Predictors of dissatisfaction with day care chemotherapy services among patients with cancer: A single center retrospective study

Abstract

ABSTRACT Background: Administration of chemotherapy in the day care is an integral part of medical oncology and involves a complex flow of diverse patients with varied needs. Objective: To analyze the factors predicting the overall patient dissatisfaction with the day care chemotherapy services. Materials and Methods: Two prospective audits were conducted to record the time and duration of all patient-related activities using structured questionnaires and a patient satisfaction survey, both of which were validated in-house. The audit forms were filled out by the psychologist and the satisfaction surveys were filled out by the patients or the parents in case of pediatric patients (below 18 years old). The audits were conducted between February 1, 2022 and February 20, 2022. Patient satisfaction was scored on a scale of 1 (very poor) to 5 (very good). A psychologist interviewed the key stakeholders daily to document the delays and the reasons for the delays in the Day Care Chemotherapy Unit. The waiting time and delays in chemotherapy preparation or delivery were considered non-value-added activities. Results: A total of 257 audit forms were collected. The male-to-female ratio was 1:4. The primary diagnosis was breast cancer in 121 (47%) patients. Seventeen patients (6.6%) had their chemotherapy sessions canceled, due to abnormalities in blood investigations and/or poor general condition. The mean system time for each patient was 5 h 40 min (Standard deviation [SD], 3 h 42 min). The mean oncologist waiting time was 30 min (SD, 17.4) and the bed allotment time was 1 h (SD, 1.04). The mean satisfaction score was 4.6 (SD, 0.3) out of 5. The satisfaction score was lowest for pharmacy services (mean, 3.96; SD, 0.67). Non-value-added activities constituted 41% of the overall system time. The patient-to-nurse ratio was 2.6:1, nurse-to-bed ratio was 1:1.4, and patient-to-bed ratio was 1.8:1. Dissatisfaction (score <5) was noted in all the pediatric patients. The place of residence, payment method, waiting time for the oncologist, and flow of patients was associated with patients’ complaints. Conclusion: Dedicated pediatric day care chemotherapy services and streamlining pharmacy services are required. Improving the appointment system of oncologists and increasing the bed strength will help improve patient satisfaction.