Patient-expressed perceptions of wait-time causes and wait-related satisfaction
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PERCEPTIONS OF WAIT-TIME CAUSES
105
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Copyright © 2015 Multimed Inc. Following publication in
Current Oncology
, the full text of each article is available immediately and archived in PubMed Central (PMC).
ORIGINAL ARTICLE
Patient-expressed perceptions
of wait-time causes and
wait-related satisfaction
M. Mathews
p
h
d
,* D. Ryan
ma
,*
and D. Bulman
p
h
d
†
underlying reasons for wait-related satisfaction or
dissatisfaction. Although our findings shed light
on patient experiences with the health system and
identify where interventions could help to inform the
expectations of patients and the public with respect
to wait time, more research is needed to understand
wait-related satisfaction among cancer patients.
KEY WORDS
Wait times, patient satisfaction, breast cancer, pros
–
tate cancer, colorectal cancer, lung cancer
1.
BACKGROUND
“Patient satisfaction” refers to personal evaluations
by patients about whether their lived health care ex
–
periences measure up to their expectations
1
. Patient
satisfaction is generally accepted as a dimension of
quality of care
2
and patient-centred care
3
. A num
–
ber of studies have examined patient satisfaction in
cancer care and have highlighted communication
between the physician (and other members of the
team) and the patient
3,4
. Nonetheless, wait times for
care are frequently cited as a cause of patient dis
–
satisfaction with the health care system
5
.
Studies examining wait times for cancer care and
wait-related satisfaction have a number of limitations.
First, some studies examine the length of time spent
in a waiting room preceding a single visit; few stud
–
ies have looked at waits as patients progress from
symptoms, to testing, and to diagnosis and treatment.
Second, some researchers have described wait times
for the various intervals from symptoms to treat
–
ment, but we found only one Canadian study that
considered patient satisfaction with those waits. In
a study of colorectal cancer patients in Nova Scotia,
researchers found only a modest correlation between
length of wait and wait-related satisfaction
6
.
Does patient satisfaction vary based on the cause
of the wait? Wait times along the pathway from
symptoms to treatment are commonly described in
ABSTRACT
Background
This study set out to identify patterns in the causes of
waits and wait-related satisfaction.
Methods
We conducted qualitative interviews with urban,
semi-urban, and rural patients (
n
= 60) to explore
their perceptions of the waits they experienced in the
detection and treatment of their breast, prostate, lung,
or colorectal cancer. We asked participants to de
–
scribe their experiences from the onset of symptoms
to the start of treatment at the cancer clinic and their
satisfaction with waits at various intervals. Interview
transcripts were coded using a thematic approach.
Results
Patients identified five groups of wait-time causes:
•
Patient-related (beliefs, preferences, and non-cancer
health issues)
•
Treatment-related (natural consequences of treatment)
•
System-related (the organization or functioning
of groups, workforce, institution, or infrastructure
in the health care system)
•
Physician-related (a single physician responsible
for a specific element in the patient’s care)
•
Other causes (disruptions to normal operations
of a city or community as a whole)
With the limited exception of physician-related
absences, the nature of the cause was not linked to
overall satisfaction or dissatisfaction with waits.
Conclusions
Causes in themselves do not explain wait-related
satisfaction. Further work is needed to explore the
Curr Oncol
, Vol. 22, pp. 105-112; doi: http://dx.doi.org/10.3747/co.22.2243
MATHEWS
et al.
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2015
Copyright © 2015 Multimed Inc. Following publication in
Current Oncology
, the full text of each article is available immediately and archived in PubMed Central (PMC).
the literature as resulting from patient and provider
delay. “Patient delay” refers to the interval from the
onset of symptoms to the first medical consultation,
usually with the patient’s regular physician
7–9
. “Pro
–
vider delay” refers to the period after the first visit to
a health care provider (in Canada, usually the general
practitioner or family physician)
6,10,11
. The terminol
–
ogy suggests that waits during those periods result
from the provider or the patient. For example, a lengthy
wait to see a physician about symptoms is attributed to
the patient, and delays occurring after the initial visit
are attributed to physician- or health system–related
issues. Although some studies have described patient
and provider delays, we were unable to find studies that
examined the relationship between patient satisfaction
and wait time causes. The purpose of the present study
was therefore to identify patterns in causes of waits
and wait-related satisfaction.
Using qualitative interviews, we asked patients
from Newfoundland and Labrador to describe their
experiences from the onset of symptoms to the start
of treatment at the cancer clinic. As in other provinces
in Canada, Newfoundland and Labrador has invested
resources in improving wait times for cancer care
12
.
By examining the care-seeking process, we adopt a
patient-centred approach and aim to better understand
the patient’s experience of cancer and interactions with
the health care system. The study contributes to the
understanding of public perceptions of wait times and
efforts to improve timely access to cancer care.
2.
METHODS
Memorial University’s Human Investigations Com
–
mittee approved the study. We conducted semis
–
tructured qualitative interviews with breast, lung,
colorectal, and prostate cancer patients who, in an
earlier survey, had expressed satisfaction or dis
–
satisfaction with their wait times while seeking care
for their cancer.
Eligible study participants were residents of New
–
foundland and Labrador who were 19 years of age or
older and who had been diagnosed between January
2009 and August 2011. We excluded participants with
previous or multiple cancer diagnoses because their
wait-time experiences might differ from those of
patients who are diagnosed with one type of cancer
for the first time. For the initial survey, we recruited
cancer patients from regional cancer clinics across the
province and mailed invitations to individuals identi
–
fied through the provincial cancer registry. The survey
gathered information about dates in the care-seeking
process, satisfaction with interval-specific wait times
(for example, from symptoms to first visit with a health
care provider, from first visit to diagnosis, and so on),
and clinical and personal characteristics. A fuller
description of the survey procedures are provided
elsewhere
13
. At the end of the survey, respondents were
invited to take part in the qualitative interview, and
willing respondents were later contacted to complete
consent forms and schedule interviews.
Patients were selected for an interview based
on their responses to survey questions about com
–
munity of residence and satisfaction with various
waits. From among the survey respondents, we
identified urban (population =100,000), semi-urban
(population 10,001–99,999), and rural (population
=10,000) residents who were satisfied or dissatisfied
with their overall wait time from onset of symptoms
to care at the cancer clinic. Because patients were
overwhelmingly satisfied with the overall wait time,
we then amended our recruitment to patients who had
expressed dissatisfaction with any wait interval. For
each cancer type and community size, we recruited
a minimum of 3 patients who were satisfied or dis
–
satisfied with their wait time experiences. The final
number of interviews was determined when satura
–
tion of ideas and concepts was reached
14
.
The interviews were conducted in person or by
telephone and ranged in length from 8 minutes to
82 minutes. We asked participants about their wait
times and causes of waits from onset of symptoms
to receiving treatment for their cancer, their level of
satisfaction with those wait times, any barriers to
receiving care in their community, factors that might
make cancer care accessible in their area, and what
could have been done to improve their wait times or
the quality of care that they received. Each interview
was tape-recorded and later transcribed verbatim.
Using a thematic approach, three members of the
research team each independently read 4 transcripts
to identify key themes and concepts. We then devel
–
oped a template to code the remaining transcripts.
To ensure consistency in coding, we defined and
described each code. Each transcript was then read
and coded by two members of the team (one research
assistant read and coded all transcripts). Throughout
this process, data from previous interviews were con
–
tinuously compared to identify concepts, categories,
clusters, and themes
14,15
. Disagreements in coding
were resolved by consensus. Where disagreements
arose, members of the research team re-examined
the descriptions of individual themes to determine
the source of disagreement. Those discussions led, as
needed, to clarification of code and theme definitions,
the creation of new themes, or the integration of new
ideas within a theme. The NVivo
9 qualitative data
analysis software (version
9, 2010: QSR International,
Doncaster, Australia) was then used to re-code all
transcripts using the final coding template.
In the present article, we focus on the causes
of disruptions in timely care. Numbers are used to
identify individual participants.
3.
RESULTS
Of 128 invited patients, 60 (46.9%) participated in an
interview. Table
i
shows participant characteristics

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