Patient Satisfaction: An Increasingly Important Measure of Quality

There has been an ongoing national effort to improve the quality of health care. In accordance with a popular model described by Donabedian, quality measures should address three areas for improvement: structural items (environment within which care is delivered), processes of care (professional activities associated with providing care), and outcomes (changes in the patient s current and future health status as a result of care). Recently, some groups, including the National Quality Forum and the National Comprehensive Care Network, have been working to identify processes of care to help improve the quality of cancer care. As these quality measures in cancer care are identified, they likely will be added to the growing list of ‘‘pay for performance’’ process measures used by the Centers of Medicare and Medicaid Services and other payers. Patient satisfaction, although not specific to cancer, is also being used as a measure of quality health care. Patient satisfaction can be evaluated concerning all three items of the Donabedian model and is, in large part, influenced by the providers of health care. Currently, employers publish patient satisfaction surveys to help employees choose a health plan. Some organizations are linking patient satisfaction with physician income. Obviously, patient satisfaction is a very complex entity that is dependent on patient demographics, comorbidities, disease, and, to a large extent, patient expectations. Whether or not one agrees with ‘‘patient satisfaction’’ as a valid measure of quality, it is already being used as such. Therefore, it behooves the surgeon to understand the variables that determine patient satisfaction because in the near future, not only may the economics of our care become more determined by it, but also the public is becoming increasingly aware of, appreciative of, and likely insistent on satisfaction scores. As surgeons, we have a natural bias that our patient s satisfaction, along with our own, is tied to surgical or physical outcome. Surgeons experience satisfaction when, for example, an operation is performed without incident or the patient goes home earlier than expected. Although our satisfaction as surgeons may be at times congruent with a patient s, projection of our satisfaction onto the patient may not necessarily be correct. Rather, most believe that patient satisfaction is inherently tied to a patient s expectations. It follows that patients would be more satisfied if we were able to help manage and shape their expectations in a more realistic manner. Obviously, knowledge and understanding of an individual patient s expectations are necessary before we can address them. In this issue of Annals of Surgical Oncology, Avery et al. investigate patient satisfaction in patients undergoing either curative or palliative surgical treatment of esophageal or gastric cancer. A consecutive cohort of patients was polled after discharge from the hospital by using the European Organization for Research and Treatment of Cancer (EORTC IN-PATSAT32) questionnaire to measure their satisfaction relative to treatment, surgical morbidity, Received January 9, 2006; accepted January 11, 2006; published online April 13, 2006. Address correspondence and reprint requests to: Clifford Y. Ko, MD, MS, MSHS; E-mail: cko@mednet.ucla.edu.