Abstract
This study described the various components of access to care for resectable colorectal cancer, and correlated the timeliness of these components with patient satisfaction. With a prospective/retrospective cohort design, all patients undergoing surgical resection for primary colorectal cancer from 2/1/01 to 15/12/01, were identified during their admission for surgery. A comprehensive, standardized method of ascertaining specific time intervals, which included a patient interview, was used. A patient satisfaction questionnaire was developed, tested, and used in consenting patients. Over the study period, 118 patients underwent colorectal cancer resection. Of these, 110 (93%) consented to participate and 101 (86%) completed the satisfaction questionnaire, including test–retest. The median time intervals (interquartile range) for the various components of access to care were as follows: symptoms to first physician visit, 32 days (10–75); first physician visit to diagnosis, 88 days (44–218); diagnosis to surgery, 19 days (10–44); surgery to chemotherapy (where applicable), 54 days (47–72). On multivariate analysis, tumor location in the rectum was associated with longer prediagnosis intervals, whereas increasing tumor stage was associated with shorter intervals from diagnosis to surgery. Variation in the time interval from diagnosis to surgery was associated with patient satisfaction (r = 0.49; P < 0.0001). Substantially less correlation was identified between patient satisfaction and the time from first physician visit to diagnosis (r = 0.25, P = 0.04). No significant correlation was identified between patient satisfaction scores and the time interval from symptoms to first physician visit (r = 0.11; P = 0.7). Despite concerns regarding surgical waitlists, the longest time intervals experienced by colorectal cancer patients precede diagnosis. However, variations in the relatively short time period from diagnosis to surgery appeared to have the most impact on patient satisfaction. Interventions which improve the timeliness of specific components of access to care may not necessarily result in improved patient satisfaction.
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Financial support for this work was provided through grant 5490 from Nova Scotia Cancer Research and Education (CaRE), National Cancer Institute of Canada.
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Contributions of each author: Geoffrey A. Porter: concept and design, data analysis and interpretation, manuscript draft and revision, supervision, overall responsibility of study; Karen Inglis: data acquisition, manuscript revision; Lori A Wood: concept and design, data interpretation, manuscript revision; Paul A. Veugelers: concept and design, data analysis and interpretation, manuscript revision.
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Porter, G.A., Inglis, K.M., Wood, L.A. et al. Access to Care and Satisfaction in Colorectal Cancer Patients. World J. Surg. 29, 1444–1451 (2005). https://doi.org/10.1007/s00268-005-7955-1
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DOI: https://doi.org/10.1007/s00268-005-7955-1