von Gruenigen Vivian E, Hutchins Jessica R, Reidy Anne Marie, Gibbons Heidi E, Daly Barbara J, Eldermire Elisa M, Fusco Nancy L
University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
Health Qual Life Outcomes. 2006 Oct 30;4:84. doi: 10.1186/1477-7525-4-84.
Research on quality and satisfaction with care during palliative chemotherapy in oncology patients has been limited. The objective was to assess the association between patient's satisfaction with care and symptom severity and to evaluate test-retest of a satisfaction survey in this study population.
A prospective cohort of patients with recurrent gynecologic malignancies receiving chemotherapy were enrolled after a diagnosis of recurrent cancer. Patients completed the Quality of End-of-Life care and satisfaction with treatment scale (QUEST) once upon enrollment in an outpatient setting and again a week later. Patients also completed the Mini-Mental Status Exam, the Hospital Anxiety/Depression Scale, a symptom severity scale and a demographic survey. Student's t-test, correlation statistics and percent agreement were used for analysis.
Data from 39 patients were analyzed. Mean (SD) quality of care summary score was 41.95 (2.75) for physicians and 42.23 (5.42) for nurses (maximum score was 45; p = 0.76 for difference in score between providers). Mean (SD) satisfaction of care summary score was 29.03 (1.92) for physicians and 29.28 (1.70) for nurses (maximum score was 30; p = 0.49 for difference between providers). Test-retest for 33 patients who completed both QUEST surveys had high percent agreement (74-100%), with the exception of the question regarding the provider arriving late (45 and 53%). There was no correlation between quality and satisfaction of care and symptom severity. Weakness was the most common symptom reported. Symptom severity correlated with depression (r = 0.577 p < 0.01). There was a trend towards a larger proportion of patients reporting pain who had three or more prior chemotherapy regimens (p = 0.075). Prior number of chemotherapy regimens or time since diagnosis was not correlated with symptom severity score. Anxiety and depression were correlated with each other (r = 0.711, p < 0.01). There was no difference in symptom severity score at enrollment between those patients who have since died (n = 19) versus those who are still alive.
The QUEST Survey has test-retest reliability when used as a written instrument in an outpatient setting. However, there was no correlation between this measure and symptom severity. Patient evaluation of care may be more closely related to the interpersonal aspects of the health care provider relationship than it is to physical symptoms.
关于肿瘤患者姑息化疗期间护理质量和满意度的研究有限。目的是评估患者护理满意度与症状严重程度之间的关联，并在本研究人群中评估满意度调查的重测信度。
对诊断为复发性癌症后接受化疗的复发性妇科恶性肿瘤患者进行前瞻性队列研究。患者在门诊就诊时完成一次临终护理质量和治疗满意度量表（QUEST），一周后再次完成。患者还完成了简易精神状态检查、医院焦虑/抑郁量表、症状严重程度量表和人口统计学调查。采用学生t检验、相关统计和百分比一致性进行分析。
分析了39例患者的数据。医生的护理质量平均（标准差）总结评分为41.95（2.75），护士为42.23（5.42）（最高分45分；提供者之间评分差异p = 0.76）。医生的护理满意度平均（标准差）总结评分为29.03（1.92），护士为29.28（1.70）（最高分30分；提供者之间差异p = 0.49）。33例完成两次QUEST调查的患者的重测具有较高的百分比一致性（74 - 100%），但提供者迟到问题除外（分别为45%和53%）。护理质量和满意度与症状严重程度之间无相关性。虚弱是报告的最常见症状。症状严重程度与抑郁相关（r = 0.577，p < 0.01）。接受过三种或更多先前化疗方案的患者中报告疼痛的比例有增加趋势（p = 0.075）。先前化疗方案的数量或诊断后的时间与症状严重程度评分无关。焦虑和抑郁相互相关（r = 0.711，p < 0.01）。已死亡患者（n = 19）与仍存活患者在入组时的症状严重程度评分无差异。
QUEST调查在门诊环境中作为书面工具使用时具有重测信度。然而，该测量与症状严重程度之间无相关性。患者对护理的评价可能与医疗服务提供者关系的人际方面比与身体症状更密切相关。
