Factors associated with satisfaction with prostate cancer care: results from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE)

VA Tennessee Valley Geriatric Research, Education and Clinical Care Department of Urologic Surgery, Vanderbilt University, Nashville, TN Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA Department of Urology and the UCSF-Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
BJU International (Impact Factor: 3.13). 08/2012; 111(2). DOI: 10.1111/j.1464-410X.2012.11423.x
Source: PubMed

ABSTRACT Study Type - Therapy (quality of care analysis) Level of Evidence 2b What's known on the subject? and What does the study add? Satisfaction with care is a comprehensive measure that incorporates structure, process, and outcome elements of individual patient's interaction with the healthcare system. Despite the worldwide public health burden of prostate cancer, little is known about predictors of satisfaction with prostate cancer care. Available data has evaluated differences in post-treatment satisfaction by treatment and demographic factors; however, few data exist regarding the contribution of both baseline and post-treatment patient-reported measures on satisfaction with care. We evaluated the relationship of various demographic, clinical, treatment, and patient-reported measures on satisfaction with care. Interestingly, while none of the evaluable demographic, clinical, or treatment parameters were associated with satisfaction, numerous patient-reported parameters were associated with satisfaction with prostate cancer care. Specifically, baseline general health-related quality of life (HRQOL) and change in prostate cancer-specific HRQOL after treatment were associated with satisfaction. Additionally, fear of cancer recurrence was also found to be associated with satisfaction. Taken together, these data may be used, in part, to identify a cohort of patients at-risk for dissatisfaction with prostate cancer care. Identification of such a group may allow for incorporation of these data into treatment counseling and/or implementing intervention strategies to improve post-treatment satisfaction. OBJECTIVE: •  To evaluate the impact of demographic, clinical, treatment and patient-reported parameters on satisfaction with prostate cancer care. Despite the significant worldwide impact of prostate cancer, few data are available specifically addressing satisfaction with treatment-related care. PATIENTS AND METHODS: •  CaPSURE comprises participants from 40 US sites who were monitored during and after their treatment course. •  Participants who were diagnosed with clinically localized prostate cancer after 1999 underwent radical prostatectomy, radiation therapy or primary androgen deprivation, and those who also completed the satisfaction questionnaire within 2 years of treatment were included in the present study. •  Satisfaction was measured using a validated instrument that assesses contact with providers, confidence in providers, communication skills, humanness and overall satisfaction. •  Multivariable linear regression analysis were performed to evaluate the independent relationships between demographic, clinical, treatment and patient-reported parameters and satisfaction. RESULTS: •  Of the 3056 participants, 1927 (63%) were treated with radical prostatectomy, 843 (28%) were treated with radiation therapy and 286 (9%) were treated with primary androgen deprivation. •  Multivariable analysis showed that multiple patient-reported factors were independently associated with satisfaction, whereas clinical, demographic and treatment parameters were not. •  Baseline health-related quality of life, measured by the 36-item short-form health survey, baseline fear of cancer recurrence (all P < 0.01) and declines in the sexual (P= 0.03), urinary (P < 0.01) and bowel (P= 0.02) function domains of the University of California Los Angeles Prostate Cancer Index were all independently associated with satisfaction. •  Patient-reported outcomes were more strongly associated with satisfaction in the low-risk subgroup. CONCLUSIONS: •  Patient-reported factors such as health-related quality of life and fear of cancer recurrence are independently associated with satisfaction with care •  Pretreatment parameters should be used to identify populations at-risk for dissatisfaction to allow for intervention and/or incorporation into treatment decision-making.

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