Patient Experience Drivers of Overall Satisfaction With Care in Cancer Patients: Evidence From Responders to the English Cancer Patient Experience Survey

Background: Surveys collecting patient experience data often contain a large number of items covering a wide range of experiences. Knowing which areas to prioritize for improvements efforts can be difficult. Objective: To examine which aspects of care experience are the key drivers of overall satisfaction with cancer care. Methods: Secondary analysis of the National Cancer Patient Experience Survey. Logistic regression was used to examine the relationship between overall satisfaction and 10 core questions covering aspects of experience applicable to all patients. Supplementary analyses examined a further 16 questions applying only to patients in certain groups or on specific treatment pathways. Results: Of 68 340 included patients, 58 697 (86%) rated overall satisfaction highly (8 or more out of 10). The strongest predictors of overall satisfaction across all models were responses to 2 questions on experience of care administration and care coordination (odds ratio [OR] = 2.11, 95% confidence interval [95% CI = 2.05-2.17, P < .0001; OR = 2.03, 95% CI = 1.97-2.09, P < .0001, respectively, per 1 standard deviation change). Conclusion: Focusing improvement efforts on care administration and coordination has potential to improve overall satisfaction with oncological care across diverse patient groups/care pathways

Predictors of postal or online response mode and associations with patient experience and satisfaction in the english cancer patient experience survey

This is the final version. Available on open access from Journal of Medical Internet Research via the DOI in this recordBackground: Patient experience surveys are important tools for improving the quality of cancer services, but the representativeness of responders is a concern. Increasingly, patient surveys that traditionally used postal questionnaires are incorporating an online response option. However, the characteristics and experience ratings of online responders are poorly understood. Objective: We sought to examine predictors of postal or online response mode, and associations with patient experience in the (English) Cancer Patient Experience Survey. Methods: We analyzed data from 71,186 patients with cancer recently treated in National Health Service hospitals who responded to the Cancer Patient Experience Survey 2015. Using logistic regression, we explored patient characteristics associated with greater probability of online response and whether, after adjustment for patient characteristics, the online response was associated with a more or less critical evaluation of cancer care compared to the postal response. Results: Of the 63,134 patients included in the analysis, 4635 (7.34%) responded online. In an adjusted analysis, male (women vs men: odds ratio [OR] 0.50, 95% confidence interval [CI] 0.46-0.54), younger (<55 vs 65-74 years: OR 3.49, 95% CI 3.21-3.80), least deprived (most vs least deprived quintile: OR 0.57, 95% CI 0.51-0.64), and nonwhite (nonwhite vs white ethnic group: OR 1.37, 95% CI 1.24-1.51) patients were more likely to respond online. Compared to postal responders, after adjustment for patient characteristics, online responders had a higher likelihood of reporting an overall satisfied experience of care (OR 1.24, 95% CI 1.16-1.32). For 34 of 49 other items, online responders more frequently reported a less than positive experience of care (8 reached statistical significance), and the associations were positive for the remaining 15 of 49 items (2 reached statistical significance). Conclusions: In the context of a national survey of patients with cancer, online and postal responders tend to differ in their characteristics and rating of satisfaction. Associations between online response and reported experience were generally small and mostly nonsignificant, but with a tendency toward less than positive ratings, although not consistently. Whether the observed associations between response mode and reported experience were causal needs to be examined using experimental survey designs.Macmillan Cancer SupportCancer Research U

Reliability of hospital scores for the Cancer Patient Experience Survey: analysis of publicly reported patient survey data

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordOBJECTIVES: To assess the degree to which variations in publicly reported hospital scores arising from the English Cancer Patient Experience Survey (CPES) are subject to chance. DESIGN: Secondary analysis of publically reported data. SETTING: English National Health Service hospitals. PARTICIPANTS: 72 756 patients who were recently treated for cancer in one of 146 hospitals and responded to the 2016 English CPES. MAIN OUTCOME MEASURES: Spearman-Brown reliability of hospital scores on 51 evaluative questions regarding cancer care. RESULTS: Hospitals varied in respondent sample size with a median hospital sample size of 419 responses (range 31-1972). There were some hospitals with generally highly reliable scores across most questions, whereas other hospitals had generally unreliable scores (the median reliability of question scores within individual hospitals varied between 0.11 and 0.86). Similarly, there were some questions with generally high reliability across most hospitals, whereas other questions had generally low reliability. Of the 7377 individual hospital scores publically reported (146 hospitals by 51 questions, minus 69 suppressed scores), only 34% reached a reliability of 0.7, the minimum generally considered to be useful. In order for 80% of the individual hospital scores to reach a reliability of 0.7, some hospitals would require a fourfold increase in number of respondents; although in a few other hospitals sample sizes could be reduced. CONCLUSIONS: The English Patient Experience Survey represents a globally unique source for understanding experience of a patient with cancer; but in its present form, it is not reliable for high stakes comparisons of the performance of different hospitals. Revised sampling strategies and survey questions could help increase the reliability of hospital scores, and thus make the survey fit for use in performance comparisons.Macmillan Cancer SupportCancer Research U

The underlying structure of the English Cancer Patient Experience Survey: Factor analysis to support survey reporting and design

BACKGROUND: The English Cancer Patient Experience Survey (CPES) is a regularly conducted survey measuring the experience of cancer patients. We studied the survey's underlying structure using factor analysis to identify potential for improvements in reporting or questionnaire design. METHODS: Cancer Patient Experience Survey 2015 respondents (n = 71,186, response rate 66%) were split into two random subgroups. Using exploratory factor analysis (EFA) on the first subgroup, we identified the survey's latent structure. EFA was then applied to 12 sets of items. A first ("core") set was formed by questions that applied to all participants. The subsequent sets contained the "core set" plus questions corresponding to specific care pathways/patient groups. We used confirmatory factor analysis (CFA) on the second data subgroup for cross-validation. RESULTS: The EFA suggested that five latent factors underlie the survey's core questions. Analysis on the remaining 11 care pathway/patient group items also indicated the same five latent factors, although additional factors were present for questions applicable to patients with an overnight stay or those accessing specialist nursing. The five factors models had an excellent fit (comparative fit index = 0.95, root mean square error of approximation = 0.045 for core set of questions). Items loading on each factor generally corresponded to a specific section or subsection of the questionnaire. CFA findings were concordant with the EFA patterns. CONCLUSION: The findings suggest five coherent underlying sub-constructs relating to different aspects of cancer health care. The findings support the construction of evidence-based composite indicators for different domains of experience and provide options for survey re-design

Development and validation of a tool to measure belongingness as a proxy for participation in undergraduate clinical learning

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this record.Background ‘Participation’ in a ‘community of practice’ is often proposed as a mechanism for clinical learning; however, the use of both terms is variable – ranging from technical to vernacular. Belongingness is a related single concept and development of a tool that measures belongingness may therefore be useful in adding to our understanding of when participation and hence learning takes place in clinical settings. Methods After identifying relevant material from the literature, a draft belongingness assessment tool was developed, based on previously published work. This was piloted on 181 undergraduate medical students and the results subjected to factor analysis. The final version was then used to identify whether differences exist between two different clinical teaching environments. Results Our belongingness assessment tool had internal and external validity, with Cronbach’s alpha = 0.940, and detected statistically significant differences between primary and secondary care teaching environments. Conclusions The belongingness scale described in this paper is a valid tool for the study of undergraduate medical students. This has the potential to investigate how variation in student experiences of participation in communities of practice influences learning. This tool revealed significant differences in student belongingness between primary and secondary care learning environments

Bounded Components of Positive Solutions of Nonlinear Abstract Equations

In this work a general class of nonlinear abstract equations satisfying a generalized strong maximum principle is considered in order to show that any bounded component of positive solutions bifurcating from the curve of trivial states (λ, u) = (λ, 0) at a nonlinear eigenvalue λ = λ₀ must meet the curve of trivial states (λ, 0) at another singular value λ₁ ≠ λ₀. Since the unilateral theorems of P. H. Rabinowitz [13, Theorems 1.27 and 1.40] are not true as originally stated (c.f. the counterexample of E. N. Dancer [6]), in order to get our main result the unilateral theorem of J. Lopez-Gomez [11, Theorem 6.4.3] is required

Reliability of hospital scores for the Cancer Patient Experience Survey: analysis of publicly reported patient survey data

OBJECTIVES: To assess the degree to which variations in publicly reported hospital scores arising from the English Cancer Patient Experience Survey (CPES) are subject to chance. DESIGN: Secondary analysis of publically reported data. SETTING: English National Health Service hospitals. PARTICIPANTS: 72 756 patients who were recently treated for cancer in one of 146 hospitals and responded to the 2016 English CPES. MAIN OUTCOME MEASURES: Spearman-Brown reliability of hospital scores on 51 evaluative questions regarding cancer care. RESULTS: Hospitals varied in respondent sample size with a median hospital sample size of 419 responses (range 31-1972). There were some hospitals with generally highly reliable scores across most questions, whereas other hospitals had generally unreliable scores (the median reliability of question scores within individual hospitals varied between 0.11 and 0.86). Similarly, there were some questions with generally high reliability across most hospitals, whereas other questions had generally low reliability. Of the 7377 individual hospital scores publically reported (146 hospitals by 51 questions, minus 69 suppressed scores), only 34% reached a reliability of 0.7, the minimum generally considered to be useful. In order for 80% of the individual hospital scores to reach a reliability of 0.7, some hospitals would require a fourfold increase in number of respondents; although in a few other hospitals sample sizes could be reduced. CONCLUSIONS: The English Patient Experience Survey represents a globally unique source for understanding experience of a patient with cancer; but in its present form, it is not reliable for high stakes comparisons of the performance of different hospitals. Revised sampling strategies and survey questions could help increase the reliability of hospital scores, and thus make the survey fit for use in performance comparisons

The rural dispensing practice – better medication adherence and clinical outcomes compared to non-dispensing practices? A cross-sectional analysis of routine data

This is the author accepted manuscript. The final version is available on open access from the Royal College of General Practitioners via the DOI in this record.Background Most patients obtain medications from pharmacies by prescription, but rural general practices can dispense medications. Clinical implications of this difference in drug delivery are unknown. We hypothesised that dispensing status may be associated with better medication adherence. This could impact intermediate clinical outcomes dependent on medication adherence in, for example, hypertension or diabetes. Aim We investigated whether dispensing status is associated with differences in achievement of Quality and Outcome Framework (QOF) indicators that rely on medication adherence. Design and Setting Cross-sectional analysis of QOF data for 7,392 general practices in England. Method We analysed QOF data from 2016/17 linked to dispensing status for general practices with list sizes ≥1000 in England. QOF indicators were categorised according to whether their achievement depended on a record of prescribing only, medication adherence, or neither. We estimated differences between dispensing and non-dispensing practices using mixed-effects logistic regression adjusting for practice population age, sex, deprivation, list size, single-handed status and rurality. Results Data existed for 7,392 practices; 1,014 (13.7%) could dispense. Achievement was better in dispensing practices than in non-dispensing practices for seven of nine QOF indicators dependant on adherence, including blood pressure targets. Only one of ten indicators dependent on prescribing but not adherence displayed evidence of a difference; indicators unrelated to prescribing showed a trend towards higher achievement by dispensing practices. Conclusion Dispensing practices may achieve better clinical outcomes than prescribing practices. Further work is required to explore underlying mechanisms for these observations, and to directly study medication adherence rates.South West General Practice Trus

Role of practices and Clinical Commissioning Groups in measures of patient experience: analysis of routine data

This is the final version. Available from BMJ Publishing Group via the DOI in this record. Data may be obtained from a third party and are not publicly available