Rijnstate Hospital, Arnhem, The Netherlands.
Department of Health Technology and Services Research, technical Medical Centre, Faculty of behavioural, management and social sciences (BMS), University of Twente, Enschede, The Netherlands.
BMC Cancer. 2021 Mar 6;21(1):231. doi: 10.1186/s12885-021-07943-0.
Taking patient centeredness into account is important in healthcare. The European Cancer Consumer Quality Index (ECCQI) is a validated tool for international benchmarking of patient experiences and satisfaction. This study aimed to further validate the ECCQI in larger and more uniform groups of high volume tumours such as breast and prostate cancer. A second objective was the verification of the influence of cultural factors of the country to determine its possible use in international benchmarking.
Data from two survey studies in eight European countries were combined. Socio-demographic correlations were analysed with Kruskall-Wallis and Mann-Whitney tests. Cronbach's alpha was calculated to validate internal consistency. Influences of masculinity (MAS), power distance (PD) and uncertainty avoidance (UA) were determined by linear regression analysis in a general model and subgroup models.
A total of 1322 surveys were included in the analysis (1093 breast- and 348 prostate cancer patients). Cronbach's alpha was good (α ≥ 0.7) or acceptable (0.5 ≤ α ≤ 0.7) in 8 out of 9 questionnaire categories, except in the category 'Safety' (α = 0.305). Overall ECCQI scores ranged from 22.1 to 25.1 between countries on a 1-35 scale (categories had a 1-4 scale). In certain subcategories such as 'Organisation' (range 2.2 vs 3.0) and 'Supervision & Support' (range 3.0 vs 3.8) a large difference was observed between countries. Differences in 'Overall opinion' were however small: mean scores of 3.7 vs 3.9, whereas median scores were all the maximum of 4.0. Power distance was positively associated with higher patient satisfaction scores whereas Uncertainty avoidance was negatively associated with these scores. Masculinity was only associated with patient satisfaction scores in lower educated patients. We found the highest impact of culture on overall scores in Hungary and Portugal and the lowest in Romania.
The ECCQI shows high internal consistency in all categories except 'Safety'. Especially in separate categories and overall ECCQI scores the questionnaire showed discriminative value. This study showed a positive correlation of power distance and a negative correlation for uncertainty avoidance in some countries. When using the ECCQI for international benchmarking these two dimensions of culture should be taken into account.
在医疗保健中，考虑以患者为中心非常重要。欧洲癌症患者质量指数（ECCQI）是一种经过验证的工具，可用于对患者体验和满意度进行国际基准测试。本研究旨在进一步验证 ECCQI 在更大且更统一的高容量肿瘤（如乳腺癌和前列腺癌）群体中的有效性。第二个目标是验证文化因素对国家的影响，以确定其在国际基准测试中的可能用途。
合并了来自 8 个欧洲国家的两项调查研究的数据。采用 Kruskal-Wallis 和 Mann-Whitney 检验分析社会人口统计学相关性。用克朗巴赫 α 系数评估内部一致性。采用线性回归分析在一般模型和亚组模型中确定男性气质（MAS）、权力距离（PD）和不确定性规避（UA）的影响。
共纳入 1322 份调查（1093 例乳腺癌和 348 例前列腺癌患者）。9 个问卷类别中有 8 个类别具有良好（α≥0.7）或可接受的克朗巴赫 α 值（0.5≤α≤0.7），除“安全性”类别（α=0.305）外。在 1-35 分制的量表上，各国的整体 ECCQI 评分在 22.1 到 25.1 之间（类别为 1-4 分制）。在某些子类别中，如“组织”（范围 2.2 比 3.0）和“监督与支持”（范围 3.0 比 3.8），各国之间存在较大差异。然而，“总体意见”的差异很小：平均得分分别为 3.7 和 3.9，而中位数得分均为 4.0。权力距离与较高的患者满意度得分呈正相关，而不确定性规避与这些得分呈负相关。男性气质仅与受教育程度较低的患者的患者满意度得分相关。我们发现文化对匈牙利和葡萄牙的总体评分影响最大，对罗马尼亚的影响最小。
ECCQI 在除“安全性”以外的所有类别中均具有较高的内部一致性。特别是在单独的类别和整体 ECCQI 评分中，该问卷表现出了区分度。本研究显示，在一些国家，权力距离呈正相关，不确定性规避呈负相关。当使用 ECCQI 进行国际基准测试时，应考虑这两个文化维度。
