Applying fit theory: exploratory analysis of an online survey of care coordination and satisfaction with ambulatory cancer care during the COVID-19 pandemic in Manitoba, Canada (Preprint)

Abstract

During the COVID19 pandemic in Manitoba, Canada, the cancer experience was explored using two sibling studies. One study consisted of an online survey designed to assess how patient satisfaction and experience with care coordination differed among the population of cancer patients undergoing cancer treatment. The survey facilitated recruitment for a grounded theory study exploring the cancer experience and how the pandemic impacted it.

This report presents the results of the survey, with discussion informed by the findings of the grounded theory study.

A link to an online survey was made available to patients receiving cancer treatment (intravenous treatments and radiotherapy) in Manitoba, Canada, between July 31, 2020, and February 28, 2022, primarily through invitations printed on patient’s individualized treatment schedules. The survey included validated patient reported experience measures (PREMs) for patient satisfaction and care coordination as well as an option to opt into being contacted for additional research opportunities. Analysis included the generation of descriptive statistics and logistic regression, including univariate and stepwise multivariate model building, exploring predictors of above and below average PREMs scores.

A total of 203 responses were collected, 154 were complete for at least one PREM measure and were included in the analysis. Average age was 65 years (SD = 11.7). Most respondents were male (n = 79, 52.7%), and being treated with curative intent (n = 81, 53.6%). The most common type of cancer was breast (n = 41, 26.6%). Univariate analysis demonstrated that age 60 – 69 was associated with above average satisfaction with care (OR = 2.205, 95% CI = 1.045 – 4.624, P = .04), while age < 60 (OR = 0.437, 95% CI = 0.204 – 0.934, P = .03) and ECOG ≥ 2 were associated with below average patient satisfaction (OR = 0.327, 95% CI = 0.137 – 0.782, P = .01). Age between 60 – 69, ECOG ≥ 2, and hematological malignancy were selected through stepwise model building, resulting in an explanatory model (R2 = 0.129) of patient satisfaction. ECOG ≥ 2 was associated with below average care coordination (OR = 0.357, 95% CI = 0.145 – 0.880, P = .03), and was the only identified predictor of care coordination, with no explanatory multivariate model generated.

This survey identified that those with poor functional status, as well as those outside of the 60 – 69 age range, are likely to have a below average experience with regards to satisfaction and coordination of care. Through the lens of the sibling grounded theory study, it is possible that these findings are due to unmet supportive care needs that need to be further characterized and addressed. The approach to collecting PREMs used in this study was simple to deploy, and yielded meaningful results, however further work is needed to improve response rates.