Patient Experiences with Outpatient Cancer Care in British Columbia, 2012/13

 
 
Patient Experiences with Outpatient Cancer Care in British Columbia, 2012/13
Patient Experiences with
Outpatient Cancer Care in
British Columbia, 2012/13
January 2014




Charlyn Black MD ScD
Dawn Mooney MPH
Sandra Peterson MSc
Patient Experiences with Outpatient Cancer Care in British Columbia, 2012/13
Patient Experiences with Outpatient Cancer Care in British
Columbia, 2012/13 was produced by:

Centre for Health Services and Policy Research
University of British Columbia
201–2206 East Mall
Vancouver, BC V6T 1Z3
Phone: 604-822-4969
Email: enquire@chspr.ubc.ca

You can download this publication from www.chspr.ubc.ca
Patient Experiences with Outpatient Cancer Care in British Columbia, 2012/13
U B C c e n t r e f o r h e a lt h s e r v i c e s a n d p o l i c y r e s e a r c h




Contents
 2    List of tables and figures

 4    About CHSPR

 5    Acknowledgments

 6    Executive Summary
 6    About this survey
 6    Findings

 7    Introduction
 7    The importance of understanding patient experience
 7    Approaches to understanding patient experience in BC
 8    BC’s 2005/06 and 2012/13 outpatient cancer care surveys
 10   The Canadian benchmarks
 11   About this report

 12   1. What did we learn? Findings from 2012/13
 12   1.1 Characteristics of patients who responded to the survey
 16   1.2 Overall evaluations of care
 21   1.3 Evaluations of individual patient-centred dimensions of care
 29   1.4 Areas of strength reported by BC patients
 30   1.5 Areas for improvement reported by BC patients

 31   2. How have patient experiences changed since 2005/06?
 31   2.1 Approaches to comparing 2005/06 and 2012/13 survey responses
 32   2.2 Overall evaluations of care, 2012/13 vs. 2005/06
 33   2.3 Overall evaluations based on combined dimensions of care, 2012/13
      vs. 2005/06
 34   2.4 Dimension scores 2012/13 vs. 2005/06
 35   2.5 Areas of strength, 2012/13 vs. 2005/06
 36   2.5 Areas for improvement, 2012/13 vs. 2005/06

 37   Discussion and conclusions

 41   References

 42   Appendix 1: Participating facilities by 2012/13 peer group




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Patient Experiences with Outpatient Cancer Care in British Columbia, 2012/13
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List of tables and figures
       12            Table 1: Number and percent of respondents or patients, by age, sex, ethnicity, and
                     type of cancer
       13            Table 2: Number and percent of respondents or patients, by type and location of
                     care
       14            Figure 1: Health status among patients receiving outpatient cancer care in BC,
                     2012/13, compared to Canadian benchmark
       14            Figure 2: Emotional health among patients receiving outpatient cancer care in BC,
                     2012/13
       15            Figure 3: Amount of pain among patients receiving outpatient cancer care in BC,
                     2012/13, compared to Canadian benchmark
       16            Figure 4: Overall rating of outpatient cancer care in BC, 2012/13, compared to
                     Canadian benchmark
       16            Figure 5: Overall rating of outpatient cancer care in BC and health authorities,
                     2012/13, compared to Canadian benchmark
       17            Figure 6: Overall rating of outpatient cancer care in BC, 2012/13, compared to
                     Canadian benchmark
       17            Figure 7: Overall rating of outpatient cancer care in BC and health authorities,
                     2012/13, compared to Canadian benchmark
       18            Figure 8: Overall rating of outpatient cancer care in BC, 2012/13
       18            Figure 9: Overall rating of outpatient cancer care in BC and health authorities,
                     2012/13
       19            Figure 10: Overall rating of outpatient cancer care in BC and health authorities,
                     2012/13, compared to Canadian benchmark
       20            Figure 11: Overall rating of outpatient cancer care in BC, 2012/13, compared to
                     Canadian benchmark
       21            Figure 12: Dimension scores in BC, 2012/13, compared to Canadian benchmark
       22            Figure 13: Dimension scores in BC and health authorities, 2012/13, compared to
                     Canadian benchmark
       23            Figure 14: Respect for patient preferences dimension: Composite score and
                     individual question scores in BC, 2012/13, compared to Canadian benchmark
       24            Figure 15: Access to care dimension: Composite score and individual question
                     scores in BC, 2012/13, compared to Canadian benchmark
       25            Figure 16: Physical comfort dimension: Composite score and individual question
                     scores in BC, 2012/13, compared to Canadian benchmark
       26            Figure 17: Coordination and continuity dimension: Composite score and individual
                     question scores in BC, 2012/13, compared to Canadian benchmark
       27            Figure 18: Information, communication and education dimension: Composite score
                     and individual question scores in BC, 2012/13, compared to Canadian benchmark
       28            Figure 19: Emotional support dimension: Composite score and individual question
                     scores in BC, 2012/13, compared to Canadian benchmark
       29            Figure 20: Ten questions with highest ratings in BC, 2012/13, compared to
                     Canadian benchmark




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30   Figure 21: Ten questions with lowest ratings in BC, 2012/13, compared to Canadian
     benchmark
32   Figure 22: Overall rating of outpatient cancer care in BC, by health authority,
     2012/13 replication group compared to 2005/06
33   Figure 23: Overall rating of outpatient cancer care in BC, by health authority,
     2012/13 replication group compared to 2005/06
34   Figure 24: Dimension scores in BC, 2012/13 replication group compared to 2005/06
35   Figure 25: Ten questions with highest ratings in BC,
35   2012/13 replication group compared to 2005/06
36   Figure 26: Ten questions with highest ratings in BC, 2012/13 replication group
     compared to 2005/06




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About CHSPR
The Centre for Health Services and Policy Research (CHSPR) is an independent research centre
based in the School of Population and Public Health of the University of British Columbia. Our
mission is to stimulate scientific enquiry into health system performance, equity and sustainability.


Our faculty are among Canada’s leading experts in primary health care, health care funding,
variations in health services utilization, health human resources, and pharmaceutical policy. We
promote interdisciplinarity in our research, training, and knowledge translation activities because
contemporary problems in health care systems transcend traditional academic boundaries.


We are active participants in various policy-making forums and are regularly called upon to
provide policy advice in British Columbia, Canada, and abroad.


We receive core funding from University of British Columbia. Our research is primarily
funded through competitive, peer-reviewed grants obtained from Canadian and international
funding agencies.



For more information about CHSPR, please visit www.chspr.ubc.ca.




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Acknowledgments
We would like to acknowledge the work of the many people and organizations that have contrib-
uted to the development of this report.


First and foremost, the responses of British Columbia (BC) residents to questionnaires asking them
about their experiences in receiving outpatient care for treatment of cancer have made this report
possible. This includes the more than 13,000 cancer patients who completed surveys: over 6,900
between November 2005 and May 2006, and approximately 6,300 between October 2012 and June
2013. Their contributions of time and perspective made this report possible.


The BC Patient Reported Experience Measures Steering Committee (PREMS Committee) has been
the primary leader of work to understand the experiences of BC residents with their health care
system. Under the direction of the Deputy Minister of Health and Chief Executive Officers of the
health authorities of BC, this committee has undertaken numerous province-wide surveys to learn
and share information about the health care experiences of BC residents. In 2005/06 and again
in 2012/13, they undertook an Ambulatory Oncology Patient Satisfaction Survey to report on
the experiences BC patients have with outpatient cancer care. In 2007, and again in 2013, the BC
PREMS Steering Committee engaged the UBC Centre for Health Services and Policy Research to
assist them in portraying the results of the two surveys.


The project has benefitted from the contributions and advice of many individuals. In particular,
Lena Cuthbertson, Provincial Director and Co-Chair, and Jennifer May, Project Manager, both
with the BC PREMS Committee, provided invaluable insight and direction. Michael A. Murray
PhD, an independent health services consultant, researcher, and educator, designed the sampling
strategy for the survey and provided valuable input into the interpretation of results. Sandra
Broughton, Regional Administrator BC Cancer Agency – Sindi Ahluwalia Hawkins Centre for
the Southern Interior, contributeded helpful comments and clarification in response to an earlier
version of the report.


The National Research Corporation Canada (NRCC) collected survey data and generated reports,
under contract with the BC PREMS Steering Committee, that form the basis of the information
presented in this report.


This report is intended to summarize the results of provincial and health authority reports for
this sector, and is therefore descriptive in nature. It relies primarily on documents containing the
results of analyses conducted by researchers and analysts at NRCC. Errors or omissions in this
report may therefore reflect errors in the original collection or analysis of data. Any conclusions
are those of the authors and no official endorsement by the Government of BC is intended or
should be inferred.



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Executive Summary
The purpose of this report is to describe British                                            Findings
Columbians’ perceptions and reported experi-                                                 Findings from BC’s outpatient cancer survey suggest
ences with outpatient cancer care, to compare their                                          that BC cancer outpatients are highly satisfied with
responses to those of other Canadians, and to deter-                                         the care that they receive, and that there is a pattern of
mine if there have been changes in patient experiences                                       high, and increasingly positive ratings of patient satis-
for comparable BC patients who were surveyed in                                              faction over time. When the focus is shifted to aspects
2005/06. This is the second report to provide                                                of care that more deeply reflect patient experiences,
descriptive information about this sector of the health                                      ratings of care are lower. Patients give reasonably high
care system. The first, published in 2007, described the                                     ratings to some aspects, including respect for patient
results of the 2005/06 survey (6).                                                           preferences, access to care, and physical comfort.
                                                                                             They give much lower ratings to aspects of care that
About this survey                                                                            reflect attention to their social and emotional needs;
In BC, the Patient Reported Experience Measures                                              these include ratings for coordination and continu-
Steering Committee (PREMS Committee) has been                                                ity; information, communication and education;
tasked with developing a provincial approach to                                              and emotional support. In 2012/13, only 46.7% of
measure patient experience. The PREMS Commit-                                                BC cancer outpatients gave positive ratings to the
tee contracted the National Research Corporation                                             emotional support dimension of their care; this was
Canada (NRCC) to collect survey data and generate                                            an improvement from 2005/06, when the score for
reports that, in turn, form the basis of the informa-                                        this dimension was 45.7%. The results of this survey
tion presented in this report. Surveys of patients                                           suggest patterns of overall stability, with improvement
were conducted using a standardized instrument, the                                          in several areas since 2005/06. While there have been
Ambulatory Oncology Patient Satisfaction Survey.                                             declines in some aspects, improvement has occurred
This survey tool includes standard questions to                                              in some of the areas of greatest weakness.
evaluate care, plus scales that have been developed
to measure six dimensions of patient-centred care:                                           Results for the 2012/13 survey suggest that BC cancer
respect for patient preferences; access to care; physical                                    outpatients give slightly, but consistently, lower ratings
comfort; coordination and continuity; informa-                                               of their care in comparison to a Canadian benchmark
tion, communication and education; and emotional                                             that includes cancer patients in other provinces. These
support. In addition to questions that are used in                                           patterns may reflect slightly lower ratings among BC
surveys in several Canadian provinces, the BC survey                                         cancer outpatients. Alternatively, they may be related
included additional questions that were developed                                            to differences in the composition of respondents in
specifically for use in this province. Two surveys of                                        the BC survey, especially the inclusion of almost 70%
outpatient oncology patients have been conducted in                                          of patients who received only non-IV therapy during
BC, the first in 2005/06 and a more recent 2012/13                                           the survey period. Further study to understand the
survey, which is the focus of this report.                                                   experiences of the non-IV therapy group, as compared
                                                                                             to other groups, would provide additional information
                                                                                             about this issue.




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Introduction
The importance of understanding                                          Approaches to understanding
patient experience                                                       patient experience in BC
In health care systems across the world, there is now                    Over the past two decades there has been growth in
widespread understanding that patients’ views provide                    the development of rigorous approaches to under-
essential information to guide us in achieving high                      standing patient experiences. Surveys of patient
quality health care. Patients offer a complementary                      experience are becoming increasingly important
perspective to that of clinicians, providing unique                      and are now widely used to ensure and encourage
information and important insights into the human-                       improved health care delivery. Since 2003, province-
ity of care (such as dignity and respect, emotional                      wide surveys have been conducted to understand the
support, privacy, meeting information needs, waiting                     experiences of patients in six different sectors in BC’s
and delays, and cleanliness of facilities). Measuring                    health care system. The results of these surveys are
patient experience is important not only because it                      intended to provide information to improve the ability
can facilitate care that improves clinical outcomes, but                 of health care providers, health authorities and the
also because it represents an important outcome in its                   provincial government to understand and respond to
own right (1).                                                           the needs of patients in BC.


Perhaps more importantly, ‘embedding’ the patient                        These surveys have been led by the BC Patient
perspective—building an understanding of patients’                       Reported Experience Measures Steering Committee
experiences into the care that we provide—is increas-                    (PREMS Committee), which has been tasked with
ingly considered a hallmark of high quality cancer                       developing a provincial approach to measure patient
care. It provides a mechanism to deliver care that is                    experience and overseeing the implementation of
respectful of, and responsive to, individual patient’s                   surveys. The PREMS Committee work plan for 2012
preferences, needs and values (2).                                       included the outpatient cancer care sector as one of
                                                                         the priorities for this work and the Committee initi-
Most often, when patients encounter the health care                      ated the Ambulatory Oncology Patient Satisfaction
system with a diagnosis of cancer, it is at a time when                  Survey (AOPSS) project to measure the experiences of
they face fear or uncertainty—they are ill, or are                       patients receiving cancer care on an outpatient basis.*
facing unknown recommendations (even for wellness                        The project strategy is designed to ensure that surveys
surveillance) that will have unknown consequences                        are conducted in a scientifically rigorous, coordinated
for their lives. The health care system can seem over-                   fashion across all six health authorities in BC. The
whelming, daunting, impersonal, and foreign. And                         project is guided by the Joint Ministry of Health/
patients are often beginning an intensive regime of                      Health Authority PREMS Committee, which has
interaction with the system. Understanding how the                       representation from each health authority, Providence
health care system responds to their needs provides                      Health Care, and the BC Ministry of Health.
critical information for health care managers and
providers, governments and the public.

* We have chosen to refer to the set of services that do not require patients to stay overnight in a health care facility as outpatient
  care in this report. The Canadian survey used to assess patient experiences with outpatient cancer care is entitled the Ambulatory
  Oncology Patient Satisfaction Survey (AOPSS).


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       Outpatient cancer care refers to care                                                 community chemotherapy centres, together with the
       that does not require patients to stay                                                Regional Cancer Centres, with facilitation by the BC
       overnight in a health care facility; for                                              Cancer Agency, to support delivery of high quality
       cancer care, it includes treatments such as
                                                                                             cancer care to patients and their families in the com-
       intravenous chemotherapy and radiation
                                                                                             munities where they live. All those involved in cancer
       therapy that are provided by cancer facilities
       on an outpatient basis, as well as ‘non-                                              care and treatment rely on provincial standards and
       intravenous’ therapy that patients use in                                             guidelines established by the Agency.
       their homes (e.g. pills, capsules, liquids,
       creams and injections) or receive in their                                            Given the enormous web of outpatient cancer care
       physician’s office (e.g. injections).                                                 services provided across Canada, the AOPSS was
                                                                                             developed to understand outpatient cancer care
BC health care facilities provide an enormous number                                         through the eyes of patients. The survey is a standard
and variety of cancer care services, both inpatient and                                      patient survey that has been used internationally and
outpatient, to cancer patients throughout the prov-                                          elsewhere in Canada; it was developed by the Picker
ince and beyond. In addition to interactions with care                                       Institute and validated for use in Canada (including
providers for diagnosis, therapy, and disease manage-                                        BC) by the National Research Corporation Canada
ment, these services include provision of radiation                                          (NRCC). The tool and data extract methodology
therapy and systemic (i.e. chemotherapy) treatments                                          have been used since March 2004 in eight Canadian
that can be delivered intravenously or in other forms                                        provinces (Alberta, British Columbia, Saskatchewan,
such as pills, capsules, liquids and injections. While                                       Manitoba, Ontario, Nova Scotia, PEI, and Quebec).
the BC Cancer Agency plays a primary role in the                                             The survey has been conducted twice in BC, first in
delivery and oversight of cancer services throughout                                         2005/06 and more recently in 2012/13. BC has used
the province, outpatient cancer services are provided                                        the same standardized survey tool in both cycles,
by a large number of facilities and providers (see                                           with some modifications and additional questions,
Appendix 1). These include the BC Cancer Agency                                              described below.
Regional Cancer Centres, which provide a full range
of radiation and systemic therapy (and are the only                                          BC’s 2005/06 and 2012/13 outpatient
locations where BC cancer patients can receive radia-                                        cancer care surveys
tion therapy); and community chemotherapy centres,                                           For both surveys, adults who received outpatient
which range from large full service hospital-based                                           cancer care over a six month period from one of the
centres that deliver outpatient oral and intravenous                                         BC facilities that deliver cancer services* were eligible
chemotherapy together with medical and nursing                                               to participate. Both surveys were restricted to BC
support, to small community chemotherapy ser-                                                patients who were over 18 years of age, were alive, had
vices that provide minimal services such as hospital                                         a known address, and who received active treatment
pharmacies that dispense drugs to treat cancer. The                                          during a defined six month window (in 2005/06, from
Communities Oncology Network is a collabora-                                                 November 15, 2005 to May 15, 2006; in 2012/13, from
tive voluntary partnership that includes a range of                                          June 15 to December 15, 2012).


* The facilities included differ slightly between 2005/06 and 2012/13. See Appendix 1 for a list of facilities included in the surveys.


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In both 2005/06 and 2012/13, surveys were admin-                         in the paragraph above) and to denote this similarity,
istered using a questionnaire that was mailed to the                     is sometimes referred to as the ‘replication group’.
patient’s home address. Patients could respond using
a paper and pencil, or a web-based version. Surveys                      In recent years approaches to treating cancer have
were available in a number of different languages:                       shifted from a reliance on radiation therapy and/or
English, French, Chinese and Punjabi in 2005/06; and                     IV chemotherapy (which must be administered in
in 2012/13, in all of those languages plus German.                       specialized facilities), to a variety of other treatments
While there was a major focus on making the two                          that include pills, capsules, liquids or creams, all of
surveys comparable, a number of changes were made                        which can be taken at home or administered in a doc-
to the 2012/13 survey. These are outlined below.                         tor’s office. Given the cancer care system’s increasing
                                                                         reliance on these additional approaches to treating
The 2005/06 survey was offered only to patients with                     cancer, a sample of patients who were receiving this
a primary diagnosis of cancer. In 2012/13, the survey                    type of outpatient treatment was added to the survey
was expanded to include patients who had a myelo-                        in 2012/13. This additional group, referred to as
proliferative blood disorder,* in addition to those                      those receiving only non-IV treatment modalities,†
with a primary diagnosis of cancer. The two surveys                      is an important new group in the 2012/13 survey.
therefore differ to some degree in terms of the types                    Treatment with non-IV chemotherapeutic agents
of patients who were eligible to participate, with the                   represents a significant change in the delivery of care,
2012/13 survey including this additional group                           and this group of patients is a growing segment of the
of patients.                                                             outpatient cancer treatment population. Given the fact
                                                                         that most of their care takes place away from cancer
A second difference in 2012/13 involved the expan-                       treatment centres, it is important to understand their
sion of the survey to include an even larger additional                  experiences with care. In summary, the 2012/13
group of patients, based on the type of cancer treat-                    survey therefore contains information for patients
ment they received. In 2005/06, the survey was                           who received three major types of treatment: radiation
restricted to the census of patients (i.e. all patients)                 therapy; IV chemotherapy; and non-IV therapy.
who received intravenous (IV) chemotherapy and/
or radiation therapy. This approach was repeated in                      The 2012/13 survey instrument was itself modified
2012/13. Once again, all patients who received IV che-                   in several ways. As in 2005/06, the survey used the
motherapy and/or radiation therapy during the time                       NRC Picker Canada AOPSS. Given earlier findings
of the survey were invited to participate. This subset                   of poor patient experiences in the area of emotional
of the 2012/13 survey respondents is comparable to                       support, newly developed ‘made-in-BC’ questions
those surveyed in 2005/06 (with the exception noted                      related to this area were added to the 2012/13 survey.



* Myeloproliferative blood disorders, a form of cancer of the blood, are sometimes treated by an oncologist, but more often treated
  by a hematologist. Patients with this condition are not always told they have a ‘cancer’, in spite of the fact that they receive
  intravenous chemotherapy drugs dispensed by the BC Cancer Agency.
†
  Non-intravenous treatment refers to a variety of treatments that patients may receive for cancer, including pills, capsules, liquids
  or creams used at home, injections at a doctor’s office, and injections that were administered by the patient or someone else in
  their home.


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In addition, new questions were also included for                                            The Canadian benchmarks
the newly added sample of patients receiving non-IV                                          Similar surveys were conducted in seven other
therapy. Language related to blood disorders was                                             Canadian provinces between January 2011 and
added to relevant questions, and additional changes                                          December 2012. To provide context for understand-
were made to 2005/06 survey items to align with                                              ing BC results, comparative national benchmark
changes made in other provinces, and findings from                                           scores (referred to as the Canadian benchmark) were
validation studies. Where questions were added or                                            developed for questions that were comparable across
changed, we have included them in this report with                                           surveys from these seven other provinces, and BC
notes to interpret findings with caution, recognizing                                        results were tested to see if they were statistically
that they are not strictly comparable to the                                                 different from these benchmark scores. A general
2005/06 results.                                                                             benchmark that included results for 19,333 patients
                                                                                             was developed for provincial and health authority
The BC survey involved a disproportional sampling                                            comparisons (with the exception of the Provincial
scheme, with questionnaires sent to all patients receiv-                                     Health Services Authority, see below). These patients
ing IV chemotherapy or radiation therapy, but to                                             come from a range of settings: three Alberta hospitals,
only a sample of patients receiving non-IV therapy.                                          the Saskatchewan Cancer Agency, Cancer Care Mani-
Overall, about 16% of all patients receiving non-IV                                          toba, 21 Ontario hospitals, three Quebec hospitals,
therapy were mailed questionnaires. These patients                                           Cancer Care Nova Scotia, and the Prince Edward
were sampled differentially, based on facility size,                                         Island Cancer Treatment Center. In most cases, ques-
resulting in large differences in sampling rates within                                      tions were identical for all patients. However, for some
this group. Sampling rates for the non-IV therapy                                            areas, questions related to radiation therapy were not
patients ranged from as low as two percent in the                                            relevant for all patients. In this case, a benchmark
largest regional cancer centre, to 100 percent in the                                        based on a smaller number of patients was developed;
11 smallest facilities. This disproportional sampling                                        where this occurred, footnotes are included.
scheme resulted in the need to use weights when con-
ducting any analyses involving the group of non-IV                                           A second comparative benchmark, the ‘Canadian
therapy patients, including analyses of the BC 2012/13                                       Regional Centres Average’, was developed to provide
overall survey results.* Using these weights adjusts                                         relevant comparisons for patients treated at more spe-
the disproportional sample so that it ‘looks’ like the                                       cialized facilities that provide a full range of radiation
results came from a random sample of the BC overall                                          and systemic therapy for cancer patients, such as the
population of all outpatient cancer patients, regardless                                     BC Cancer Agency Regional Cancer Centres; this was
of patient subgroup (3).                                                                     used to provide a comparable benchmark for patients
                                                                                             receiving care from the Provincial Health Services
                                                                                             Authority (PHSA), which is the health authority
                                                                                             that runs these Regional Cancer Centres. The 11,972




* Michael A. Murray PhD developed the sampling strategy and weighting scheme for the BC survey.


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patients included in this benchmark come from orga-                  This report relies on documents that contain the
nizations in two provinces: three Alberta hospitals and              results of data analyses undertaken by the National
21 Ontario hospitals.                                                Research Corporation Canada, which conducted
                                                                     the survey. While researchers at the UBC Centre for
It should be noted that while the surveys conducted in               Health Services and Policy Research ran some checks
other provinces are comparable, they differ from the                 on the analyses, we have not conducted these analyses
approach used in BC in a number of ways. Differ-                     ourselves and cannot attest to their validity.
ences include the frequency of conducting surveys,*
whether surveys are conducted at a single point in                   Presentation of results
time or over a longer time period, the type of out-                  In presenting the results of this work, we rely on
patient cancer patients that are included, and the                   graphical presentation of results accompanied by
specific questions that are used. Of particular impor-               explanatory text. In providing results for the 2012/13
tance for comparisons is the type of patients that                   survey, we typically present results for BC overall, but
are included. Some provinces only survey patients                    in some cases we report results for subgroups, either
seen at cancer centres, while others, like BC, survey                to ensure comparability with the 2005/06 survey, or
patients who receive services at local hospitals. BC is              to focus on differences in patient experience across
the only province to produce survey results that have                health authorities. When comparisons are made (for
been weighted to reflect the experiences of all cancer               example when BC results are compared to those from
patients receiving active treatment, including those                 the rest of Canada), we have provided information
receiving non-IV therapy. Since the composition of                   that indicates whether there are statistically significant
the Canadian benchmarks in relation to the types of                  differences at the 95 percent confidence level. Because
care that have been included is not well understood,                 of the very large sample sizes that form the basis of
and since non-IV therapy patients are less likely to be              many comparisons in this report, some of
represented in these benchmarks, comparisons to BC                   the results that are statistically significant involve
results must be interpreted with caution.                            actual differences in results that are very small. On the
                                                                     other hand, some large actual differences in results
About this report                                                    do not reach statistical significance; these in turn are
The purpose of this report is to compile a snapshot                  related to somewhat smaller sample sizes involved in
of what patients with cancer have to say about their                 some of the comparisons (for example those involv-
experiences with outpatient cancer care in BC in                     ing special groups of patients and issues of interest).
2012/13. Where possible, we provide BC results                       These issues are noted in introductory text for each of
(overall and for health authorities) in comparison                   the sections. In writing up results, we have focused on
to the Canadian benchmarks, which are based on                       areas where we believe that there are important con-
results from 2011 and 2012. We also include a special                clusions to be considered, and areas of special interest
section that reviews the extent to which there have                  and possible concern.
been changes in reported patient experiences between
2005/06 and 2012/13.


* Many other provinces survey more frequently than BC; some provinces conduct surveys in this area every one to two years.


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1. What did we learn? Findings from 2012/13
1.1 Characteristics of patients who                                                          Table 1: Number and percent of respondents or patients,
                                                                                             by age, sex, ethnicity, and type of cancer
responded to the survey                                                                                                                            # of   % of cancer
                                                                                                                                            respondents   outpatients*
In total, over 13,000 patients were mailed the BC
Outpatient Cancer Care survey. A total of 6,385 indi-                                          All categories                                    6,385          100.0

viduals provided responses, for an overall response                                                                   18-34 years                   44            0.6

rate of 48.7%. Response rates varied by the type                                                                      35-59 years                1,539           25.6
                                                                                               Age
                                                                                                                      60-75 years                3,191           45.6
of cancer treatment that patients received: for the
                                                                                                                      76+ years                  1,611           28.2
combined radiation therapy and IV chemotherapy
                                                                                                                      Female                     3,628           63.8
group (i.e. the ‘replication group’), the response rate                                        Sex
                                                                                                                      Male                       2,757           36.2
was 48.2%; and for the newly added non-IV therapy                                                                     White                      4,982           86.3
group, it was 50.0%. These response rates were compa-                                                                 Chinese                      311            5.6
rable to those from AOPSS surveys that took place in                                                                  South Asian                   78            1.8
                                                                                               Ethnicity,
other Canadian provinces in 2011 and 2012, for which                                           self-reported†         Aboriginal Person             93            1.1

response rates ranged from 44.0% in Alberta, to 65.8%                                                                 Other                        310            5.2

in Nova Scotia.                                                                                                       No response                  611              --

                                                                                                                      Breast                     1,614           42.5

                                                                                                                      Prostate                     911           22.0
The results presented in this section focus on describ-
                                                                                                                      Hematology (blood)           308            6.9
ing the experiences of all BC cancer patients who
                                                                                                                      Lymphoma                     463            4.3
received outpatient care, that is, the combined groups                                                                Lung                         363            4.3
of patients receiving IV chemotherapy, radiation                                                                      Colorectal                   356            3.6
therapy, or both, together with the new sample of                                              Primary                Cervix/Uterus/Ovary          247            2.6
                                                                                               type of cancer,
patients receiving non-IV therapy.                                                             self-reported‡
                                                                                                                      Brain                         75            1.5

                                                                                                                      Bowel                        105            1.3

Table 1 provides background information about the                                                                     Bladder                       95            1.2

                                                                                                                      Melanoma                      93            1.0
survey respondents, with the first column presenting
                                                                                                                      Neck                          75            0.8
unweighted numbers of respondents, and the second
                                                                                                                      Stomach                       42            0.6
column presenting weighted percentages (i.e. they
                                                                                                                      Head                          40            0.3
have been weighted to reflect the population of outpa-                                                                Kidney                        30            0.9
tient cancer patients in active treatment in 2012/13).                                                                Sarcoma                       27            0.3
Over 99% of outpatient cancer patients were 35 years                                                                  Testicular                     3            0.0

of age or older, and over 73% were 60 years of age                                                                    Other                        380            5.9

or older. The highest percentage of patients fell into                                                                Don’t Know                    21            0.2

                                                                                                                      No response                1,137              --


* Percentages are calculated using total number of respondents to each question (i.e. non-responders have been excluded from
    numerator and denominator), and have been weighted to represent the entire outpatient population of BC cancer patients for 2012/13.
†
    These results were provided in response to the question “The following question will help us better understand the communities we
    serve. Do you consider yourself to be … ? Aboriginal Person (e.g., North American Indian, Metis, Inuit (Eskimo)); White; Chinese;
    South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.); Black; Filipino; Latin American; Southeast Asian (e.g., Vietnamese,
    Cambodian, Malaysian, Laotian, etc.); Arab; West Asian (e.g., Iranian, Afghan, etc.); Korean; Japanese; or Other.”
‡
    These results were provided in response to the question “What was the primary type of cancer or blood disorder you were being
    treated for in the past 6 months?”


12
U B C c e n t r e f o r h e a lt h s e r v i c e s a n d p o l i c y r e s e a r c h




the age range of 60 to 75 years (45.6%), with smaller                Table 2: Number and percent of respondents or patients,
                                                                     by type and location of care
percentages in age groups 35 to 59 years (25.6%) and                                                                              # of       % of cancer
                                                                                                                           respondents       outpatients*
76 years and older (28.2%). A much higher percentage
of outpatient cancer patients were female than male                    All categories                                             6,385             100.0

(63.8% compared to 36.2%).                                                                     Radiation therapy
                                                                                               &/or IV chemo-
                                                                       Type of                 therapy (i.e. ‘repli-
                                                                                                                                  4,694              30.8
                                                                       cancer                  cation group’)
When asked to identify their ethnicity, the largest                    therapy
                                                                       received
percentage (86.3%) self-identified as ‘white’. The next                                        Non-IV therapy                     1,691              69.2

largest groups included: Chinese 5.6%, South Asian                                             Interior Health                       883             12.7

1.8%, and Aboriginal Person 1.1%. Smaller numbers                                              Fraser Health                         373              4.5

of other groups self-identified; they are included in the              Health                  Vancouver Coastal
                                                                                                                                     583              6.7
                                                                       authority               Health
category ‘other’ and represent 5.2 percent of outpatient               where cancer
                                                                       care received           Island Health                         608              8.6
cancer patients.
                                                                                               Northern Health                       390              3.5

                                                                                               PHSA                               3,548              63.9
When results from respondents are weighted to reflect
the results for BC cancer outpatients, breast (42.5%)
and prostate cancer (22.0%) were reported as the most                Across the province, the majority of BC cancer outpa-
frequent types of cancer. Together these patients rep-               tients received their care from PHSA facilities (63.9%),
resent 64.5% of cancer outpatients. The new category                 reflecting services provided by the BC Cancer Agency
of patients in the 2012/13 survey, those with myelo-                 through regional centres in Vancouver, Vancouver
proliferative blood disorder, appear in the category                 Island, the Fraser Valley, Abbotsford, the Southern
“Hematology (blood)”; they are the third largest group               Interior, and the North. Interior Health provided care
and represent 6.9% of BC cancer patients receiving                   to the next largest group (12.7%), while Northern
outpatient care.                                                     Health provided cancer services to the smallest per-
                                                                     centage (3.5%) of BC cancer outpatients.
In terms of the type of cancer therapy received (Table
2), while the vast majority of respondents (4,694)
received radiation therapy and/or IV chemotherapy,
when their numbers were weighted to reflect the
overall BC outpatient cancer population, they repre-
sented only 30.8% of cancer outpatients. In contrast,
when weights are applied to the 1,691 respondents
who received only non-IV therapy, they represented
the vast majority (69.2%) of BC cancer outpatients.




* Percentages are calculated using total number of respondents to each question (i.e. non-responders have been excluded from
  numerator and denominator), and have been weighted to represent the entire outpatient population of BC cancer patients for 2012/13.


                                                                                                                                                       13
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To describe other characteristics of survey respon-                                          or ‘poor’. Not surprisingly, cancer patients report lower
dents, information about health status, emotional                                            levels of health status in comparison to the general
status, and the amount of pain that BC cancer patients                                       Canadian population. In the 2012 CCHS, 59.9% of
experience is presented below. These results are                                             Canadians reported their health as ‘excellent’ or ‘very
based on reports from respondents. They have been                                            good’, in comparison to 36.5% of BC cancer patients
weighted to reflect responses from the entire popula-                                        and 38.0% of other Canadian cancer patients (4).
tion of BC cancer patients, and where possible, are
presented in comparison to Canadian benchmark                                                In terms of self-reported emotional health (Figure 2),
results. Because of the large sample sizes involved in                                       when positive responses (i.e. ‘excellent’, ‘very good’
comparisons, small differences are likely to achieve                                         or ‘good’)
                                                                                             Health     are among
                                                                                                     status combined,  86.5%
                                                                                                                   patients   of BC cancer
                                                                                                                            receiving      patients
                                                                                                                                      outpatient cancer                                       Overall ratin
                                                                                             care in BC, 2012/13, compared to Canadian benchmark                                              compared to
statistical significance and attention should be paid                                        rated their emotional health in this category. No
to the magnitude of differences. Results are also                                            Canadian benchmark is available for this question.                                               Individual quest
                                                                                             Individual question score                                                                        Overall quality
compared to reports from all Canadians in the 2012                                           Rating of health status
Canadian Community Health Survey (CCHS).                                                     AOPSS respondents were asked aboutBCthe amount of
                                                                                                                                       Canada                                                   58.5* 61.0
                                                                                             pain they had in the last six months. In response, a
Overall, BC cancer patients report better health in                                                                 42.4*
                                                                                             high percentage of respondents
                                                                                                                          38.1 reported having no
comparison to other Canadian outpatient cancer                                               pain over this28.7
                                                                                                            period
                                                                                                                28.8 (Figure 3). This response was

patients (Figure 1). They were more likely to report                                                                         16.9* 18.4
                                                                                             much higher for BC cancer outpatients than for those
                                                                                                7.8* 9.2                                                                    5.5
their health as falling into a positive category (i.e.                                       in other Canadian provinces. Moreover, fewer4.2*
                                                                                                                                          BC
‘excellent’, ‘very good’ or ‘good’) (78.9%) compared                                         cancer   patients
                                                                                               Excellent    Veryhad
                                                                                                                 goodpain that
                                                                                                                          Goodwas mild,
                                                                                                                                     Fairmoderate or
                                                                                                                                                Poor                                             Excellent

to their Canadian counterparts (76.1%), even though                                          severe in comparison to Canadian outpatient cancer
                                                                                                              Positive response                                                                                 Po
they were less likely to rate their health status as ‘excel-                                 patients. In comparison to the general Canadian pop-                                             * Statistically signi
lent’. They were less likely to report their health as ‘fair’                                ulation, cancer patients report higher levels of pain.
                                                                                             * Statistically significant difference from Canadian benchmark


                                                                                                                                                                                              Overall ratin
Health  status
Figure 1:      among
          Health statuspatients
                        among receiving   outpatient cancer
                                patients receiving                                            Overall
                                                                                             Figure 2: rating of among
                                                                                                        Emotionaloutpatient  cancer
                                                                                                                   healthpatients
                                                                                                                          among     care inreceiving
                                                                                                                                  patients  BC,  2012/13,                                     authorities,
                                                                                             Emotional   health                   receiving  outpatient
care in BC, cancer
outpatient  2012/13, compared
                   care         to Canadian
                        in BC, 2012/13,       benchmark
                                         compared  to                                         compared
                                                                                             outpatient   to Canadian
                                                                                                         cancer  care inbenchmark
                                                                                                                         BC,
                                                                                             cancer care in BC, 2012/13/13   2012/13
                                                                                                                                                                                              Individual quest
Canadian benchmark
                                                                                               Individual question score
                                                                                                                                                                                              Overall quality
Individual question score                                                                     Overall quality
                                                                                             Individual questionofscore
                                                                                                                    care in past six months
Rating of health status                                                                      Rating of emotional health*
                                                          BC           Canada                    58.5* 61.0                                              BC          Canada
                                                                                                                                                                                                      Vancouv
                                    42.4*
                                            38.1
                                                                                                                    36.4*
                    28.7 28.8                                                                                      29.6 28.7          31.2*

                                                     16.9* 18.4                                    18.9*
   7.8* 9.2                                                                                                                         9.4* 8.3          10.9*
                                                                       4.2* 5.5                                                                      2.1* 1.6          0.4
                                                                                                                                                                        2.5* 0.4              * Statistically signi
                                                                                                                                                                                              †
                                                                                                                                                                                                The PHSA score
   Excellent       Very good           Good               Fair            Poor                    Excellent
                                                                                                 Excellent        Verygood
                                                                                                                 Very  good           Good
                                                                                                                                     Good                Fair
                                                                                                                                                        Fair             Poor
                                                                                                                                                                        Poor                  centres. This bench



                Positive response                                                                              Positive response
                                                                                                              Positive response
                                                                                               * Statistically significant difference from Canadian benchmark                                 Overall ratin
*
* Statistically
   Statisticallysignificant difference
                   significant         from Canadian
                                  difference from thebenchmark
                                                      Canadian benchmark.                    *
                                                                                             * Statistically
                                                                                                A Canadian   significant difference
                                                                                                                 benchmark          from
                                                                                                                                is not   Canadian
                                                                                                                                       available asbenchmark
                                                                                                                                                    this is a ‘made-in-BC’ question           compared to
                                                                                                 added to the 2012/13 survey to better understand the area of emotional
                                                                                              Overall
                                                                                                support. rating of outpatient cancer care in BC and health   Individual quest
                                                                                              authorities, 2012/13, compared to Canadian benchmark           Providers did
Emotional health among patients receiving outpatient                                         Amount of pain among patients receiving outpatient
cancer
14     care in BC, 2012/13/13                                                                cancer   care
                                                                                              Individual     in BC,
                                                                                                         question    2012/13, compared to Canadian benchmark
                                                                                                                  score
                                                                                               Overall quality of care in past six months                                                                       8
                                                                                                                                                                                                  85.0*
Individual question score                                                                    Individual question scoreBC
                                   *                                                                                                                                                  97.5*
Interior                                                     97.1
                                                                                                                   Fraser                                                   94.9*
                                                                                                   Vancouver Coastal                                                         97.8
                                                                                 U B C c e n t r e f o r h e a lt hIsland
                                                                                                                      services and policy research                          96.2*
                       36.4*                                                                                  Northern                                                      95.5*
                                         31.2*                                                                      PHSA                                                     98.0†
     18.9*
                                                                                                              Canada                                                         98.0
                                                         10.9*
                                                                         2.5*            * Statistically significant difference from Canadian benchmark
                                                                                         †
                                                                                           The PHSA score is better compared to a Canadian benchmark that includes only regional
   Excellent        Very good            Good              Fair          Poor            centres. This benchmark is
In the 2012 CCHS, 14.2% of Canadians reported pain                                     specialist as the person most involved in treatment
levels as ‘moderate’     or ‘severe’, in comparison to 28.6%
            Positive response                                                          planning (72.6% vs. 80.4%) and more likely to identify
of BC cancer patients and 36.2% of other Canadian                                      aOverall rating of
                                                                                        family doctor     outpatient
                                                                                                        (6.4%        cancer
                                                                                                              vs. 2.5%) or a care in BC,
                                                                                                                             surgeon     2012/13,
                                                                                                                                      (18.4%
* Statistically significant difference from Canadian benchmark                           compared to Canadian benchmark
cancer patients (4).                                                                   vs. 15.1%) as playing that role. They were more likely
                                                                                         Individual question score
                                                                                       toProviders
                                                                                           have seen    only one to
                                                                                                   did everything doctor   in the past disorder
                                                                                                                    treat cancer/blood six months
Amount
Figure 3: of pain among
          Amount    of painpatients
                            among receiving   outpatient
                                    patients receiving
cancer carecancer
             in BC, care
                    2012/13, compared
                                                               (39.2% vs. 26.4%) and less likely to have had one or
outpatient               in BC, 2012/13,tocompared
                                            Canadiantobenchmark
Canadian benchmark                                             more hospital
                                                                          89.7stays (19.9% vs. 34.1%).
                                                                                             85.0*
Individual question score
                                                                                                                                                   BC         Canada
Amount of pain in last 6 months                                                        The remainder of this report will focus on provid-
                                                          BC        Canada             ing results of the 2012/13 survey. Section 1 presents
   51.5*
                                                                                       findings for the entire set of 6,385 respondents and
            37.4                                                                       therefore reports on the combined experiences of
                                  26.4
                        19.9*                 20.8*
                                                        24.8                           those who received any of three types of cancer
                                                                                                            13.5*
                                                                                                                                       9.2
                                                                  7.8*
                                                                          11.4         treatment (radiation therapy, IV chemotherapy,
                                                                                                                              1.5*
                                                                                                                                      and
                                                                                                                                      1.1
                                                                                       non-IV  therapy) across
                                                                                         Yes, completely
                                                                                                               all age and sex categories.
                                                                                                            Yes, somewhat            No
     No pain in              Mild                Moderate           Severe
    last 6 mos.
                                                                                       Results are presented for the outpatient cancer popu-
                                                                                       lation  overall
                                                                                           Positive       and by the health authority from which
                                                                                                    response
* Statistically significant difference from Canadian benchmark
* Statistically significant difference from the Canadian benchmark.                    cancer      care was received. Where relevant, compari-
                                                                                        * Statistically significant difference from Canadian benchmark


                                                                                       sons are made to the Canadian benchmark results.

In summary, BC cancer outpatients report better                                          Overall rating of outpatient cancer care in BC and health
                                                                                       Section 2 focuses
                                                                                        authorities,     on comparing
                                                                                                     2012/13,           results
                                                                                                              compared to       frombenchmark
                                                                                                                          Canadian  the
health status and lower levels of pain when compared
                                                                                       2005/06     and 2012/13 surveys. It therefore includes
to patients who responded to the outpatient cancer                                      Individual question score
                                                                                       only  the ‘replication
                                                                                        Providers did everythinggroup’
                                                                                                                 to treatfrom  2012/13disorder
                                                                                                                          cancer/blood  (i.e. only
survey in other provinces.
                                                                                       those respondentsBC
                                                                                                         who received IV chemotherapy                                85.0*
                                                                                       and/or radiation  treatment).
                                                                                                      Interior                                  85.2*
Responses to other survey questions also indicate                                                        Fraser                                84.5*
that BC patients differ from patients included in the                                        Vancouver Coastal                                     92.9*
                                                                                       An additional report,
                                                                                                         Island to follow, will focus on issues of
                                                                                                                                                86.6*
Canadian benchmark. For example, in comparison to                                                    Northern                                   86.4*
                                                                                       special interest, including
                                                                                                          PHSA
                                                                                                                     the experiences of non-IV 84.0†
other Canadian respondents to the survey, BC cancer
                                                                                       therapy patients and Aboriginal cancer patients, and 89.7
outpatients were more likely to have first been told of                                              Canada
                                                                                       understanding issues related to emotional support in
their diagnosis one or more years ago (76.8% BC vs.                                      * Statistically significant difference from Canadian benchmark
                                                                                       greater depth.
43.3% Canadian benchmark)—that is, they had been
living with a cancer diagnosis for a longer period of
time before responding to the survey. They were more                                     Overall rating of outpatient cancer care in BC, 2012/13

likely to have been told of their diagnosis by a family                                  Individual question score
                                                                                         Would recommend hospital to family/friends
doctor (41.5% vs. 30.1%) or cancer specialist (37.3%
vs. 25.7%), and less likely to have heard this news from                                                        81.6

a surgeon (15.7% vs. 31.2%). In terms of their care pat-
terns, BC patients were less likely to identify a cancer


                                                                                                                                                                       15
                                                                                                                                16.9

                                                                                                                                                1.4
Pat i e n t E x p e r i e n c e s w i t h o u t pat i e n t c a n c e r c a r e i n b r i t i s h c o l u m b i a , 2 0 1 2 / 1 3




                  1.2 Overall evaluations of care                                                               In comparison with the Canadian benchmark, there
                  There are many ways to report patients’ overall evalu-                                        were interesting differences in the manner in which
                  ations of the care they receive. Several key approaches                                       BC residents reported their care. In terms of positive
                  are presented in this section, and the results are sum-                                       responses, BC residents were slightly less likely to rate
                  marized at the end of the section.                                                            their care as ‘excellent’ in comparison to other Cana-
                                                                                                                dians (58.5% vs. 61.0%), equally likely to rate their
                  Overall evaluations of care based on ‘overall                                                 care as ‘very good’, and more likely to rate their care as
                  rating’ question                                                                              ‘good’ (9.4% vs. 8.3%). In terms of negative responses,
                  The first approach used an ‘overall rating’ question to                                       BC residents were more likely to assign a rating of
                  ask patients to think about the outpatient care in the                                        ‘fair’ (2.1% vs. 1.6%) and equally likely to assign a
                  facilitystatus
                 Health      whereamong
                                      they received
                                            patientstreatment
                                                      receiving in the preced-
                                                                outpatient  cancer                              rating
                                                                                                                Overallofrating
                                                                                                                          ‘poor’of
                                                                                                                                . outpatient cancer care in BC, 2012/13,
                 care   in BC,  2012/13,   compared    to Canadian
                  ing six months, and to rate that care as falling  benchmark
                                                                        into                                    compared to Canadian benchmark

                  one of five categories: ‘excellent’, ‘very good’, ‘good’,                                     Figure
                                                                                                                Individual5question
                                                                                                                            presentsscoreresponses to the ‘overall rating’ ques-
                 Individual question score                                                                      Overall quality of care in past six months
                  ‘fair’ or
                 Rating      ‘poor’.status
                          of health   This question is regarded as a standard                                   tion using a format that better facilitates comparisons
                  approach to measuring patient satisfaction. Responses                                         and reporting over multiple jurisdictions. For Canada
                                                                                                                                                               this
                                                              BC       Canada                                     58.5* 61.0                          BC
                  from the 2012/13 survey’s 6,385 respondents are out-                                          graph, overall percent positive scores were created by
                  lined in Figure 4.           42.4*
                                                     38.1                                                       summing ‘excellent’, ‘very good’, and ‘good’ categories.
                                     28.7 28.8                                                                  Tests for statistical differences were conducted by
                                                                                                                               29.6 28.7

                  Just over 58% of BC patients rated16.9*
                                                     their18.4
                                                            outpatient                                          testing for differences from the Canadian benchmark.
                    7.8* 9.2                                                                                                                          9.4* 8.3
                  care in the facility where they received treatment
                                                                 4.2* as
                                                                       5.5                                      As a reminder, this question asks patients
                                                                                                                                                   2.1* 1.6to think
                                                                                                                                                                0.4 0.4
                  ‘excellent’
                    Excellent (58.5%),
                                Very good29.6%Good
                                               rated it as ‘very
                                                            Fair good’,Poor
                                                                        and                                     about  the outpatient
                                                                                                                  Excellent  Very good care Good
                                                                                                                                            in the facility
                                                                                                                                                          Fairwhere they
                                                                                                                                                                      Poor
                  9.4% as ‘good’. Two percent (2.1%) rated their care as                                        received treatment in the preceding six months. It
                                 Positive response                                                                              Positive response
                  ‘fair’ and 0.4% as ‘poor’.                                                                    reports results for all patients (including those who
                                                                                                                * Statistically significant difference from Canadian benchmark
                 * Statistically significant difference from Canadian benchmark
patient cancer    Overall4:rating
                  Figure          ofrating
                            Overall  outpatient  cancer care
                                           of outpatient     in BC,
                                                         cancer care2012/13,
                                                                     in BC,                                     Figure 5: Overall rating of outpatient cancer care in BC
benchmark         compared    to Canadian  benchmark
                  2012/13, compared to Canadian benchmark                                                       Overall
                                                                                                                and     rating
                                                                                                                    health     of outpatient
                                                                                                                            authorities,       cancer
                                                                                                                                         2012/13,     care in to
                                                                                                                                                  compared    BCCanadian
                                                                                                                                                                 and health
                                                                                                                authorities, 2012/13, compared to Canadian benchmark
                                                                                                                benchmark
                 Emotional     health
                  Individual question    among patients receiving outpatient
                                      score
                 cancer
                  Overall care   inof
                           quality  BC,  2012/13/13
                                       care in past six months                                                  Individual question score
                                                                                                                Overall quality of care in past six months

   Canada           58.5* 61.0
                 Individual question score                                   BC          Canada
                                                                                                                                           BC                                                         97.5*
                 Rating of emotional health*
                                                                                                                                 Interior                                                             97.1
                                                                                                                                   Fraser                                                            94.9*
                                      29.6 28.7                                                                        Vancouver Coastal                                                              97.8
                                                                                                                                   Island                                                            96.2*
                                        36.4*                                                                                  Northern                                                              95.5*
                                                         31.2*8.3
                                                        9.4*                                                                        PHSA                                                              98.0†
   4.2* 5.5                                                              2.1* 1.6         0.4     0.4
                      18.9*
                                                                                                                                     Canada                                                            98.0
     Poor            Excellent        Very good           Good              Fair
                                                                          10.9*             Poor
                                                                                           2.5*                 * Statistically significant difference from Canadian benchmark
                                                                                                                †
                                  Positive response                                                             * The   PHSA scoresignificant
                                                                                                                    Statistically   is better compared  to afrom
                                                                                                                                                difference   Canadian benchmark benchmark.
                                                                                                                                                                 the Canadian   that includes only regional
                    Excellent        Very good          Good                Fair           Poor                 †centres.
                                                                                                                    The This
                                                                                                                          PHSAbenchmark is
                                                                                                                                  score is compared to a Canadian benchmark that includes
                  * Statistically significant difference from Canadian benchmark                                    only regional cancer centres. This benchmark is 98.2%, and the compa-
                                                                                                                    rision is not statistically significant.
                  * Statistically significant difference from the Canadian benchmark.
                                Positive response

                  Overall rating of outpatient cancer care in BC and health                                     Overall rating of outpatient cancer care in BC, 2012/13,
                 * Statistically significant difference from Canadian benchmark
                  authorities, 2012/13, compared to Canadian benchmark                                          compared to Canadian benchmark
outpatient
                   Individual question score                                                                    Individual question score
                  1Overall
                     6      quality of care in past six months                                                  Providers did everything to treat cancer/blood disorder
                 Amount of pain among patients receiving outpatient
                 cancer care in BC, 2012/13, compared to Canadian benchmark
                                             BC                                                         97.5*
                                                                                                                                89.7
Island                                                            96.2*
                                                                                                              Fraser                                                            94.9*
                       36.4*                                                                              Northern                                                              95.5*
                                        31.2*                                                  Vancouver Coastal                                                                 97.8†
                                                                                                               PHSA                                                              98.0
                                                                                                              Island                                                            96.2*
     18.9*                                                                     U B C c e n t r e f o r h e a lt h s e r v i c e s a n d p o l i c y r e s e a r c h
                       36.4*                                                                              Northern
                                                                                                            Canada                                                              95.5*
                                                                                                                                                                                 98.0
                                        31.2*            10.9*                                                 PHSA                                                              98.0†
                                                                      2.5*             * Statistically significant difference from Canadian benchmark
     18.9*                                                                             †
                                                                                                                Canada
                                                                                         The PHSA score is better                                                             98.0
                                                                                                                      compared to a Canadian benchmark that includes only regional
   Excellent        Very good          Good              10.9*
                                                          Fair        Poor             centres. This benchmark is
                                                                      2.5*             * Statistically significant difference from Canadian benchmark
                                                                                       †
                                                                                         The PHSA score is better compared to a Canadian benchmark that includes only regional
   Excellent Positive
                Very response
                      good             Good                Fair       Poor             centres. This benchmark is

 received radiation therapy, IV chemotherapy, and                                      Overall
                                                                                       Figure 6:rating of rating
                                                                                                  Overall  outpatient cancer care
                                                                                                                 of outpatient    in BC,
                                                                                                                               cancer care2012/13,
                                                                                                                                           in BC,
* Statistically significant difference from Canadian benchmark                         compared    to Canadian   benchmark
                                                                                       2012/13, compared to Canadian benchmark
                Positive response
 non-IV therapy) who responded in 2012/13.                                             Overall rating of outpatient cancer care in BC, 2012/13,
                                                                                       Individual question score
* Statistically significant difference from Canadian benchmark                         compared to Canadian benchmark
                                                                                       Providers did everything to treat cancer/blood disorder
Amount of pain among patients receiving outpatient
 Using a test of statistical significance, overall percent
cancer care in BC, 2012/13, compared to Canadian benchmark Individual question score
 positiveof
Amount    scores
            pain were
                 amonglower  for BC
                         patients    patientsoutpatient
                                  receiving   in com-                                  Providers did everything to treat cancer/blood disorder
                                                                                                        89.7
                                                                                           85.0*
 parison
cancer   to in
       care other
               BC, Canadians,  but the to
                   2012/13, compared
Individual question score              actual  magnitude
                                          Canadian  benchmark
                                                                                                                                                   BC            Canada
Amount  of pain in last 6 months                                                                        89.7
 of the difference   was   very small (97.5% vs. 98.0%).                                   85.0*
 Patients in three of BC’s health authorities
Individual question score             BC      had
                                                Canada                                                                                             BC            Canada
Amount of pain in last 6 months
  51.5*
 statistically significant lower ratings in comparison
                                                          BC        Canada
 to51.5*
     patients
         37.4 responding to the survey in the rest of

 Canada, but again
               19.9*
                    the26.4
                         actual20.8*
                                magnitudes
                                     24.8  of the differ-                                                                13.5*
            37.4
                                                                                                                                      9.2
 ence were small (Fraser
                     26.4
                          Health 94.9%, Island Health
                                            7.8*
                                                 11.4
                                                                                                                                                        1.5*          1.1
                                                        24.8
              19.9* Health20.8*
 96.2%, and Northern       95.5% vs. 98.0% for the                                                                       13.5*
                                                                                           Yes, completely                        9.2
                                                                                                                         Yes, somewhat                         No
   No pain in       Mild                        Moderate                11.4
                                                                    Severe
 Canadian
  last 6 mos.
              benchmark).                                         7.8*                                                                                  1.5*          1.1
                                                                                           Yes, completely
                                                                                           Positive response             Yes, somewhat                         No
   No pain in    Mild                           Moderate            Severe
* Statistically significant difference from Canadian benchmark                         * Statistically significant difference from Canadian benchmark
  last 6 mos.
 Overall evaluations                      of care based on ‘providers
                                                                                       * Positive response
                                                                                         Statistically significant difference from the Canadian benchmark.
 did      everything’              question
* Statistically significant difference from Canadian benchmark                         * Statistically significant difference from Canadian benchmark
 Other questions on the survey also provide additional
                                                                                       Overall rating of outpatient cancer care in BC and health
 perspective on the overall experience of patients.                                    authorities, 2012/13, compared to Canadian benchmark
                                                                                       Figure 7: Overall rating of outpatient cancer care in BC
 Responses to a question asking patients to assess                                     Overall
                                                                                       and health rating   of outpatient
                                                                                                      authorities,  2012/13,cancer  care in BC
                                                                                                                                compared       and health
                                                                                                                                            to Canadian
                                                                                       Individual question score
 whether providers did everything to treat their cancer/                               authorities,
                                                                                       benchmark
                                                                                       Providers        2012/13,  compared     to Canadian    benchmark
                                                                                                   did everything to treat cancer/blood disorder
 blood disorder show that 85.0% of respondents replied                                 Individual question score
                                                                                                                   BC                                                       85.0*
                                                                                       Providers did everything to treat cancer/blood disorder
 ‘yes, completely’, while 13.5% replied ‘yes, somewhat’                                                  Interior                                                           85.2*
 and only 1.5% replied ‘no’ (Figure 6). These responses                                                    Fraser
                                                                                                               BC                                                           84.5*
                                                                                                                                                                            85.0*
                                                                                               Vancouver Coastal                                                                92.9*
                                                                                                         Interior                                                           85.2*
 were different from the Canadian benchmark, with                                                          Island                                                            86.6*
                                                                                                                                                                            84.5*
                                                                                                           Fraser
                                                                                                       Northern                                                              86.4*
 the percent of BC patients answering ‘yes completely’                                         Vancouver Coastal                                                                92.9*
                                                                                                            PHSA                                                            84.0†
                                                                                                           Island                                                            86.6*
 almost 5 percentage points lower.                                                                     Northern                                                              86.4*
                                                                                                         Canada                                                               89.7
                                                                                                            PHSA                                                            84.0†
                                                                                       * Statistically significant difference from Canadian benchmark
 When ‘completely’ positive responses are compared                                                           Canada                                                           89.7

 across BC and health authorities, important differ-                                   * Statistically significant difference from Canadian benchmark
                                                                                       * Statistically significant difference from the Canadian benchmark.
 ences are seen (Figure 7). Percent positive responses                                 † The PHSA score is compared to a Canadian benchmark that includes
                                                                                       Overall     rating of outpatient cancer care in BC, 2012/13
                                                                                          only regional cancer centres. This benchmark is 89.8%, and the compa-
 range from 84.0% to 92.9% across health authorities,                                     rision is statistically significant.
                                                                                       Individual question score
 in comparison to the Canadian benchmark of 89.7%.                                     Overall rating of outpatient cancer care in BC, 2012/13
                                                                                       Would recommend hospital to family/friends
 Most health authorities have responses that are low in                                Individual question score
                                                                                                     81.6
 comparison to the Canadian benchmark. The excep-                                      Would recommend hospital to family/friends

 tion is Vancouver Coastal Health, with an extremely                                                            81.6
 high score of 92.9%.



                                                                                                                               16.9

                                                                                                                                                1.4                            17
                                                                                                                               16.9
                                                                                                              Yes,             Yes,             No
                                                                                                            definitely       probably           1.4
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