Determinants of Patient Satisfaction for Patients Receiving Radiation Therapy

Reporter: Annemarie Fernandes, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 30, 2012

Presenter: Robin Famiglietti, FACHE, MBA
Presenter's Affiliation: The University of Texas, MD Anderson Cancer Center


  • Overall patient satisfaction is an important point of clinical cancer care.
  • Value based purchasing has been implemented in our health care system for many years. However, beginning in October 2012, the Centers for Medicare and Medicaid Services (CMS) will being withholding payments to hospitals that do not achieve adequate patient satisfaction metrics
  • The purpose of this prospective study was to determine how specific domains of radiation oncology patient care correlate with overall patient satisfaction

Materials and Methods

  • HCAHPS is a national standardized survey of patient experience designed by CMS and AHRQ (Agency for Healthcare Research and Quality)
  • From September 2006-February 2012, patient satisfaction data was prospectively collected on patients receiving radiation treatment
  • Patients were asked to fill out a 28 question survey
  • Questions were rated on a 10 point scale and categorized into 4 domains:
    • Quality of provider care (ex: care by physician, nursing or radiation therapist, pain management)
    • Patient access/environment (ex: telephone/staff courtesy, check-in process, scheduling of appointments, 24 hours phone responsiveness)
    • Wait times (ex: things to do while waiting, explanation of treatment delay, wait time for weekly clinic visit)
    • Patient education (ex: explanation of side effects, explanation of research protocols, explanation of home care by nursing)
  • Correlation was made between the overall satisfaction score and each question and each domain using logistic regression


  • The surveys were distributed to 8069 patients, and the presenter notes about a 30% response rate
  • There was a positive correlation between all questions and the overall patient satisfaction
  • The 4 questions with the strongest R-square correlations were:
    • Experiences with nursing care
    • Experiences with physician care
    • Explanation of side effects and addressing of concerns by nursing staff
    • Radiation therapist care
  • By domain, quality of provider care had the highest correlation with overall patient satisfaction, followed by patient access/environment then wait time and lastly patient education
  • With the quality of provider care domain, evaluation of odds ratios to predict overall satisfaction revealed that satisfaction with radiation therapist care (OR: 2.47) had a higher likelihood of resulting in overall patient satisfaction compared to satisfaction with nursing care (OR ~1) or physician care (OR: 0.95).

Author's conclusions

  • The authors conclude that the quality of care provided by physicians, nurses and therapists has the greatest impact on overall patient satisfaction with radiation care
  • Quality of care provided by therapists has a greater impact on overall patient satisfaction compared to quality of care provided by physicians or nurses
    • The authors hypothesize that one explanation for this may be that patients expect to receive high quality physician care, but prior to starting treatment are unaware of the supportive care that radiation therapists provide
  • Other measures typically associated with patient satisfaction (phone access, scheduling and ease of the check-in process) were less strongly correlated with overall satisfaction rating

Clinical Implications

  • Radiation therapy is a multidisciplinary field that requires an exquisite amount of coordination and effective communication among the different groups within the department (physician, nursing, therapy, dosimetry, physics, administration)
  • Patient satisfaction with their care is an important point of clinical cancer care.
  • As the healthcare field moves to consider patient satisfaction when reimbursing payment, there is an increasing interest to identify factors that contribute to patient satisfaction.
  • The authors present an intriguing analysis of patient satisfaction. While they distributed over 8,000 surveys, the presenter notes about a 30% response rate. This low response rate may bias the results by selecting for patients who have had uncharacteristically good or bad experiences.
  • In this analysis, quality of provider care had the highest correlation with overall patient satisfaction. Interestingly, quality of care provided by therapists has a greater impact on overall patient satisfaction compared to quality of care provided by physicians or nurses. As the authors explain, this finding may be the result of patients' upfront expectations.
  • It would be interesting to study the impact of patients' expectations prior to starting treatment on overall satisfaction. For example, it would be interesting to study the impact of counseling by physicians, nurses or therapists on wait time and treatment delay in order to frame the patients' expectations during treatment.
  • The authors note anecdotally that patient satisfaction with wait time is dependent on effective communication. At the presenter's institution, they have screens displaying the order of patients on the machine, so the patients are aware of what is happening on the machines. Patients feel more satisfaction when they understand why they are waiting.
  • As healthcare providers, we are concerned about the patient's overall well-being. Just as we want to effectively treat their cancer, we want them to be satisfied with their care. Additional studies like this are necessary to identify areas of improvement and to help provide patients with satisfactory experiences during a very difficult time in their lives.