UBC CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH

Patient Experiences with Ambulatory Cancer Care in British Columbia, 2005/06

March 2007

Diane E Watson PhD MBA Dawn Mooney BA Sandra Peterson MSc PATIENT EXPERIENCES WITH AMBULATORY CANCER CARE IN BC

Library and Archives Canada Cataloguing in Publication

Watson, Diane E. Patient experiences with ambulatory cancer care in British Columbia, 2005/06 [electronic resource] / Diane E. Watson, Dawn Mooney, Sandra Peterson.

Includes bibliographical references. ISBN 1-897085-11-7

1. Cancer--Patients--British Columbia--Care--Evaluation. 2. Cancer--Treatment--British Columbia--Evaluation. 3. Ambulatory medical care--British Columbia--Evaluation. 4. Health services accessibility--British Columbia--Evaluation. 5. Patient satisfaction-- British Columbia. 6. Medical care surveys--British Columbia. I. Mooney, Dawn II. Peterson, Sandra III. University of British Columbia. Centre for Health Services and Policy Research IV. Title.

RC279.C3W38 2007 362.196’994009711 C2007-901676-6

2 UBC CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH

Contents

4 About CHSPR 5 Acknowledgements

6 Executive Summary 8 Introduction

10 What Did We Learn? Cancer Diagnoses and Health Status Use of Health Services Overall Impressions and Experiences Patients give high ratings to overall quality Patients give high ratings to some, but not all, dimensions of quality Patients give high ratings to access to care Patients report that health care providers off er physical support but that more could be done to control their pain or discomfort Patients report that health care providers have respect for their preferences Patients understand explanations off ered by care providers but report that they don’t receive enough information about what to expect Patients know who is in charge of their therapies but report that their care could be better coordinated Patients see the area of emotional support as having the most room for improvement Patients in BC report few medical errors or mistakes What do Patient Experiences Tell us About Quality Improvement Priorities?

21 Conclusion

22 Appendix 1: Participating Cancer Care Facilities 23 Appendix 2: How Was the Survey Done?

25 References

MARCH 2 0 0 7 PATIENT EXPERIENCES WITH AMBULATORY CANCER CARE IN BC

About CHSPR

The Centre for Health Services and Policy Research Funding and Support (CHSPR) is an independent research centre based at the CHSPR receives core funding from the BC Ministry of University of British Columbia. CHSPR’s mission is to Health, and ongoing support from the University of Brit- advance scientific enquiry into issues of health in popu- ish Columbia and the UBC College of Health Disciplines. lation groups, and ways in which health services can best This enables the Centre to focus on research that has a be organized, funded and delivered. Our researchers direct role in informing policy and health reform, and carry out a diverse program of applied health services facilitates CHSPR’s continuing development of the BC and population health research under this agenda. The Linked Health Database. Centre’s work is: Our researchers are also funded by competitive external • Independent grants from provincial, national and international fund- • Population based ing agencies. They include the Canadian Health Services • Policy relevant Research Foundation, the Canadian Institutes of Health • Interdisciplinary Research, the Commonwealth Fund, Health Canada, • Privacy sensitive the Michael Smith Foundation for Health Research, and WorkSafeBC. CHSPR aims to contribute to the improvement of population health by ensuring our research is relevant to contemporary health policy concerns and by work- ing closely with decision makers to actively translate research findings into policy options. Our researchers are active participants in many policy-making forums and provide advice and assistance to both government and non-government organizations in British Columbia (BC), Canada and abroad.

4 UBC CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH

Acknowledgements

Under the direction of the Deputy Minister of Health and Chief Executive Offi cers of the health authorities of British Columbia (BC), a Patient Satisfaction Steering Committee has undertaken to learn and share information about the experiences that BC residents have with health care they receive in the province. In late 2006, that Steering Com- mittee engaged our team to: (a) assist them in portraying the results of their work in the area of ambulatory cancer care, and (b) conduct work in 2007 to glean additional insights from survey data collected under a contract with NRC+Picker (www.nrcpicker.com).

Between November 2005 and May 2006, more than 12,200 adults with cancer received health care services on an ambulatory or outpatient basis in BC.

Over 6,900 of these patients completed a survey in order to share information about their fi rst-hand experiences with ambulatory cancer care. Th eir Th e BC Ministry of Health provided funding to support this project under a contribution agreement between the contributions made this report Ministry and the UBC Centre for Health Services and Policy Research. Th e conclusions are those of the authors possible. and no offi cial endorsement by the Ministry is intended or should be inferred. Th is project has benefi ted from the contributions of many other individuals. In particular, we would like to acknowl- Th is report relies solely on documents that contained the edge the expert advice provided by Lena Cuthbertson, results of analyses conducted by researchers and analysts Co-Chair, BC Patient Satisfaction Steering Committee, at NRC+Picker. Errors or omissions in this report may and Sandra Broughton, Regional Administrator of the BC therefore refl ect errors in the original analyses of data. Cancer Agency, Centre for the Southern Interior. Each of our external reviewers also provided valuable insights and comments. Heidi Matkovich assisted with copy-editing and Chris Balma assisted with layout and design.

MARCH 2 0 0 7 PATIENT EXPERIENCES WITH AMBULATORY CANCER CARE IN BC

Executive Summary

British Columbians are increasingly learning more respect for patient preferences. Access to care is the about the accessibility and quality of health care in one dimension of quality in which BC outperformed their province. In 2003, a council comprised of the the Canadian average of other jurisdictions that have Deputy Minister of Health, other Ministry execu- implemented the same survey. tives, and the Chief Executive Officers of the health authorities struck a steering committee to com- After patients knew what their treatment was going mission and oversee surveys of patients to obtain to be, 78% feel that they did not wait too long to get information for quality improvement initiatives. In their first appointment for treatment. After arriving 2006, the spotlight was directed toward understand- at scheduled appointments, 69% of patients waited ing and reporting on the accessibility and quality of less than 30 minutes for chemotherapy and 74% of cancer care through the eyes of patients. Between patients waited less than 15 minutes for radiation November 2005 and May 2006, more than 12,200 therapy treatments. When asked how often this wait adults received ambulatory cancer care for intra- time exceeded expectations, approximately 60% venous chemotherapy and/or radiation services in reported “never” and an additional 35% reported British Columbia (BC). Over 6,900 of these patients “sometimes”. The majority of patients who had to wait completed a survey—the Ambulatory Oncology for treatment indicate that staff did everything they Patient Satisfaction Survey, which was developed and could to make them feel comfortable (80%). Most validated in Canada—in order to share information also report that they received all of the services they about their first-hand experiences with ambulatory thought they needed (81%). cancer care. Patients report that care providers had respect for A cancer diagnosis marks the beginning of a complex their preferences, treated them with dignity and partnership between health care providers, patients respect, and offered opportunities for family and and their families. Patients require ongoing assess- friends to be involved in their care and treatment. ment, treatment, care and support. Thus, they often The majority of patients feel they could trust their begin a regime of intensive health services and may care provider with confidential information (88%). have a lot to say about the accessibility and quality of Care providers also offered support to address their cancer care. When asked about the overall quality of physical comfort needs. Many patients report that the ambulatory cancer care they received in the pre- care providers did everything they could to ad- ceding six months, 97% of patients rated the quality dress the side effects of cancer treatment but could of services as excellent, very good or good. When re- do more to control their pain or comfort. Five per sponses to more detailed questions regarding specific cent of patients report that they believe that they aspects of quality are tallied, patients see more room or their families suffered personal injury or harm for improvement. At this level, they give relatively resulting from a medical error or mistake. higher ratings to access to care, physical comfort and

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Patients in BC rate overall quality of care highly, Many patients report they were given enough infor- but give mixed ratings when asked about more mation about cancer therapies (66%), felt comfort- specifi c dimensions of quality able talking with providers about new cancer treat- ments (73%), and understood why tests were needed Patients in BC Patients in the rest of Canada (79%), and their results (69%). But half report that

Individual question score they didn’t receive enough information about what

Overall quality of care 97% to expect regarding possible changes in their energy levels, nutritional needs and work or usual activities. Tally of composite scores for questions in each of six dimensions Only half report that someone fully discussed differ- 76% Access to care ent treatments with them. Information, communication 61% and education Patients see the area of emotional support as having Coordination and 65% continuity of care the most room for improvement. Sixty-nine per cent

Physical comfort 77% report being told of their diagnosis in a sensitive mat- ter, but few were put in touch with other care provid- Dimensions of quality Respect for 74% patient preferences ers who could help with anxieties and fears when 53% Emotional support they were first told of their illness (35%) or thereaf-

0% 20% 40% 60% 80% 100% ter (24%). Few patients report that they were given % of patients who rated care positively enough information about possible changes in their emotions (34%) or their relationship with a spouse or Patients in BC and elsewhere in Canada also give partner (28%). relatively lower quality ratings to coordination and continuity of care, to information, communication The experiences of patients who receive cancer care and education, and to emotional support. Most pa- matter—to themselves, their families and friends, tients in BC report that they knew who was in charge and to those who work in health care. They also of their therapies (83%) and that care providers knew matter to other British Columbians, who look to enough about therapies to treat cancer (79%). But just first-hand accounts to learn and pass judgement over half report that they always knew what the next about the performance of their health care system. steps in their care would be (53%) or who to ask when This report provides a snapshot of what patients they had questions about health problems (57%). Half with cancer have to say about the accessibility and of patients report that their care providers were not quality of ambulatory cancer care. We hope that always familiar with their medical history. this work will inform and stimulate improvements to patient-centred care in BC.

MARCH 2 0 0 7 PATIENT EXPERIENCES WITH AMBULATORY CANCER CARE IN BC

Introduction

Canadians care passionately about their health care receiving a cancer diagnosis, patients often begin a system—two-thirds of adults identify health care as regime of intensive health services and may have a the sector they want their leaders to give the great- lot to say about the accessibility and quality of care. est attention to.1 Over time, Canadians have become Patient experiences, therefore, provide an essential increasingly concerned about lack of timely access to perspective from which we can assess information needed services and the quality of health care.2 Many that is critical to further stimulate, inform and target people want greater transparency and information initiatives to improve cancer care in BC. regarding the performance of their health system and the results of initiatives to improve the situation.3 These views have not gone unnoticed—health care The purpose of this report is policy makers, managers and providers have made commitments to health care system renewal and are to compile a snapshot of what taking action to improve access, quality and account- ability. patients with cancer have to

British Columbians are increasingly learning more say about the accessibility and about the accessibility and quality of health care in their province from first-hand accounts. In 2003, a quality of ambulatory cancer council comprised of the Deputy Minister of Health, other Ministry executives and the Chief Executive Of- care in BC. ficers of the health authorities struck a steering com- mittee to commission and oversee surveys of patients Between November 15, 2005 and May 15, 2006, over who receive health care in all emergency rooms, acute 12,200 adults received intravenous chemotherapy care hospitals and long-term care facilities. In 2006, and/or radiation services at 50 cancer care facilities the spotlight was directed toward understanding and across the province (Appendix 1 lists these facilities). reporting on access to and quality of ambulatory can- All of these patients were mailed the Ambulatory On- cer care through the eyes of patients. Ambulatory care cology Patient Satisfaction Survey (AOPSS)—a stan- includes services provided to people who do not stay dard patient survey that has been used internationally overnight in a health care facility. and elsewhere in Canada5—which 6,974 individuals (60%) elected to complete (Appendix 2 describes this Quality of health care is a multi-faceted concept and survey in more detail). The results presented in this measurement of it requires assessment from many report summarize the experiences of these patients. different perspectives. Patient-centred care has been In some instances, experiences of British Columbians identified as one of six* domains of quality and it are compared to patients in other Canadian jurisdic- focuses on “the patient’s experiences of illness and tions who completed the same survey.** health care and on the systems that work or fail to work to meet individual patients’ needs.”4 Upon

* The other five domains of quality include: safe, effective, timely, efficient and equitable. ** The AOPSS has been used to assess ambulatory cancer care in Alberta, Manitoba, Nova Scotia, Ontario, and Saskatchewan (n=26,616).

8 UBC CENTRE FOR HEALTH SERVICES AND POLICY RESEARCH

We focus on features of health care deemed impor- The former features are included in the AOPSS, while tant to patients—respect for their values, preferences the latter facets of quality were included in the survey and expressed needs; coordination and continuity as additional questions asked of residents in BC. of care; information, communication and education; physical comfort; emotional support, including relief This report does not rely on analyses of survey data of fear and anxiety; and involvement of family and conducted by the UBC Centre for Health Services friends.6 We report on composite scores for six survey and Policy Research. We relied solely on documents categories (or dimensions), and results for individual that contained the results of data analyses undertaken questions within each category. We also pay attention by researchers and analysts at NRC+Picker (www. to other facets of quality that have been identified as a nrcpicker.com), who conducted the survey. priority by those that work in health care in BC—ac- cess to care and safety (i.e., medical error or mistake).

MARCH 2 0 0 7 PATIENT EXPERIENCES WITH AMBULATORY CANCER CARE IN BC

What did we learn?

Cancer Diagnoses and Health Status When asked to rate their general health, patients report Patients report being first told of their cancer diagnosis it to be excellent (10%), very good (27%), good (38%), by a family physician (39%), surgeon (33%), cancer spe- fair (19%) or poor (6%). The general health reported by cialist (20%) or someone else. Sixty-nine per cent report patients is lower than that reported by the adult popula- being told about their diagnosis in a sensitive manner, tion in BC. Patients are less likely to rate their health as but of those who had anxieties or fears, 65% report that excellent or very good and more likely to rate it as good, their health care provider “did not put them in touch” fair or poor relative to other BC residents (Figure 1). or “only somewhat put them in touch” with other care providers who could help with any anxieties or fears. Over the six-month period prior to completing the survey, 62% of patients experienced pain and rated it to Forty-two per cent of patients were first told about their be severe (12%), moderate (26%) or mild (24%). Thirty- diagnosis between six and 12 months prior to completing eight per cent report that they did not have pain in the survey. Others were told within the past six months the past six months. These levels of pain are markedly (12%) or one or more years ago. Many report that their higher than those reported by the general population of treatment was for a first-time cancer diagnosis (70%). The adults in BC (Figure 2). most common diagnoses were breast (33%), prostate/tes- ticular (15%), colorectal/bowel (11%) and lung (8%).

Figure 1» Patients in BC report poorer Figure 2» Patients in BC report more pain health than BC residents overall than BC residents overall

100%

BC residents overall 80% Patients s 60%

40% % of patient 38%

26% 20% 24%

12%

0% No pain Mild Moderate Severe Severity of pain and discomfort

AOPSS respondents were asked “In general, how would you rate your AOPSS respondents were asked “In the past 6 months, if you had pain, was health?” Comparison data is for population aged 12+. Sources: Statistics it usually severe, moderate, or mild?” Comparison data is for the population Canada. Canadian Community Health Survey (Cycle 3.1), 2005. CANSIM aged 12+ who answered “yes” or “no” when asked if they were usually free table 105-0422. Ambulatory Oncology Patient Satisfaction Survey data of pain or discomfort. Severity of pain is measured as severe, moderate or collection and statistical analyses by NRC+Picker, 2006. mild. Sources: Statistics Canada. Canadian Community Health Survey (Cycle 3.1), 2005. CANSIM table 105-0422. Ambulatory Oncology Patient Satisfac- tion Survey data collection and statistical analyses by NRC+Picker, 2006.

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Use of Health Services Sixty-one per cent of patients received chemotherapy When asked which health care provider was “involved at a hospital setting within BC’s Community Oncology most” in their treatment planning, patients were most Network. Forty-nine per cent of patients received radia- likely to report cancer specialists (81%), surgeons (11%) tion therapy. Sixty per cent had surgery aft er their cancer and family doctors (6%). When asked about the number diagnosis. Eighty-seven per cent of patients report being of diff erent doctors they visited for cancer treatment given information before they were fi rst seen in a cancer in the past six months, patients report having seen one program, such as an orientation to the program, who to (27%), two (32%), three (22%) or four or more (19%). see or what to bring. Approximately one-third had stayed Th ese patterns of use of physician and specialist services at a hospital overnight—one night (19%), two nights are similar to Canadians in other provinces who receive (6%) or more than two nights (9%). ambulatory cancer care.

MARCH 2 0 0 7 PATIENT EXPERIENCES WITH AMBULATORY CANCER CARE IN BC

Overall Impressions and Experiences

Patients give high ratings to overall quality When responses to separate, more detailed sets of ques- When asked to think about the ambulatory cancer care tions regarding the quality of ambulatory cancer care in BC they received in the preceding six months in BC, 97% are tallied, 66% of responses were positive. Performance on of patients rate the quality of their care and services as this metric of overall impressions among patients in BC is excellent (50%), very good (34%) or good (13%). This similar to that reported by Canadians who received ambu- level of overall satisfaction with quality of care and latory cancer care in other provinces (Figure 3). services is similar to Canadians who received ambula- tory cancer care in other provinces. Patients give rat- Aspects of ambulatory cancer care in which providers ings ranging from 90% to 100% to different sites across are doing well relate to wait times for scheduled ap- BC and Canada (Figure 3). pointments, treating patients with dignity and respect, giving family and friends opportunities to be involved If patients give high ratings to overall quality, would in care and treatment, and making patients feel com- patients recommend their health care providers to fortable sharing confidential information. Table 1 lists family and friends? Eighty-five per cent answered “yes, the top five areas in which close to 90% or more of completely” when asked this question and an addi- patients offer positive ratings. Respondents offer posi- tional 13% answered “yes, somewhat”. This provides tive ratings of approximately 80% to the next five areas confirmation of high ratings of overall impressions. when survey questions are rank ordered on the basis of positive ratings.

Figure 3» Patients in BC generally rate the quality ... but a tally of ratings on individual questions of care and services very highly... shows patients rate quality less highly when asked more specific questions.

IndividualIndividual question questionscore score Tally of scoresTally offor scores all questions for all questions

BC Good BC GoodVery good Very good Excellent Excellent 97% 97% 66% 66%

Rest of Rest of 97% 97% 66% 66% Canada Canada

Best sites Best sites for care for care 100% 100% 79% 79% in Canada in Canada

Worst sitesWorst sites for care for care 90% 90% 62% 62% in Canada in Canada Location of care and services Location of care and services Best sites for Best sites for 100% 100% 70% 70% care in BCcare in BC

0% 0%20% 20%40% 40%60% 60%80% 80%100% 100% 0% 0%20% 20%40% 40%60% 60%80% 80%100% 100% % of patients% of who patients rated whocare rated positively care positively % of patients% of who patients rated whocare rated positively care positively

AOPSS respondents were asked “Overall, how would you rate the quality of all of your care in the past 6 months?” as well as many more questions. The tally of ratings on individual questions is the percentage of total responses in the survey that were positive. Sites could be a geographic region, group of similar facilities or a single facility. Best and worst sites are those with the highest or lowest ratings. Comparisons should be made with cau- tion as results are not adjusted for other factors (age and gender) that might account for differences between groups. Sources: Ambulatory Oncology Patient Satisfaction Survey data collection and statistical analyses by NRC+Picker, 2006.

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Table 1» Top fi ve areas where health care providers are doing well, rank ordered

Patients who offer Ambulatory Oncology Patient Satisfaction Survey question positive ratings How long did you usually have to wait from your scheduled appoint- Access 95% ment until your radiation treatment?* Did your care providers treat you with dignity and respect?** Respect for patient preferences 92% How much opportunity did your care provider give your family or Respect for patient preferences 92% friends to be involved in your care and treatment?† How long did you usually have to wait from your scheduled appoint- Access 90% ment until your chemotherapy treatment?‡ Did you feel you could trust your care providers with confi dential Emotional support 88% information?** Notes: *Rating is the percentage who answered ‘15 minutes or less’ or ‘between 15 and 30 minutes’. Other possible answers were ‘between 30 and 45 minutes’, ‘between 45 and 60 minutes’, or ‘more than 60 minutes’. **Rating is the percentage who answered ‘yes, completely’. Other possible answers were ‘yes, somewhat’ or ‘no’. †Rating is the percentage who answered ‘right amount’. Other possible answers were ‘not enough’ or ‘too much’. Individuals who an- swered ‘family or friends were not involved’ were not included in the calculation. ‡Rating is the percentage who answered ‘less than 30 minutes’ or ‘between 30 minutes and 60 minutes’. Other possible answers were ‘between 1 and 3 hours’ and ‘more than 3 hours’.

Patients give high ratings to some, but not Figure 4» Patients in BC give mixed ratings to all, dimensions of quality different dimensions of quality

Patients give different ratings to different dimensions Patients in BC of quality. They give the highest quality ratings to ac- Patients in the rest of Canada cess to care, physical comfort and respect for patient Tally of composite scores for questions in each of six dimensions preferences. But patients also see room for improve- Access to care 76% ment—they give the lowest quality ratings to informa- Information, tion, communication and education, coordination and communication 61% and education continuity of care, and emotional support. Coordination and 65% continuity of care

Patients see the area of emotional support as having Physical comfort 77% the most room for improvement. These responses are

Dimensions of quality Respect for 74% similar to those reported by Canadians in other juris- patient preferences

53% dictions (Figure 4). Emotional support

0% 20% 40% 60% 80% 100% % of patients who rated care positively

Ratings refl ect composite index scores for each dimension of quality. Sources: Ambulatory Oncology Patient Satisfaction Survey data collection and statistical analyses by NRC+Picker, 2006.

MARCH 2 0 0 7 PATIENT EXPERIENCES WITH AMBULATORY CANCER CARE IN BC

Patients give high ratings to access to care Figure 5» Patients in BC give high ratings to The accessibility of ambulatory cancer care includes is- access to care sues related to the availability of services and wait time Patients in BC experiences, as well as the degree to which patients Patients in the rest of Canada report that they received all the services they need. Access to care 76% Patients in BC give relatively high ratings to access composite score (composite score = 76% positive ratings)—higher rat- Individual question scores for all patients ings than reported by Canadians who received ambu- Received all services needed 81%

Figures 4 and 5 Travel concerns were 56% latory cancer care in other provinces ( ). considered in treatment plan

Indeed, this is the one area in which BC outperforms Did not have to wait too long 78% from diagnosis to first treatment the Canadian average of other jurisdictions that have implemented the same survey. For patients who received chemotherapy Usually waited 60 minutes 90% or less from scheduled time of chemotherapy appointment Never waited longer than 60% In the last six months, for adults who received ambula- expected for chemotherapy Staff did everything they tory cancer care and “needed medical advice or help could to make waiting for 81% chemotherapy comfortable right away”, the following approaches to access were For patients who received radiation deemed by patients to be “most helpful”: Usually waited 30 minutes or less from scheduled time 95% of radiation appointment

Never waited longer than 64% • Call to the cancer centre/hospital (22%) expected for radiation Staff did everything they could to make waiting 79% • Visit with family doctor (20%) for radiation comfortable • Emergency department (14%) 0% 20% 40% 60% 80% 100% % of patients who responded positively • Call to family doctor (10%) or other Source: Ambulatory Oncology Patient Satisfaction Survey data collection and statistical analyses by NRC+Picker, 2006. An additional 26% of patients report not needing medical advice or help right away. Patients from BC were slightly less likely to call a cancer centre/hospital Patients who received chemotherapy or radiation and slightly more likely to visit/call family doctors therapy were asked how long they usually had to wait than Canadians who received ambulatory cancer care for scheduled appointments. Many patients waited less in other provinces. Importantly, the majority of pa- than 30 minutes for chemotherapy (69%) or less than tients report that they received all of the services they 15 minutes for radiation (74%) (Figure 7). When pa- thought they needed over the past six months (81%). tients were asked how often their wait time exceeded expectations, approximately 60% reported “never” and After patients knew what their treatment was going an additional 35% reported “sometimes” (Figure 8). to be, many feel that they did not wait too long to get The vast majority of patients who had to wait report their first appointment for treatment (78%). If a wait that “staff did everything they could to make [them] was experienced, half of patients were given a com- feel comfortable” during their wait (Figure 9). plete explanation (51%) and an additional 23% were given “somewhat” of an explanation (Figure 7). Many of those who underwent surgery report being given enough information about how long they would have to wait until the day of surgery (76%). Lastly, over half of all patients report that health care providers took their travel concerns into consideration when plan- ning their treatment (56%) (Figure 5).

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Figure 6» Most patients in BC did not wait too long from diagnosis to fi rst treatment, and when they did wait, an explanation was usually offered Individual question score for all patients Individual question score for all patients

“After you knew what your treatment “If you had to wait for your was going to be, do you feel you had first appointment, did to wait too long to get your first someone explain why?” Individual question score for allappointment patients for treatment?” Individual question score for all patients Yes, 8% Yes, 51% completely “After you knew what your treatment completely “If you had to wait for your Individual question score for wasall patientsgoing to be, do you feel you had Individual question score for all patientsfirst appointment, did to wait too long to get your first someone explain why?” Yes, 15% appointment for treatment?” Yes, 23% somewhat “After you knew what your treatment somewhat “If you had to wait for your Yes, Yes,

to first treatment 8% was going to be, do you feel you had first51% appointment, did completely completely to wait too long to get your first someone explain why?” No appointment for treatment?”78% No 26%

Waited too long from diagnosis Waited Yes, Yes, Yes, 8% 15% Yes, 23% 51% completelysomewhat completelysomewhat Wait for first treatment was explained Wait

to first treatment 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Yes,No 15% % of patients 78% Yes,No 23%26% % of patients somewhat somewhat Waited too long from diagnosis Waited

Source:to first treatment Ambulatory Oncology Patient Satisfaction Survey data collection and statistical analyses by NRC+Picker, 2006. Wait for first treatment was explained Wait No0% 20% 40% 60% 78% 80% 100% No 0% 20%26% 40% 60% 80% 100% Waited too long from diagnosis Waited % of patients % of patients For patients who received chemotherapy For patients who received radiation Wait for first treatment was explained Wait Figure 7» Most0% patients20% in BC40% did not60% wait80% long from100% the time of their0% scheduled20% 40% 60% 80% 100% appointmentMore than until their treatment% of patients More than % of patients 1% 1% “How long did you usually 3 hours “How long did you usually have 1 hour For patients who received chemotherapyto wait from your scheduled For patients who received radiationhave to wait from your appointment until your 45 to 60 1% scheduled appointment until minutes 1 to 3 9% [chemotherapy] treatment?” your [radiation] treatment?” hours More than More than 1% 30 to 45 1% “How long did you usually For patients3 hours who received chemotherapy“How long did you usually have For patients1 hour who3% received radiation minutes have to wait from your 30 to 60 to wait from your scheduled 21% 45 to 60 scheduled appointment until minutes appointment until your 15 to 30 1% More1 than to 3 Moreminutes than 22% your [radiation] treatment?” 1%9% [chemotherapy] treatment?” minutes 1% “How long did you usually 3 hourshours “How long did you usually have 1 hour Less than to wait from your scheduled 30 to 45 have to wait from your Waiting time for radiation Waiting Less than 3% 69% 45minutes to 60 scheduled appointment74% until 30 minutes appointment until your 15 minutes 1% Waiting time for chemotherapy Waiting 301 to to 60 3 21% [chemotherapy] treatment?” minutes your [radiation] treatment?” minutes 9% hours 15 to 30 22% 30minutes to 45 3% 0% 20% 40% 60% 80% 100% minutes0% 20% 40% 60% 80% 100% Less than

30 to 60 time for radiation Waiting 21% % of patients69% Less than % of patients 74% 30 minutes 15 15minutes to 30 Waiting time for chemotherapy Waiting 22% minutes

Less than 0% 20% 40% 60%69% 80% 100% time for radiation Waiting Less than0% 20% 40% 60% 74% 80% 100% 30 minutes 15 minutes Waiting time for chemotherapy Waiting % of patients % of patients

ForSource: patients Ambulatory who0% Oncologyreceived20% Patient chemotherapy Satisfaction40% Survey60% data 80%collection and100% statisticalFor analyses patients by NRC+Picker, 0%who received 20%2006. radiation40% 60% 80% 100% % of patients % of patients

Always 1% “How often did you wait Always 0.3% “How often did you wait longer Figure 8» Most patients in longerBC did than notexpected usually for your wait much longer than expected fromthan the expected for your For patients who received chemotherapy[chemotherapy] treatment?” For patients who received radiation[radiation] treatment?” time ofUsually their 4%scheduled appointment until their treatment Usually 1% For patientsAlways who1% received chemotherapy“How often did you wait For patientsAlways who0.3% received radiation“How often did you wait longer longer than expected for your than expected for your Sometimes 35% [chemotherapy] treatment?” Sometimes 35% [radiation] treatment?” UsuallyAlways 1%4% “How often did you wait UsuallyAlways 0.3%1% “How often did you wait longer longer than expected for your for radiation Waited than expected for your Waited for chemotherapy Waited Never [chemotherapy]60% treatment?” Never [radiation]64% treatment?” SometimesUsually 4% 35% SometimesUsually 1% 35%

0% 20% 40% 60% 80% 100% for radiation Waited 0% 20% 40% 60% 80% 100%

Waited for chemotherapy Waited SometimesNever 35% % of patients60% SometimesNever 35% % of patients64% Waited for radiation Waited

Waited for chemotherapy Waited Never0% 20% 40% 60%60% 80% 100% Never0% 20% 40% 64%60% 80% 100% % of patients % of patients

For patients who0% received20% chemotherapy40% 60% 80% 100% For patients 0%who received20% radiation40% 60% 80% 100% % of patients % of patients

Source: Ambulatory Oncology Patient Satisfaction“If you had Survey to wait data for collectionyour and statistical analyses by NRC+Picker, 2006. “If you had to wait for your For patients who received chemotherapy[chemotherapy] treatment, do you For patients who received radiation[radiation] treatment, do you think the staff did everything they think the staff did everything they could to make you feel comfortable?” No 3% could to make you feel comfortable?” No 3% For patients who received chemotherapy“If you had to wait for your For patients who received radiation“If you had to wait forMARCH your 2 0 0 7 [chemotherapy] treatment, do you [radiation] treatment, do you Yes, 16% Yes, 18% somewhat think the staff did everything they somewhat think the staff did everything they could to make you feel comfortable?” could to make you feel comfortable?” No 3% “If you had to wait for your No 3% “If you had to wait for your [chemotherapy] treatment, do you [radiation] treatment, do you Yes, 81% Yes, 79% completely think the staff did everything they completely think the staff did everything they Yes, Yes, Made to feel comfortable by staff 16% could to make you feel comfortable?” Made to feel comfortable by staff 18% could to make you feel comfortable?” somewhatNo 3% somewhatNo 3% 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Yes, Yes, Yes, 16% % of patients 81% Yes, 18% % of patients 79% completelysomewhat completelysomewhat Made to feel comfortable by staff Made to feel comfortable by staff

Yes, 0% 20% 40% 60% 81%80% 100% Yes, 0% 20% 40% 60% 79%80% 100% completely completely

Made to feel comfortable by staff % of patients Made to feel comfortable by staff % of patients

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% % of patients % of patients Individual question score for all patients Individual question score for all patients

“After you knew what your treatment “If you had to wait for your was going to be, do you feel you had first appointment, did to wait too long to get your first someone explain why?” appointment for treatment?” Yes, 8% Yes, 51% completely completely

Yes, 15% Yes, 23% somewhat somewhat to first treatment

No 78% No 26% Waited too long from diagnosis Waited Wait for first treatment was explained Wait 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% % of patients % of patients

For patients who received chemotherapy For patients who received radiation

More than More than 1% 1% “How long did you usually 3 hours “How long did you usually have 1 hour to wait from your scheduled have to wait from your appointment until your 45 to 60 1% scheduled appointment until minutes 1 to 3 9% [chemotherapy] treatment?” your [radiation] treatment?” hours 30 to 45 3% minutes 30 to 60 21% minutes 15 to 30 22% minutes

Less than 69% time for radiation Waiting Less than 74% 30 minutes 15 minutes Waiting time for chemotherapy Waiting

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% % of patients % of patients

For patients who received chemotherapy For patients who received radiation

Always 1% “How often did you wait Always 0.3% “How often did you wait longer longer than expected for your than expected for your [chemotherapy] treatment?” [radiation] treatment?” Usually 4% Usually 1%

Sometimes 35% Sometimes 35% Waited for radiation Waited

Waited for chemotherapy Waited Never 60% Never 64%

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% PATIENT EXPERIENCES WITH AMBULATORY CANCER CARE IN BC % of patients % of patients

Figure 9» Most patients in BC report staff made them comfortable during their wait

For patients who received chemotherapy For patients who received radiation

“If you had to wait for your “If you had to wait for your [chemotherapy] treatment, do you [radiation] treatment, do you think the staff did everything they think the staff did everything they could to make you feel comfortable?” No 3% could to make you feel comfortable?” No 3%

Yes, 16% Yes, 18% somewhat somewhat

Yes, 81% Yes, 79% completely completely Made to feel comfortable by staff Made to feel comfortable by staff

0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% % of patients % of patients Source: Ambulatory Oncology Patient Satisfaction Survey data collection and statistical analyses by NRC+Picker, 2006.

Patients report that health care providers offer Figure 10» Patients report that care providers physical support but that more could be done offer support relative to physical comfort to control their pain or discomfort Patients in BC Another dimension of quality relates to the degree to Patients in the rest of Canada which health care providers offer support to address Physical comfort 77% composite score patient needs relative to physical comfort. Patients in BC give relatively high ratings to this dimension (com- Individual question scores for all patients Staff did everything they could 69% posite score = 77% positive ratings)—ratings similar to to control pain or discomfort those reported by Canadians who received ambulatory For patients who received chemotherapy cancer care in other provinces (Figure 10). Told how to manage 79% chemotherapy side effects

Staff did everything they could to help with 81% The majority of patients report that health care pro- chemotherapy side effects viders did everything they could to help them with For patients who received radiation Told how to manage 79% the side effects of chemotherapy (81%) or radiation radiation side effects Staff did everything they therapy (80%) and told them how to manage any side could to help with 80% radiation side effects effects of chemotherapy (79%) or radiation therapy 0% 20% 40% 60% 80% 100% (79%). % of patients who responded positively Source: Ambulatory Oncology Patient Satisfaction Survey data collec- tion and statistical analyses by NRC+Picker, 2006. Of the 62% of patients who report they experienced severe (12%), moderate (26%) or mild (24%) pain in the preceding six months, 69% report that staff did everything they could to control their pain or discom- fort. However, it is important to note that three in 10 patients who experienced pain do not have this view.

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Patients report that health care providers Figure 11» Patients report that health care providers have respect for their preferences respect their preferences Another dimension of quality relates to the degree Patients in BC to which patients report that health care providers Patients in the rest of Canada

have respect for their preferences. Patients in BC give Respect for patient preferences 74% relatively high ratings to these issues (composite score composite score = 74% positive ratings)—ratings similar to those re- Individual question scores Treated with dignity and 92% ported by Canadians who received ambulatory cancer respectPatients by carein BC providers Patients in the rest of Canada Figure 11 Family and friends appropriately 92% care in other provinces ( ). involved in care and treatment Respect for 74% Involvedpatient in decisions preferences about care 73% as much ascomposite respondent wantedscore Most patients report that health care providers treated Family and living situation Individualtaken question into account scores when 55% planning treatment them with dignity and respect (92%) and involved Treated with dignity and 92% Comfortablerespect bytalking care withproviders staff 53% their family and friends appropriately in their care about alternative therapies Family and friends appropriately 92% and treatment (92%). Many were involved in decisions involved in care and treatment0% 20% 40% 60% 80% 100% % of patients who responded positively Involved in decisions about care 73% about their care as much as they wanted (73%). as much as respondent wanted Source:Family Ambulatory and living situationOncology Patient Satisfaction Survey data taken into account when 55% collection andplanning statistical treatment analyses by NRC+Picker, 2006. Approximately half of patients report that health care Comfortable talking with staff 53% about alternative therapies Patients in BC providers took their family and living situation into 0% 20% 40% 60% 80% 100% Patients in the rest of Canada account in planning treatment (55%), or that they felt Figure 12» Patients offer %relatively of patients who modestresponded positively ratings Information, communi- comfortable talking with health care providers about to communicationcation and education and report they don’t61% receive composite score complementary, alternative or non-traditional treat- enough information Individual question scores Provider explained ment (53%). 79% Patientsunderstandably in BC why tests were needed Patients in the rest of Canada Test results were 69% explained understandably Patients understand explanations offered by Information, communi- cationComfortable and education talking 61% with staff about clinical 73% care providers but report that they don’t receive trialscomposite or new treatments score If there was a wait enough information about what to expect Individualbefore question first treatment, scores 51% someone explained why Provider explained 79% understandablySomeone discussed why 57% Another dimension of quality relates to the degree to different testscancer were treatments needed Test results were 69% which patients and providers communicate and share Receivedexplained enough understandably information 66% about cancer therapies Comfortable talking information. Patients in BC give relatively modest Received enough information 73% with staff about clinical 52% trialsabout or possible new treatments changes in energy levels ratings to these issues (composite score = 61% positive If there was a wait before first treatment, 51% Receivedsomeone enough explained information why 54% ratings)—ratings similar to those reported by Cana- about nutritional needs Someone discussed 57% Receiveddifferent enough cancer information treatments about possible changes in 44% dians who received ambulatory cancer care in other work or usual activities Received enough information 66% provinces (Figure 12). about possiblecancer therapies changes 63% in physical appearance Received enough information about possible changes 52% in energy levels0% 20% 40% 60% 80% 100% Many patients report that health care providers ex- Received enough information % of patients who responded54% positively about nutritional needs plained why tests were needed (79%) or explained test Received enough information about possible changes in 44% results in an understandable manner (69%). Among work or usual activities Received enough information about possible changes 63% those who had surgery, many report that the results of in physical appearance this intervention were explained in an understandable 0% 20% 40% 60% 80% 100% % of patients who responded positively manner (78%). Many were comfortable talking with their health care provider about new or experimental Source: Ambulatory Oncology Patient Satisfaction Survey data cancer treatments (73%). collection and statistical analyses by NRC+Picker, 2006.

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Over half of patients report that someone fully Figure 13» Patients give modest ratings to discussed different treatments for cancer with them coordination and continuity (57%) and more felt they were given enough informa- Patients in BC tion about different treatments for cancer (66%). Only Patients in the rest of Canada half report that they got enough information about Coordination and continuity of care 65% possible changes in their energy levels (52%) or about composite score their nutritional needs (54%). A minority report that Individual question scores Knew who was in charge 83% they got enough information about possible changes in of care for each therapy

Providers knew enough 79% their work or usual activities (44%). about cancer therapies

Providers always 61% aware of test results Patients know who is in charge of their Family doctor knew enough 61% therapies but report that their care could about your cancer care Always knew 53% be better coordinated next step in care

Always knew who to ask 57% Another dimension of quality relates to the degree to about health problems

Providers always familiar 48% which health care is coordinated and patients expe- with medical history

Never given confusing or rience continuity in their care. Patients in BC give contradictory information 75% about health or treatment relatively modest ratings to these aspects of their care 0% 20% 40% 60% 80% 100% (composite score = 65% positive ratings)—ratings % of patients who responded positively similar to those reported by Canadians who received Source: Ambulatory Oncology Patient Satisfaction Survey data collec- ambulatory cancer care in other provinces (Figure 13). tion and statistical analyses by NRC+Picker, 2006.

The majority of patients knew who was in charge of care for each of their therapies (83%) and report that Patients see the area of emotional support care providers knew enough about therapies for treat- as having the most room for improvement ing cancer (79%). Sixty-one per cent report that health An important dimension of quality, particularly from care providers were always aware of their test results. the patient perspective, relates to how well health Among those who had a visit with their family doctor care providers offer support to address patient needs in the preceding six months, 61% thought that this relative to emotional well-being. Patients in BC give doctor knew enough about their cancer care. relatively low ratings to this dimension (composite score = 53% positive ratings); ratings similar to those Patients see the area of coordination of their care as reported by Canadians who received ambulatory can- having room for improvement. Approximately half of cer care in other provinces (Figure 14). patients always knew what the next steps in their care would be (53%), or who to ask when they had ques- Many patients report being told of their diagnosis in a tions about their health problems (57%). Less than half sensitive manner (69%), and that a care provider went report that their care providers were always aware of out of their way to help them feel better (67%). Fur- their medical history (48%). One-quarter were given thermore, patients report that they usually or always conflicting or contradictory information about their got as much help as they wanted in figuring out how health or treatment (Figure 13: 75% were never given to pay the extra costs for cancer care (64%). conflicting or contradictory information).

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Figure 14» Patients give relatively low ratings to A minority of patients report being given enough emotional support information about possible changes in sexual activ- ity (40%) or their emotions (34%). Few were given Patients in BC Patients in the rest of Canada enough information about possible changes in their relationship with a spouse or partner (28% were given Emotional support 53% composite score enough information). Importantly, few were put in Individual question scores touch with other care providers who could help with Told of diagnosis in 69% a sensitive manner anxieties and fears (24% were put in touch) and few A care provider went out of his or her way to help 67% you or make you feel better were put in touch for these reasons when first told of Felt you could trust your care providers with 88% their illness (35% were put in touch). confidential information Received as much help as wanted in figuring out how 64% to pay for any extra costs Patients in BC report few medical errors Received enough information about possible changes 40% in sexual activity or mistakes Received enough information 34% about possible emotional changes During the course of their cancer care, 5% of patients Received enough information about possible changes in 28% report that they believe that they or their family relationship with partner Someone put you in touch with other care providers who could 24% suffered personal injury or harm resulting from a help with anxieties and fears Someone put you in touch with medical error or mistake. A preliminary analysis by care providers who could help 35% with anxieties and fears when you were first told of your illness NRC+Picker indicates that these safety issues are 0% 20% 40% 60% 80% 100% not concentrated in a single health authority, facility % of patients who responded positively type or facility. A further 86% of patients indicated Source: Ambulatory Oncology Patient Satisfaction Survey data collec- they had not suffered personal injury or harm, and tion and statistical analyses by NRC+Picker, 2006. 9% indicated they did not know if they had suffered personal injury or harm.

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What do patient experiences tell us Patients give the lowest ratings to emotional support, about quality improvement priorities? information, communication and education, and co- Patients offer insights into areas for improvement ordination and continuity of care. Table 2 lists the top when asked specific questions about their experiences. ten areas in which the lowest proportion of patients When a tally is done to identify specific issues related offered high ratings. to accessibility and quality of ambulatory cancer care, patient experiences can highlight priorities for quality improvement.

Table2» Top ten areas for quality improvement, rank ordered

Patients who offer Ambulatory Oncology Patient Satisfaction Survey question positive ratings In the past six months, has someone at [name of health care facility] Emotional support put you in touch with other care providers who could help you with 24% anxieties and fears? Did you get enough information about possible changes in your rela- Emotional support 28% tionship with your spouse or partner? Did you get enough information about possible changes in your emo- Emotional support 34% tions? When you were first told of your illness, did someone put you in touch Emotional support 35% with other care providers who could help you with anxieties and fears? Did you get enough information about possible changes in your sexual Emotional support 40% activity? Did you get enough information about possible changes in your work Information, communication and 44% or usual activities? education How often were your care providers familiar with your medical his- Coordination and continuity 48% tory?** If you had to wait for your first appointment, did someone explain Information, communication and 51% why?† education Did you get enough information about possible changes in your energy Information, communication and 52% levels? education How often did you know what the next step in your care would be?** Coordination and continuity 53% Notes: *Except where noted, rating is the percentage who answered ‘yes, completely’. Other possible answers were ‘yes, somewhat’ or ‘no’. Individuals who answered ‘doesn’t apply’ were not included in the calculation. **Rating is the percentage who answered ‘always’. Other possible answers were ‘usually’, ‘sometimes’ and ‘never’. †Rating is the percentage who answered ‘yes, completely’. Other possible answers were ‘yes, somewhat’ or ‘no’.

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Conclusion

British Columbians and those responsible for deliver- Respondents in this survey gave relatively higher quality ing their health care are increasingly learning more ratings to access to care, physical comfort and respect about the accessibility and quality of care from first- for patient preferences. Th ey gave relatively lower quality hand accounts. In 2006, the spotlight was directed ratings to information, communication and education, toward understanding and reporting on access and coordination and continuity of care and emotional sup- quality of ambulatory cancer care through the eyes of port. Patients see the area of emotional support as having patients. the most room for improvement.

Research consistently demonstrates that when Cana- This purpose of this report is to compile a snapshot of dians rate their experiences with health care they are what patients with cancer have to say about the acces- overwhelmingly positive, but have suggestions for sibility and quality of ambulatory cancer care in BC. improvements. The same is true for ambulatory cancer This work will provide more information to further care. When asked about the overall quality of the am- stimulate, inform and target initiatives to improve bulatory cancer care they received in the preceding six cancer care in BC. months, 97% of patients rated the quality of services as excellent, very good or good. But when probed, patients have a lot to say about both the areas where health care and treatment are strong, and the areas requiring improvement.

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Appendix 1: Participating Cancer Care Facilities

Provincial Health Services Authority Vancouver Coastal Health Authority British Columbia Cancer Agency Fraser Lions Gate Hospital Valley Cancer Centre Powell River General Hospital British Columbia Cancer Agency Centre The Richmond Hospital for the Southern Interior Squamish General Hospital British Columbia Cancer Agency Vancouver Centre St Mary’s Hospital British Columbia Cancer Agency St Paul’s Hospital Vancouver Island Centre Vancouver General Hospital

Interior Health Authority Vancouver Island Health Authority East Kootenay Regional Hospital Campbell River and District Hospital Arrow Lakes Hospital Cowichan District Hospital Castlegar and District Community Health Centre Nanaimo Regional General Hospital Kootenay Boundary Regional Hospital St Joseph’s General Hospital Boundary Hospital West Coast General Hospital Slocan Community Health Centre Royal Jubilee Hospital Victorian Community Health Centre Nicola Valley General Hospital Northern Health Authority Queen Victoria Hospital Prince George Regional Hospital Kootenay Lake Regional Hospital Fort Nelson General Hospital Penticton Regional Hospital Bulkley Valley District Hospital Royal Inland Hospital Dawson Creek and District Hospital Shuswap Lake General Hospital Fort St John Hospital and Health Centre Vernon Hospital Mills Memorial Hospital 100 Mile House District General Hospital Prince Rupert Regional Hospital Cariboo Memorial Hospital GR Baker Memorial Hospital Kitimat Hospital Fraser Health Authority Burnaby Hospital Chilliwack General Hospital Ridge Meadows Hospital Royal Columbian Hospital Delta Hospital Langley Memorial Hospital Mission Memorial Hospital Matsqui-Sumas-Abbotsford General Hospital

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Appendix 2: How Was the Survey Done?

In 2005, a council comprised of British Columbia’s one facility were sent a survey for each facility. These Deputy Minister of Health, other Ministry executives individuals were asked to complete each survey, since and the Chief Executive Officers of the health authori- cancer care facilities were given results for patients ties struck a Patient Satisfaction Steering Committee they served. The survey asked patients to answer ques- to commission and oversee surveys of patients who tions in six dimensions of quality. Results represent received ambulatory cancer care. The Committee the percentage of positive responses that patients gave engaged NRC+Picker to conduct the survey using to questions. Percentages were calculated by excluding a standardized instrument, the Ambulatory Oncol- non-respondents. ogy Patient Satisfaction Survey (AOPSS). This survey —based on the Picker suite of surveys—was developed Surveys with accompanying cover letters and return and validated in Canada.5 It has also been used in Al- envelopes were mailed to patients’ home addresses berta, Manitoba, Nova Scotia, Ontario and Saskatch- between June and August 2006. The mailed survey was ewan (n=26,616). in English but Chinese, Punjabi and French versions were available by calling a 1-866 number. A reminder The AOPSS was mailed to patients in BC who were 18 letter and survey were sent 24 days later to those who years or older, had a confirmed diagnosis of cancer, had not yet responded. Privacy officers for all health and who received chemotherapy or radiation treat- regions approved of this project and the Office of the ment or follow-up on an ambulatory care basis at Information and Privacy Commissioner was notified one of 50 designated health care facilities or centres of this initiative. between November 15, 2005 to May 15, 2006. Patients were excluded from the survey if they had no fixed Th e overall response rate to the survey was 60%; this address, had not received active treatment on an out- varied from 56% to 67% across health authorities in patient basis in the past six months, had received only the province (Table 3). Th e age and gender structure of inpatient services or oral chemotherapy treatment or respondents did not diff er signifi cantly from the popula- were deceased. tion of adults who received ambulatory cancer care (Table 4). Among completed surveys, 83% were done by the BC Cancer Agency data were used to establish each patient, 11% by the patient with someone else’s help and patient’s eligibility status and create a census of those 6% by someone else. who were mailed a survey (N=12,215). The survey contained items to verify each patient’s eligibility status. Individuals who received care from more than

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Appendix 2: How Was the Survey Done? (Continued)

Table 3» Respondents and response rates by health authority, and overall

Survey Not People Completed Able to be Response Health Authorities Surveyed Surveys Delivered Rate Fraser 931 482 75 56% Interior 1,579 954 135 66% Northern 563 303 47 59% Provincial 6,855 3,937 193 59% Vancouver Coastal 1,236 640 88 56% Vancouver Island 1,051 658 70 67%

British Columbia 12,215 6,974 608 60%

Table 4» Age and gender structure of population of adults that received ambulatory cancer care and survey respondents

Received a questionnaire Responded Health Authority Health Authority

FHA IHA NHA PHSA VCHA VIHA FHA IHA NHA PHSA VCHA VIHA

18 - 51 15% 14% 18% 19% 17% 14% 12% 11% 16% 17% 16% 11%

52 - 58 14% 13% 20% 16% 17% 14% 15% 14% 20% 15% 15% 14%

59 - 63 13% 12% 13% 13% 13% 12% 11% 13% 14% 13% 13% 12% 64 - 68 11% 14% 13% 12% 13% 12% 13% 14% 15% 13% 13% 13% 69 - 73 14% 15% 13% 12% 12% 13% 14% 16% 16% 14% 14% 15% 74 - 78 15% 14% 8% 13% 13% 16% 18% 15% 9% 14% 13% 19% Age group (years) Age group 79 + 18% 19% 14% 14% 15% 18% 18% 17% 11% 13% 16% 17% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Female 60% 60% 57% 56% 60% 58% 59% 62% 61% 57% 62% 59%

Male 40% 40% 43% 44% 40% 41% 38% 39% 43% 38% 41% Gender

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References

1 Canadian Institute for Health Information (CIHI). Health Care in Canada, 2005. Toronto, ON: CIHI; 2005 [citing an Ipsos Reid Public Opinion Poll, p. 39]. 2 Soroka SN. A report to the Health Council of Canada. Canadian perceptions of the health care system. Toronto, ON: Health Council of Canada; 2007. 3 POLLARA Research. Health Care in Canada Sur- vey, 2003. A national survey of health care provid- ers, managers, and the public. Toronto, ON: Pollara Inc.; 2003 [cited 2007 Jan 26]. Available from: http://www.hcic-sssc.ca/. 4 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Wash- ington, DC: National Academy Press; 2001, p. 48. 5 NRC+Picker. Development and validation of the Picker Ambulatory Oncology Survey Instrument in Canada. Markham, ON: NRC+Picker; 2003 [cited 2007 Jan 26]. Available from: http://www.can- cercare.on.ca/qualityindex2006/download/Fina- lOncologyMaskedJuly11.pdf. 6 Gerteis M, Edgman-Levitan S, Daley J. Th rough the patient’s eyes: Understanding and promoting patient-centered care. San Francisco, CA: Jossey- Bass; 1993.

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