Are Patients Satisfied With The Head and Neck Skin Cancer Service? Kiren Patel BDS(Hons) MFDS RCS (Ed) Dental Core Trainee, Northampton General Hospital NHS Trust Vahe Petrosyan BDS(Hons) MFDS RCS(Ed) Middle Grade, Northampton General Hospital NHS Trust Phillip Ameerally BDS MBBS(Hons) FDS RCS FRCS(OMFS) Consultant, Northampton General Hospital NHS Trust

Background & Purpose ‘There is no point in providing a health service that is effective and cheap, if no one wants it’. The foremost epidemiologist Sir William Richard Doll recognized the importance of patient perspectives as early as 1974 stating: ‘There is no point in providing a health service that is effective and cheap, if no one wants it’.1 The purpose of this Service Evaluation was to ascertain patient reported outcomes following ‘Initial Consultation’, ‘Treatment’ and ‘Follow Up’ for Head and Neck Non-Melanoma Skin Cancer. The Authors hypothesize that patients will be most satisfied with the ‘Clinical’ aspect of their care and the ‘Treatment’ appointment is most likely to yield the greatest positive feedback. The authors are aiming for >90% of patients to rate the service as ‘Very Good’, or ‘Excellent’.

Background & Purpose Initial Consultation Treatment Follow Up The foremost epidemiologist Sir William Richard Doll recognized the importance of patient perspectives as early as 1974 stating: ‘There is no point in providing a health service that is effective and cheap, if no one wants it’.1 The purpose of this Service Evaluation was to ascertain patient reported outcomes following ‘Initial Consultation’, ‘Treatment’ and ‘Follow Up’ for Head and Neck Non-Melanoma Skin Cancer. The Authors hypothesize that patients will be most satisfied with the ‘Clinical’ aspect of their care and the ‘Treatment’ appointment is most likely to yield the greatest positive feedback. The authors are aiming for >90% of patients to rate the service as ‘Very Good’, or ‘Excellent’.

TREATMENT Background & Purpose The foremost epidemiologist Sir William Richard Doll recognized the importance of patient perspectives as early as 1974 stating: ‘There is no point in providing a health service that is effective and cheap, if no one wants it’.1 The purpose of this Service Evaluation was to ascertain patient reported outcomes following ‘Initial Consultation’, ‘Treatment’ and ‘Follow Up’ for Head and Neck Non-Melanoma Skin Cancer. The Authors hypothesize that patients will be most satisfied with the ‘Clinical’ aspect of their care and the ‘Treatment’ appointment is most likely to yield the greatest positive feedback. The authors are aiming for >90% of patients to rate the service as ‘Very Good’, or ‘Excellent’.

>90% Background & Purpose The foremost epidemiologist Sir William Richard Doll recognized the importance of patient perspectives as early as 1974 stating: ‘There is no point in providing a health service that is effective and cheap, if no one wants it’.1 The purpose of this Service Evaluation was to ascertain patient reported outcomes following ‘Initial Consultation’, ‘Treatment’ and ‘Follow Up’ for Head and Neck Non-Melanoma Skin Cancer. The Authors hypothesize that patients will be most satisfied with the ‘Clinical’ aspect of their care and the ‘Treatment’ appointment is most likely to yield the greatest positive feedback. The authors are aiming for >90% of patients to rate the service as ‘Very Good’, or ‘Excellent’.

Very Good OR EXCELLENT Background & Purpose The foremost epidemiologist Sir William Richard Doll recognized the importance of patient perspectives as early as 1974 stating: ‘There is no point in providing a health service that is effective and cheap, if no one wants it’.1 The purpose of this Service Evaluation was to ascertain patient reported outcomes following ‘Initial Consultation’, ‘Treatment’ and ‘Follow Up’ for Head and Neck Non-Melanoma Skin Cancer. The Authors hypothesize that patients will be most satisfied with the ‘Clinical’ aspect of their care and the ‘Treatment’ appointment is most likely to yield the greatest positive feedback. The authors are aiming for >90% of patients to rate the service as ‘Very Good’, or ‘Excellent’.

Materials and Methods Consenting Adults with Capacity Outpatient Appointments Head and Neck Non-Melanoma Skin Cancer September & December 2015 No Randomisation European Organisation for Research and Treatment of Cancer QLQ-SAT32 Inclusion Criteria Consenting Adults with Capacity Outpatient Appointments (Initial Consultation, Treatment, Follow Up) Head and Neck Non-Melanoma Skin Cancer September & December 2015 Service Evaluation – therefore No Randomisation To guarantee greater validity of the Service Evaluation an adapted version of the European Organisation for Research and Treatment of Cancer validated Patient Satisfaction Questionnaire (EORTC QLQ-SAT32)2 was used to collect the data.

Service & Care Organisation Nurses Service & Care Organisation Doctors

n=177 One-Way ANOVA Materials and Methods The minimum sample size that would allow meaningful statistical analysis was calculated using G*Power statistical software Comparisons between Groups was carried out using One-Way ANOVA with Prism Version 6 statistics package.

Results n=179 Treatment 4.72/5, p<0.0001 Initial Consultation – 88% Follow Up – 92% p<0.0001 179 Questionnaires completed Initial Consultation=51, Treatment=74, Follow Up=54 Treatment Appointment Scored Highest for Satisfaction 4.72/5, p<0.0001 Overall Satisfaction with Care – Treatment Appointment, p<0.0001

Results Average of 93% Questions Answered, p<0.0001 Most likely to answer questions regarding Doctors, p=0.0289 Doctors & Nurses consistently scored higher than the Service & Care Organisation, p<0.0001 The greatest proportion of questions answered was in the ‘Treatment’ group with an average of 93% (range 65-100%), p<0.0001. Comparing, ‘Doctors’, ‘Nurses’ and ‘Service & Care Organisation’ patients were most likely to answer questions regarding ‘Doctors’ with an average of 93% (range 79-99%), p=0.0289. Comparing patient satisfaction scores for ‘Doctors’, ‘Nurses’ and ‘Service & Care Organisation’ it was interesting to note the overall score for ‘Doctors’ and ‘Nurses’ was coincidentally exactly the same at 4.61/5, and for ‘Service & Care Organisation’ this was 4.29/5, p<0.0001.

Results Question with the highest percentage of ‘excellent’ scores: In the initial consultation it appears that the attributes and behavior of the nurses was the most highly rated by the patients. The way in which the nurses approached patient care was also noted to be highly commended by patients during the treatment appointment. However in the follow up appointments the delivery of information regarding their condition was the most appreciated.

Results Initial consultation Q16: ‘During your hospital visit how would you rate the nurses in terms of their human qualities (politeness, respect… etc.) (63%) Treatment Q12: ‘During your hospital visit how would you rate the nurses in terms of the way they handled your care?’ (92%) Follow up Q7: ‘During your hospital visit, how would you rate the doctors in terms of the information they gave you about their illness? (72%) In the initial consultation it appears that the attributes and behavior of the nurses was the most highly rated by the patients. The way in which the nurses approached patient care was also noted to be highly commended by patients during the treatment appointment. However in the follow up appointments the delivery of information regarding their condition was the most appreciated.

Results Question with the highest percentage of ‘poor’ scores: Q28: ‘During your hospital visit how would you rate the service and care organisation in terms of the ease of access (parking, transport…?) Interestingly the question with the highest percentage of poor scores was the same across all three groups, with the highest percentage (16%) being in the follow up group.

Results Total of 40 Comments Left Treatment Appointment – 31% Compliments – 65% Criticisms – 23% Patients were more likely to leave comments following their ‘Treatment’ appointment, where 31% had left written feedback. Less feedback was left following the ‘Initial Consultation’ and ‘Follow Up’ appointments, 12% and 20% respectively. A total of 40 comments had been left, comprising a mixture of compliments (65%) and criticisms (23%).

Patient Comments Have been treated excellently all through my visit, many many thanks Excellent hospital, appreciated the care and attention given by the nurses and the surgeon Apart from waiting time, excellent treatment Sort the parking problems More car parking required Patients were more likely to leave comments following their ‘Treatment’ appointment, where 31% had left written feedback. Less feedback was left following the ‘Initial Consultation’ and ‘Follow Up’ appointments, 12% and 20% respectively. A total of 40 comments had been left, comprising a mixture of compliments (65%) and criticisms (23%).

Discussion & Conclusions Greatest Satisfaction with Treatment Appointment Personal Nature of interaction with Clinical Team Treatment Appointment = Longest Appointment There appears to be greatest satisfaction following the ‘Treatment’ appointment. A possible explanation could simply be the relief of having finally had ‘the cancer’ removed reflected as a positive evaluation of the service. The ‘Treatment’ appointment was also the longest patients spent with ‘Clinical Team’. Furthermore patients are likely to show greater satisfaction with the ‘Clinical Team’ due to the personal nature of the interaction they have during this aspect of their care.

Discussion & Conclusions Treatment & Follow Up appointments met the Authors’ Standard of >90% The greatest problems related to waiting times and on-site parking For both the ‘Treatment’ and ‘Follow Up’ appointments over 90% of patients rated the service as ‘Very Good’ or ‘Excellent’, meeting the authors’ set target, unfortunately, however the ‘Initial Consultation’ fell just short, at 88%. It may be the case that once patients become familiar with the service and build a rapport with the team, their evaluation of the service becomes more positive. Questions 7 and 12 had the most positive answers, highlighting the excellent communication and compassion exhibited by the ‘Clinical Team’. The ‘Service & Care Organisation’ consistently yielded the poorest scores, throughout all appointments types. Specifically the greatest problems related to waiting times and on-site parking (Questions 27 & 28).

Recommendations Give patients information regarding nearby public car parks Concession rate for patients using Local Car Parks agreed with Local Council Nurse Lead Clinics set up to review completely excised BCC’s Following Implementation can re-run The Service & Care Organisation Part of Questionnaire to Complete the Audit Cycle Due to the unpredictable nature of the clinical environment it would be impossible to address the underlying causes for delayed appointments within the scope of this Service Evaluation. Simple measures, however, can be taken to improve the access to parking. Along with the appointment letter patients could be sent information regarding nearby car parks that may be used. Furthermore, a concession rate for patients using a public car park could be agreed with the Local Authority as an incentive to reduce the strain on the hospital’s parking facilities. Following implementation of the above, the ‘Service & Care Organisation’ part of the questionnaire could be repeated, resulting in a second cycle, thus a complete Audit, with a pre determined standard.

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