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  • br Discussion br In this sample

    2020-07-27


    4. Discussion
    In this Doxorubicin sample of older patients with cancer in the Southeastern U.S., satisfaction with cancer-related care demonstrated room for further im-provement. Out of the eighteen items that inquired on different aspects of satisfaction with care, high levels of satisfaction on any one item was endorsed by only 46% to 63.5% of participants. Patient satisfaction was highest with regard to the perception of being treated with courtesy and respect, which may be a product of the socio-cultural characteristics of the Southeastern U.S. regarding politeness. Furthermore, older patients are more likely to be accepting of their diagnosis and thus, more at ease with their current health status, which allows better per-sonal interaction with providers [16]. On the other hand, satisfaction scores in the patient engagement domain were generally the lowest, particularly in regard to dealing with the healthcare system or knowl-edge of future steps in care. This finding may be due to the age of the participants; for instance, in a study by Davidson and Mills [16], older patients were less satisfied than younger patients regarding the com-munication of their care, including explanation of treatment plan, rationale for treatment chosen, and possible side effects [16]. This obser-vation may partially reflect an increased likelihood of cognitive, physi-cal, and mental deficits in older patient populations, making this group less able to understand communication of their care compared to younger patients [19–21]. In addition, the majority of our study participants were in the survivorship phase of care, when there may be greater uncertainty about the next steps of care. Fear of the unknown, coupled with frustrations from navigating a complex health-care 
    system, may produce some distress and dissatisfaction in older patients with cancer. Multidisciplinary oncology care teams, although instituted to improve quality of care and reduce patient wait times, involve the co-ordination and interpretation of many different laboratory tests and ra-diologic procedures, as well as input from specialists in different areas (i.e., physicians, nurses, psychologists, social workers, etc.). When not effectively supported, multidisciplinary approaches to oncological care can produce delays in conveying next steps to patients and increase the likelihood of patients “falling through the cracks” [31]. As a result, the development and implementation of policies and procedures that can streamline the communication of treatment plan information back to the patient in a timely manner may help improve patient satisfaction within the patient engagement domain.
    In this study, patients with lung cancer had the lowest overall pa-tient satisfaction across most domains. Lung cancer treatment is highly multidisciplinary due to the complex treatment algorithms driven by multiple molecular phenotypes [32] which may contribute to lower sat-isfaction due to the reasons described above. These patients also had less education and more comorbidities compared with the patients with breast and prostate cancers– factors that have been shown to be associated with patient satisfaction [3,6,7,10]. These results suggest that strategies to improve patient satisfaction may not be a “one size fits all” model and may require modifications for patients with different cancer types or sociodemographic backgrounds.
    Although we observed positive associations between HRQoL and patient satisfaction domains, the magnitudes of these associations were trivial to small, contrary to our a priori hypothesis. In line with this result, some studies, including a systematic review, found weak or no consistent relationship between patient health status and satisfac-tion [2,15,33]. These conclusions and our findings are important be-cause they refute a common anecdotal sentiment among practicing oncologists that sicker patients with poor HRQoL are likely to report poor satisfaction due to poor disease control. The implication suggested by our results is that patient HRQoL and patient satisfaction are separate constructs and should not be assumed to be related.
    When specifically examining the covariates used in the modeling, our results suggested that race and education were the stronger corre-lates of satisfaction across domains. Adjusted for the other covariates, non-whites reported, on average, lower satisfaction than whites, and patients with lower levels of education reported lower satisfaction. These incidental findings may represent disparities in health care, in-cluding perceived access to care, communication, mistrust, and/or liter-acy issues [2,3,34,35]. Comorbidities had a positive association with satisfaction, however of small to medium magnitude. This incidental finding is in line with a large national study of all-aged adults that re-ported an association between high patient satisfaction and higher mor-tality rates [36], suggesting that patient satisfaction with care may be an indicator of illness as these patients rely more on physician and healthcare provider support.