancer care such as patient-reported experience of care, could offer health care organisations the opportunity to provide patient-tailored symptom support, and develop novel models of service delivery which might improve quality of life in ambulatory cancer patients.