Assessment of Quality of Care Using Information on Patient Satisfaction at Adult Oncology Center of Tikur Anbessa Specialized Hospital, Ethiopia: A Cross-Sectional Study

Figures & data

Table 1 Socio-Demographics Characteristics of Participants, Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia

Variable, N=384	Frequency	Percentage
Sex
Female	253	65.9
Male	131	34.1
Age in years (median age 49 years, range 19–76 years)
< 40	125	32.6
40–49	68	17.7
50–59	101	26.3
60–70	75	19.5
>70	15	3.9
Marital status
Married	258	67.2
Single*	126	32.8
Educational level
Unable to read and write	101	26.3
Only read and write	26	6.8
Primary education	63	16.4
Secondary education	73	19
Higher education	121	31.5
Residence
Out of Addis Ababa	231	60.2
Addis Ababa	153	39.8
Health service charge
With cash^$	253	65.9
With free^#	131	34.1
Occupational status
Self-employed	112	29.2
Housewife	103	26.8
Government employed	75	19.5
Farmer	35	9.1
Merchant	27	7.0
Others**	32	8.3

Notes: *Unmarried, divorced, and widowed; **student, unemployed, and retired, single; ^$those patients whose health-care services cost in the hospital is covered by the patient themselves and/or their relatives; ^#those patients who received any health-care services available in the hospital with the expense of the hospital itself.

Table 2 Disease-Related Characteristics and Treatment History of Participants, Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia

Variables, N=384	Frequency	Percentage
Disease location (tumor site)
Gynecological cancer	119	31
Head and neck cancer	67	17.4
Breast cancer	60	15.6
GI	53	13.8
Sarcoma	31	8.1
Lung	20	5.2
Lymphoma	18	4.7
Others*	16	4.2
Types of treatment
Chemotherapy + surgery	143	37.2
Chemotherapy only	112	29.2
RT + surgery	34	8.8.
Chemotherapy + RT	29	7.6
RT only	27	7.0
Chemotherapy + RT and surgery	21	5.5
Surgery only	18	4.7
ECOG status
0	64	16.7
1	142	37
2	133	34.6
3	44	11.5
Duration since treatment started in months
< 6 month	255	66.2
6–12 month	67	17.4
>12 month	62	16.4
Duration since diagnosis of cancer made in months
< 6 month	193	50.3
6–12 month	102	26.6
>12 month	89	23.2

Note: Others*: prostate, bone, bladder, liver, and nerve cancer.

Abbreviations: RT, radiation treatment; ECOG, Eastern Cooperative Oncology Group.

Table 3 Evaluation of Patient Satisfaction With Doctors, Nurses, and Radiotherapy Technologists, and Overall Tikur Anbessa Specialized Hospital Services, Addis Ababa, Ethiopia

Variables N= 384, n (%)	Poor	Fair	Good	Very Good	Excellent
Doctors’ technical skills (items 1–3)	8 (2.1)	72 (18.8)	133 (34.6)	112 (29.2)	59 (15.4)
Doctors’ information exchange (items 4–6?)	15 (3.9)	74 (19.3)	125 (32.6)	111 (28.6)	59 (15.4)
Doctors’ affective behavior (items 7–10?)	6 (1.6)	60 (15.6)	137 (35.7)	98 (25.5)	83 (21.6)
Overall satisfaction with nurses’ service (items 11–17?), N=208	5 (2.4)	46 (22.1)	90 (43.3)	41 (19.7)	26 (12.5)
Overall satisfaction with radiology technologists’ service (items 11–17), N=176	3 (1.7)	40 (22.7)	65 (36.9)	41 (23.3)	27 (15.3)
Coordination (items 18–21?)	6 (1.6)	126 (32.8)	12 3(32.6)	82 (21.4)	47 (12.2)
Interaction with health-care teams (items 22–28?)	3 (0.8)	126 (32.8)	146 (38.0)	90 (23.4)	19 (4.9)
Single items
Opportunity to be involved in their care (item 29?)	47 (12.8)	100 (26.0)	129 (33.6)	77 (20.1)	31 (8.1)
Ease of access to the hospital (item 30?)	95 (24.7)	138 (35.9)	94 (24.5)	36 (9.4)	21 (5.5)
Ease of finding different departments (item 31?)	84 (21.9)	138 (35.9)	112 (29.2)	31 (8.1)	19 (4.9)
Environment of the building (item 32?)	103 (26.8)	115 (29.9)	94 (24.5)	45 (11.7)	27 (7.0)
In general, how do you rate the care you received from the hospital (item 33?)	48 (12.5)	114 (29.7)	134 (34.9)	67 (17.4)	21 (5.5)
Special concern items
The kindness and helpfulness of the technical, reception, laboratory personnel, etc (item 22?)	106 (27.6)	108 (28.1)	87 (22.7)	60 (15.6)	23 (6.0)
The waiting time for obtaining results of medical tests (item 26)	149 (38.8)	101 (26.3)	76 (19.8)	38 (9.9)	20 (5.2)
The waiting time for undergoing medical tests and/or treatments (item 27?)	177 (46.1)	89 (23.2)	65 (16.9)	31 (8.1)	22 (5.7)

Table 4 Mean Scores of EORTC PATSAT-C33 Among Patients Treated for Cancer at Tikur Anbessa Specialized Hospital

Variables	Likert Scale Mean ± SD	Formula for Domain Mean*	Domain Mean ± SD of 100	Domain Median (Range)
Doctors’ technical skills (items 1–3?)	3.0 ±1.02	100/(15–3) x (9.2–3)	52.6 ± 25.5	50.0 (2.9–100)
Doctors’ information exchange (items 4–6?)	3.0 ±1.03	100/(15–3) x (9–3)	50.2 ± 25.8	47.6 (1.8–99.2)
Doctors’ affective behavior (items 7–10?)	3.1 ±0.97	100/(20–3) x (12.3–3)	52.0 ± 24.3	51.0 (2.3–100)
Overall satisfaction with nurses’ and radiology technologist’s service (items 11–17?)	2.8 ± 0.99	100/(35–3) x (19.9–3)	46.2 ± 24.7	46.4 (1.9–100)
Coordination (item 18–21?)	2.7 ±0.92	100/(20–3) x (10.8–3)	42.5 ± 22.9	37.5 (1.2–90.7)
Interaction with health-care teams (item 22–28?)	2.6 ± 0.84	100/(35–5) x (18–5)	39.5 ± 20.9	36.9 (1.1–97.3)
Single items
Opportunity to be involved in their care (item 29?)	2.9 ± 1.12	100/(5–1) x (2.9–1)	46.4 ± 28.0	50.1 (1.4–100)
Ease of access of the hospital (item 30?)	2.3 ± 1.11	100/(5–1) x (2.3–1)	33.7 ± 27.8	22.1 (1.0–99.0)
Ease of finding different departments (item 31?)	2.4 ± 1.06	100/(5–1) x (2.4–1)	34.6 ± 26.6	24.9 (1.0–88.9)
Environment of the building (item 32?)	2.4 ± 1.20	100/(5–1) x (2.4–1)	35.5 ± 30.0	25.7 (1.0–100)
Overall satisfaction towards hospital care (items 18–32?)	2.6 ± 0.77	100/(80–16) x (41.6–16)	40.4 ± 19.2	38.3 (1.56–96)
Mean overall satisfaction (items 1–33?)	2.79 ± 0.78	100/(165–33) x (92.11–33)	44.8 ± 19.5	43.9 (1.7–94.9)

Note: *Domain mean transformed to 100 = 100/(maximum score – no. of items) x (sum of means – no. of items)

Table 5 Ranking of Item Groups in Terms of Their Priority Towards Patient Satisfaction

S.N	Item Domain	Pearson Correlation Coefficient	P-value (2-Tailed)	N	Rank
1.	Overall satisfaction (items 1–33?)	1	<0.0001	384
2.	Interaction with healthcare teams (items 22–28?)	0.950	<0.0001	384	1
3.	Overall satisfaction with hospital organization and environment (items 18–32?)	0.942	<0.0001	384	2
4.	Coordination (items 18–21?)	0.887	<0.0001	384	3
5.	Overall satisfaction with nurses’ & radiology technologists’ service (items 11–17?)	0.750	<0.0001	384	4
6.	Doctors’ affective behavior (items 7–10?)	0.713	<0.0001	384	5
7.	Doctors’ technical skills (items 1–3?)	0.646	<0.0001	384	6
8.	Doctors’ information exchange (items 4–6?)	0.632	<0.0001	384	7

Table 6 Comparative Statistical Analysis of EORTC PATSAT-C33 Domain Mean Scores Among Patients Treated for Cancer at Tikur Anbessa Specialized Hospital, According to the Categorical Socio-Demographic and Clinical Characteristics

Variables, Mean ± SD		OS	DTS	DIE	DAB	SNRT	Coordination	IHCT	OSTHOE
Sex	Male	44.7 ± 9.4	50.1 ± 7.5	48.3 ± 4.7	53.3 ± 8.9	44.7 ± 25.6	43.4 ± 12.1	40.5 ± 10.9	37.1 ± 10.1
	Female	34.8 ± 9.6	43.9 ± 11.5	47.1 ± 3.4	51.4 ± 5.0	47.0 ± 24.3	33.9 ± 16.1	35.9 ± 12.1	29.7 ± 11.0
	P-value	<0.0001	0.004	0.308	0.461	0.393	<0.0001	0.001	<0.0001
Age in years	<40	42.7 ± 9.5	50.5 ± 16.3	48.3 ± 16.7	49.8 ± 13.4	43.1 ± 13.8	39.6 ± 12.2	37.4 ± 11.2	36.0 ± 18.9
	40–49	47.6 ± 11.7	55.1 ± 18.6	53.5 ± 18.1	54.1 ± 16.3	50.4 ± 16.1	44.3 ± 15.6	48.2 ± 12.3	38.2 ± 21.2
	50–59	43.7 ± 12.9	51.2 ± 14.7	46.9 ± 14.8	50.1 ± 15.3	45.3 ± 14.7	42.8 ± 13.2	38.1 ± 9.8	35.4 ± 18.5
	60–69	48.2 ± 11.9	54.4 ± 11.5	54.4 ± 14.0	57.9 ± 12.7	49.0 ± 14.9	49.9 ± 9.8	43.1 ± 10.9	34.0 ± 19.5
	≥70	39.7 ± 11.2	42.8 ± 16.3	50.6 ± 11.2	44.6 ± 9.6	46.2 ± 4.7	38.8 ± 6.9	30.7 ± 7.6	28.3 ± 22.5
	P-value	0.031	0.374	0.243	0.012	0.282	0.047	0.031	0.803
Marital status	Married	45.1 ± 9.7	49.5 ± 14.8	50.5 ± 15.1	52.4 ± 14.1	46.7 ± 15.7	42.9 ± 13.1	40.3 ± 11.3	36.6 ± 20.1
	Single	44.2 ± 9.0	56.9 ± 16.3	49.5 ± 17.4	51.2 ± 14.9	45.3 ± 12.6	41.6 ± 12.7	37.8 ± 10.3	44.2 ± 19.8
	P-value	0.699	0.008	0.719	0.656	0.615	0.587	0.276	0.313
Residence	AA	49.2 ± 8.7	53.3 ± 15.3	46.9 ± 14.1	50.4 ± 14.0	46.7 ± 15.1	49.0 ± 12.6	41.4 ± 11.5	41.2 ± 7.4
	Out of AA	32.6 ± 9.8	49.9 ± 15.7	52.3 ± 16.8	53.1 ± 14.5	45.5 ± 14.5	40.1 ± 13.4	32.6 ± 9.9	29.1 ± 9.1
	P-value	<0.0001	0.197	0.048	0.287	0.645	0.001	<0.0001	<0.0001
Cancer type	Gynecological	39.9 ± 10.6	47.8 ± 16.8	46.7 ± 18.8	45.3 ± 15.7	45.2 ± 15.3	39.8 ± 12.5	34.8 ± 8.9	23.6 ± 17.7
	Head and neck	41.6 ± 9.0	46.8 ± 13.6	46.1 ± 16.2	47.9 ± 12.1	44.2 ± 15.7	41.6 ± 9.6	38.8 ± 10.6	39.9 ± 18.8
	Breast	47.9 ± 8.3	61.3 ± 15.3	56.8 ± 12.3	62.2 ± 13.7	46.8 ± 14.4	45.6 ± 14.7	41.8 ± 12.1	43.3 ± 20.7
	GI	48.9 ± 9.6	55.8 ± 14.4	53.8 ± 16.7	56.6 ± 4.4	49.5 ± 15.4	47.4 ± 13.5	46.8 ± 9.5	38.3 ± 21.1
	Sarcoma	47.3 ± 9.2	49.5 ± 13.9	53.2 ± 16.5	55.1 ± 2.3	42.3 ± 12.4	47.4 ± 13.4	44.6 ± 0.5	46.7 ± 22.7
	Lung	43.1 ± 7.2	45.4 ± 10.3	48.8 ± 14.1	50.9 ± 8.7	47.9 ± 3.3	42.8 ± 11.8	39.6 ± 12.6	38.3 ± 15.5
	Lymphoma	54.3 ± 19.7	61.1 ± 27.7	57.8 ± 19.2	56.6 ± 12.8	50.0 ± 9.9	47.7 ± 13.7	44.1 ± 13.0	35.6 ± 17.7
	Others	46.0 ± 17.3	58.9 ± 21.6	42.7 ± 21.9	56.3 ± 11.8	50.7 ± 18.5	41.9 ± 18.2	42.2 ± 8.5	37.9 ± 15.3
	p-value	<0.0001	0.005	0.094	0.001	0.844	0.0018	0.007	<0.0001
Type of health-care cost	Cash	40.3 ± 9.97	51.3 ± 16.6	48.1 ± 16.0	51.4 ± 14.7	43.5 ± 23.3	39.6 ±21.3	35.7 ± 24.5	29.2 ± 19.7
	Free	49 ± 7.94	58.3 ± 19.0	53.8 ± 14.6	56.3 ± 21.2	50.9 ± 8.7	46.6 ± 19.8	44.2 ± 16.4	38.6 ± 24.2
	p-value	0.013	0.001	0.211	0.624	0.031	0.01	0.002	<0.0001
Duration since treatment started in months	<6	43.8 ± 10.0	48.6 ± 14.3	48.0 ± 16.7	50.1 ± 14.7	45.5 ± 15.	32.3 ± 13.4	29.6 ± 21.2	25.6 ± 20.3
	6–12	47.2 ± 9.8	58.7 ± 18.5	54.9 ± 15.4	54.8 ± 14.9	47.3 ± 15.1	44.7 ± 12.9	38.6 ± 10.4	37.3 ± 21.7
	>12	49.2 ± 6.5	58.3 ± 14.4	53.6 ± 11.8	56.9 ± 11.4	47.9 ± 11.6	40.7 ± 11.2	39.9 ± 11.1	33.5 ± 16.7
	p-value	0.005	0.001	0.076	0.084	0.742	0.008	0.002	<0.0001

Abbreviations: OS, overall satisfaction; DTS, doctors’ technical skills; DIE, doctors’ information exchange; DAB, doctors’ affective behavior; SNRT, overall satisfaction with nurses’ & radiology technologists’ service; IHCT, interaction with health-care teams; OSTHOE, overall satisfaction with hospital organization and environment; AA, Addis Ababa; GI, gastro-intestinal malignancies.

Table 7 Factors Associated with Patient Satisfaction Among Those Patients Treated for Cancer at Tikur Anbessa Specialized Hospital, Coordination

Model	Predictor Variables	Adjusted R Square	R Square Change	Change Statistics		p-value	Predictor Variable	Beta Coefficient (95% CI)	S.E
				F-Change	Df2
1	Residence	0.787	0.787	1414.947	382	<0.0001	Residence(ref: out of AA)	9.72(3.33, 15.1)	2.02
2	Sex	0.819	0.032	67.73	381	<0.0001	Sex(ref: male)	−3.66(−5.99,-1.41)	2.15
3	Type of cancer	0.824	0.006	12.68	380	<0.0001	Type of cancer(ref: others)
4	Duration since treatment started	0.827	0.003	6.778	379	0.01	Gynecological	−2.33(−6.31, −1.85)	1.72
5	Age in years	0.828	0.002	4.465	378	0.035	Head and neck	−1.19(−4.11, 3.88)	12.3
6	Sources of health-care costs	0.830	0.002	4.514	377	0.034	Breast	1.05(−3.34, 10.1)	2.79
							GI	−4.51(−12.1, 14.3)	8.21
							Sarcoma	0.56(−5.9, 8.31)	11.21
							Lung	−1.41(−8.66, 5.11)	4.32
							Lymphoma	3.11(0.714, 15.52)	13.11
							Duration since treatment started(ref: > 6 months since treatment started)	−0.91(−6.11, −0.11)	1.00
							Age in years	0.86(0.21, 5.21)	0.075
							Sources of health care costs(ref: cash)	0.72(0.09, 7.81)	1.94

Abbreviations: SE, standard error, AA, Addis Ababa, GI, gastrointestinal, DF, degree of freedom, CI, confidence interval.