Patient satisfaction has become a crucial point in the assessment of the quality of care, which is increasingly required by accreditation agencies in the monitoring of quality of hospital care. Moreover, an impact on disease outcome may be affected by satisfaction with care and patient compliance to treatment and consequently (Nguyen et al, 2014).
Several studies have investigated the factors of inpatient satisfaction to the care received. There is a common arrangement that satisfaction is expected by factors that can be categorized as intrinsic such as (structure, process, and outcome of care) or extrinsic as (patients' characteristics) through regular ambiguity among the findings of these studies (Xiao, 2008 & Hekkert, 2009).
Quality indicators for the structure of oncology patients' care were rare so accurate data about the quality of care is considered important for health care providers who search for realizing improvements in the quality. In adding to the prior inventory of existing indicators, interviews with patients, relatives, and caregivers provided input for the development of the breath set. Patient satisfaction with service quality is becoming a crucial tool for providers to demonstrate patient focus and differentiation in the healthcare setting, as well as enhance the patient experience. Furthermore, providers are using this data to make important decisions regarding operational and treatment plans (Akin et al, 2010). Equally, data about the quality of care can be used by patients or relatives who want to make a well-founded choice of a health care provider. Furthermore, external parties such as governments and health care inspectorates attach great importance data about the quality of care from individual health care providers (Claessen et al, 2012).
In England at 1960s, the first hospices were set up. It was aimed to decline useless high-tech medicine for patient-centered care and provide appropriate treatment of critically ill and terminal cancer patients. Having trained as a nurse, social worker and doctor. The concept of total pain management and addressing of encompassing physical, psychological, social, spiritual and practical problems were being introduced by Cicely Saunders. She launched the hospice and palliative care (PC) movement which is now known all over the world (Clark, 1999 & Howard, 2001).
The high-risk group of patients can be identified based on an evaluation of their experiences with the most common signs and symptoms associated with cancer such as pain, fatigue, sleep disturbance, and depression) and its treatment as concluded by (Miaskowski, et al, 2014).
The Institute of Medicine defined 6 aims on which to re-engineer health care delivery systems. It suggested that health care should be safe, effective, patient-centered, timely, efficient, and equitable. The report did not include patient satisfaction as one of its dimensions of quality and specifically noted that the decision to omit satisfaction ratings was purposeful because they did not consider it an adequate measure (Al-Qadir & Al Khalaileh, 2014):
In Jordan (2012) study was conducted to 'identify the difference between the dimensions of quality of health service in public sector hospitals relative to private hospitals and their impact on patient satisfaction', the researcher recommended to continue to work hard by those responsible for public sector hospitals in upgrading the quality of health service and continue the process of development and modernization, especially in the area training of human resources and upgrading of staff (Zamil,; Areiqat & Tailakh, 2012).
Kingdom of Saudi Arabia (KSA) has witnessed huge progress in socio-economic development over the last 30 years. The country has committed vast resources to improving medical care for its citizens, and it earned 26th place according to the WHO ranking of the world's healthcare systems (WHO) World Health 2000 http://www.photius.com/rankings/health.
Significant of the problem
King Abdulaziz University hospital is one of accredited hospital in the Eastern Mediterranean region in 2012 from Canada. Accreditation is considered international evaluation process used to assess effectiveness and efficiency of patient care. So this research aimed to identify oncological patient satisfaction level in oncology setting regarding Healthcare services at King Abdulaziz University Hospital after accreditation.
Aim of the study
Identify oncological patient satisfaction level in oncology setting regarding Healthcare services at University Hospital.
Subjects and Methods
1-Technical Design
Research design: Quantitative descriptive correlational study.
Setting. This study conducted in Medical, surgical and gynecology wards (male and female) at King Abdulaziz University Hospital. This hospital affiliated to King Abdulaziz University. It is one of the first Hospitals in the eastern Mediterranean region implement healthcare accreditation standards.
Subject. The total number of nonrandomized convenience sample was 123 oncology patients. Patients were included in the study from the mentioned above setting. Excluded unconscious and disoriented patient. Their age ranged from <20- >71years.
Tools of data collection
Data was collected by structured interview questionnaire this questionnaire to measure patients' appraisal of hospital doctors and nurses, as well as aspects of care organization and services. It was adopted from Br''dart, et al (2005). An international prospective study of the EORTC cancer in-patient satisfaction with care measure (EORTC IN-PATSAT32). It consisted of two parts: Part I: Demographic Data: Include information about the oncological patient such as age, gender, and. Part II: It consisted of 32 items satisfaction with care questionnaire to measure patients' appraisal of hospital doctors and nurses, as well as aspects of care organization and services.
2. Operational Design
The operational design includes preparatory phase, content validity, reliability, pilot study, and field work.
Preparatory Phase
It includes reviewing of literature, different studies and theoretical knowledge of various aspects of the problems using books, articles, internet, periodicals and magazine
Content Validity
Face validity and content validity of the instrument have been taken into account. Validated tools were used from published research for Br''dart, et al (2005). With title 'An International prospective study of the EORTC cancer in-patient satisfaction with care measure (EORTC IN-PATSAT32)'.
Reliability
It refers to the consistency of an instrument's ability to measure an attribute. It can be measured by three estimates: stability, internal consistency, and equivalence (Polit & Beck, 2004). Sorra & Nieva, (2004) stated that all dimensions were shown to have acceptable levels of reliability (defined as Cronbach's alpha equal to or greater than .60). The most popular method of testing for internal consistency in the behavioral sciences is coefficient alpha. Coefficient alpha was popularizing by (Cronbach, 1951).
Scoring system:
The scoring system was ranged from 1 to 5scores. (1=Poor 2=Fair 3=Good 4=Very good 5=Excellent.
Administrative and Ethical consideration:
Before data collection, the necessary approval obtained from the ethics committee King Abdulaziz University Hospital. Subjects were given both a written and verbal explanation of the research study. A verbal agreement to participate in the research was taken.
Pilot study
A pilot study was carried out to assess tools clarity and applicability. It applied to ten% of studied sample from the selected departments. The sample which shared in piloting stage was excluded from the main subjects of the study. Data collected from the pilot study was analyzed and necessary modifications were done prior to the final application of the study tools.
Field work:
The present study was carried out within three months started from the 1st Mayo to the 31th July 2015. The data was collected by the researchers themselves through interviewing patients and their families for the collection of demographic data, and completion of structured interview questionnaire sheet. The time required to complete the questionnaire was about 30-45 minutes.
3 Statistical Design:
Collected data was arranged, tabulated and analyzed according to the type of each data.
Scoring system: Scoring system was ranged from 1 to 5scores. (1=Poor 2=Fair 3=Good 4=Very good 5=Excellent
Statistical analysis:
Data was collected and entered into a database file. Statistical analysis was performed by using the SPSS 20 computer software statistical package. Data was described by summary tables. Differences in categorical variables between more than two groups (e.g., specialty) were assessed using ANOVA. The alpha error level was set at 0.05, with p < 0.05 being considered statistically significant.
Results
Oncology patients included in this study were 123 patients from medical and surgical units (male and female wards) at King Abdulaziz University Hospital. Table (1) showed that the most common patient age among studied sample was ranged from 41 to 50 years. 57.70% were Female while 39.8 % had the secondary school, followed by 36.6 had Bachelor's degree and only one had Master's degrees whereas the majority of studied oncology patients 85.4% were married; about one-third studied sample 37% worked as the housewife, whereas 30.9 had the private job. 41.5% of studied sample complaints of leukemia while only 5 had cancer in lungs. About 47% treated with chemotherapy followed by surgery. Few of them were treated by radiotherapy.
Table (2) illustrated that there were highly statistically significant differences relations were observed in the total level of patient's satisfaction, and care received from the physicians to the patient at p= .000. Also, the studied samples satisfied from the knowledge and experience they give about the illness. ; Information about medical tests; and the information is given about treatment at (mean= 4.67, 4.60). Moreover, the attention paid to the interest of the patient personally was also the highly significant difference at p=0.000 with the level of satisfaction at mean = 4.12.
Regarding the level of satisfaction toward the care received from the nurses. The finding illustrated total highly statistically significant differences relations were observed in the table (3) at p= .000. Furthermore, the way of the nurses carried out the physical examination (took temperature, felt puls); the way of handled nursing care (during giving the medicines, performed injections, and their human qualities (politeness, respect, sensitivity, kindness, patience,) were scored high as satisfying factors at mean = 4.4715. However, the interest they showed to patient personally was low satisfaction at mean=3.90.
In relation to services and care organization received during a hospital stay, the finding indicated that total highly statistically significant relations were cleared at table (4) regarding services& care organization at p= .000. The exchange of information between caregivers; the kindness and helpfulness of the technical, reception, laboratory personnel? And the information provided on your admission to the hospital were scored high as satisfying factors at mean = 4.24.
Discussion
Oncology patients included in this study were 123 patients from medical and surgical units (male and female wards) at King Abdul Aziz University Hospital. The findings showed that the most common patient age among studied sample was ranged from 41 to 50 years. Little above fifty percent were Female, while about third studied sample had secondary school, followed by the Bachelor's degree and only one had Master's degrees whereas majority of studied oncology patients were married; about one-third studied sample worked as housewife, approximately forty 'two percent of studied sample complaints of leukemia while only five had cancer in lungs. About fifty percent treated with chemotherapy followed by surgery. Few of them were treated by radiotherapy. This finding respected by Pita-Fern''ndez et al. (2013) consideration the characteristics associated with quality of life may help clinicians to identify patients at risk for poor quality of life, as well as to plan medical, psychological or social interventions to improve the patient's well-being. Gender, age, income, education level, and social network have been identified as general determinants of quality of life in colorectal cancer survivors.
Highly statistically significant relations were observed in the total level of patient's satisfaction, and care received from the physicians to the patient during his staying at p= .000. Also, the studied samples satisfied from the knowledge and experience they give about the illness. ; Information about medical tests; and the information is given about treatment at (mean= 4.67, 4.60). Moreover, the attention paid to the interest of the patient personally was also a highly significant difference at p=0.000 with the level of satisfaction at mean 4.12. This finding inconsistency with Claessen (2012) concluded that the quality aspects relatives considered most important were dying peacefully, getting help in good time in acute situations, and personal attention. Aftercare was the aspect with the highest priority for quality improvement. Also, this results respected by Zamil, Areiqat & Tailakh, (2012) turned out that aftercare had the highest 'need for improvement' as reflected in the scores for the aspects 'being informed about the possibilities of aftercare' and 'final conversation or discussion in which the care and treatment were evaluated.
Regarding the level of satisfaction in relation to the care received from the nurses to the patient during his staying in the hospital. The finding illustrated that in the table (2) highly statistically significant relations were observed in the total level of patient's satisfaction, at p= .000. Furthermore, there were some factors reported highly satisfied to patients such as the way of the nurses carried out the physical examination (took temperature, felt pulse'); the way of handled nursing care (during giving the medicines, performed injections, and their human qualities (politeness, respect, sensitivity, kindness, patience,) at mean = 4.4715. However, the interest they showed to patient personally was low satisfied to them. Those findings supported by Claessen, et.al (2014) their research study about measuring patients' experiences with palliative care, their findings indicated that almost half of the patients answered that they 'never' or 'sometimes' received support from care providers when they were feeling depressed. At the same time, The other 'need for improvement' scores in the same way as 'Politeness of the caregivers', 'respect for the patient's life stance' and 'receiving medical aids soon enough' are examples of care aspects with a relatively low priority for quality improvement.
Regards, the services& care organization received during a hospital stay, the finding indicated that highly statistically significant differences relations were cleared in the total level of satisfaction at p= .000. The exchange of information between caregivers; the kindness and helpfulness of the technical, reception, laboratory personnel? And the information provided on your admission to the hospital were scored high as the satisfying factor at mean = 4.24. This finding congruent with Zamil, Areiqat & Tailakh, (2012), their study showed that there were statistically significant differences in the impact of health service quality on patient satisfaction in private sector hospitals against public sector hospitals in favor of private sector hospitals as shown through the results that averages of the five quality dimensions in private hospitals is higher than the average dimensions of quality in public sector hospitals.
Conclusion
Data was collected by structured interview questionnaire, this questionnaire to measure patients' appraisal of hospital doctors and nurses, as well as aspects of care organization and services. It is an international prospective study of the EORTC cancer in-patient satisfaction with care measure (EORTC IN-PATSAT32).This instrument gives health care professionals insight into care aspects with the highest priority for quality improvement. This study has found that satisfaction with the information provided by medical staff about a patient's illness and the course of treatment. This is followed by the time spent with the physician and the interpersonal skills of the physician.