Technical Information

Percent of positive responses for six dimensions of outpatient care, fiscal year 2013/14 to 2015/16

Figure 1

Consistent review of the six dimensions over time to examine whether there has been change in the results.

• Findings from the literature indicate the importance of these six dimensions from the patients’ point of view. These dimensions are based on a large study with thousands of patients in the US.
• The results of the Ambulatory Patient Satisfaction Survey (AOPSS) are compared with other provinces using the same tool; and reported on by CPAC. No benchmarking has been done by CPAC.

Ontario compares favorably with other provinces; but there are consistently lower scores in relation to Emotional Support across the country.

​Rate=Number of Positive Responses/ Number of Responses x 100%

N/A

Percentage

Ambulatory Oncology Patient Satisfaction Survey (AOPSS) – National Research Corporation Canada (NRCC)

All available data from the selected period will be reported:

For CY 2014 – April 1, 2014 to December 31, 2014 data is available

For CY 2015 – January 1, 2015 to December 31, 2015 data is available

For CY 2016 (by January 2017) – January 1, 2016 to June 30, 2016 data will be available

Provincial

Emotional Support Dimension

Number of responses = Sum of number of “Yes, completely” responses, number of “Yes, somewhat” responses, and number of “No” responses for below questions:

• Q4. Were you told of your diagnosis in a sensitive manner?
• Q50. Did you get enough information about possible changes in your sexual activity?
• Q51. Did you get enough information about possible changes in your emotions?
• Q53. Did you get enough information about possible changes in your relationship with your spouse or partner?
• Q76. Did a care provider go out of his or her way to help you or make you feel better?

 Number of responses = sum of number of “Yes” responses and number of “No” responses for below questions

• Q5. When you were first told of your illness, were you referred to a provider who could help you with anxieties and fears?
• Q67. In the past 6 months, has someone at Alpha Hospital put you in touch with other care providers who could help you with anxieties & fears?

Number of responses = sum of number of “Always” responses, number of “Usually” responses, number of “Sometimes” responses, and number of “Never” responses for below questions:

• Q75. Did you get as much help as you wanted in figuring out how to pay for any extra costs for your cancer care?

Coordination & Continuity of Care Dimension

Number of responses = sum of number of “Yes, completely” responses, number of “Yes, somewhat” responses, and number of “No” responses for below questions:

• Q12. Do you think the care providers knew enough about therapies for treating cancer?
• Q66. Did you know who was in charge of your care for each of your therapies?
• Q77. If you had a visit with your family doctor in the past 6 months, did you feel your family doctor knew enough about your cancer care?

Number of responses = sum of number of “Always” responses, number of “Usually” responses, number of “Sometimes” responses, and number of “Never” responses for below questions:

• Q68. How often were your care providers familiar with your medical history?
• Q69. How often were your care providers aware of your test results?
• Q70. How often were you given confusing or contradictory information about your health or treatment?
• Q71. How often did you know who to ask when you had questions about your health problems?
• Q72. How often did you know what the next step in your care would be?

Respect for Patient Preferences Dimension

Number of responses = sum of number of “Yes, completely” responses, number of “Yes, somewhat” responses, and number of “No” responses for below questions:

• Q9. Were you involved in decisions about your care as much as you wanted?
• Q10. Did your care providers take your family or living situation into account in planning for your treatment?
• Q57. Did you feel comfortable talking with your care providers about complementary, alternative, or nontraditional therapies?
• Q73. Did you feel you could trust your care providers with confidential information?
• Q74. Did your care providers treat you with dignity and respect?

Number of responses = sum of number of “Right amount” responses, number of “Not enough” responses, and number of “Too much” responses for below question:

• Q11. How much opportunity did your care providers give your family or friends to be involved in your care and treatment?

Physical Comfort Dimension

Number of responses = sum of number of “Yes, completely” responses, number of “Yes, somewhat” responses, and number of “No” responses for below questions:

• Q38. Did a care provider tell you how to manage any side effects of IV chemotherapy?
• Q39. Do you think your care providers did everything they could to help you with your IV chemotherapy side effects?
• Q45. Did a care provider tell you how to manage any side effects of radiation therapy?
• Q46. Do you think your care providers did everything they could to help you with your radiation therapy side effects?
• Q48. Do you think your care providers did everything they could to control your pain or discomfort?

Information, Communication & Education Dimension

Number of responses = sum of number of “Yes, completely” responses, number of “Yes, somewhat” responses, and number of “No” responses for below questions:

• Q7. Did someone discuss different treatments for your cancer with you?
• Q8. Were you given enough information about therapies for treating cancer?
• Q13. If you had questions about clinical trials or new treatments for your cancer, did you feel comfortable talking with the staff about them?
• Q15. If you had to wait for your first consultation appointment with your care providers, did someone explain why?
• Q17. Did your care provider explain why you needed tests in a way you could understand?
• Q49. Did you get enough information about possible changes in your physical appearance?
• Q52. Did you get enough information about your nutritional needs?
• Q54. Did you get enough information about possible changes in your work or usual activities?
• Q55. Did you get enough information about possible changes in your energy/fatigue level?

Number of responses = sum of number of “Yes, completely” responses, number of “Yes, somewhat” responses, number of “No” responses, and number of “Never received results” responses for below question:

• Q18. After the tests were done, did someone explain the results in a way that you could understand?

Access to Care Dimension

Number of responses = Yes, completely” responses, number of “Yes, somewhat” responses, and number of “No” responses for below questions:

• Q14. After you knew what your treatment was going to be, do you feel you had to wait too long to get your first appointment for treatment?
• Q16. If you had to travel for any tests or treatments, did your care providers consider your travel concerns when planning for your treatment?
• Q37. If you had to wait for IV chemotherapy, do you think your care providers did everything they could to make you feel comfortable?Q44. If you had to wait for your radiation treatment, do you think your care providers did everything they could to make you feel comfortable?
• Q86. In the past 6 months, did you receive all of the services you thought you needed for your cancer treatment?

Number of responses = sum of number of “Always” responses, number of “Usually” responses, number of “Sometimes” responses, and number of “Never” responses for below questions:

• Q36. How often did you wait longer than expected for your IV chemotherapy treatment?
• Q43. How often did you wait longer than expected for your radiation treatment?

Exclusion criteria:

• Deceased patients
• Patients less than 18 years of age
• Patients who do not have confirmed cancer diagnosis
• Patients who received only inpatient services
• The numbers of the following responses, for the given questions, are not included in the calculation (numerator or denominator):

Emotional Support Dimension

Number of positive responses = number of “Yes, completely” responses for these questions:

• Q4. Were you told of your diagnosis in a sensitive manner?
• Q50. Did you get enough information about possible changes in your sexual activity?
• Q51. Did you get enough information about possible changes in your emotions?
• Q53. Did you get enough information about possible changes in your relationship with your spouse or partner?
• Q76. Did a care provider go out of his or her way to help you or make you feel better?

Number of positive responses = number of “Yes” responses for these questions:

• Q5. When you were first told of your illness, were you referred to a provider who could help you with anxieties and fears?
• Q67. In the past 6 months, has someone at Alpha Hospital put you in touch with other care providers who could help you with anxieties and fears?

Number of positive responses = number of “Always” responses for this question?

• Q75. Did you get as much help as you wanted in figuring out how to pay for any extra costs for your cancer care?

Coordination & Continuity of Care Dimension

Number of positive responses = number of “Yes, completely” responses for these questions:

• Q12. Do you think the care providers knew enough about therapies for treating cancer?
• Q66. Did you know who was in charge of your care for each of your therapies?
• Q77. If you had a visit with your family doctor in the past 6 months, did you feel your family doctor knew enough about your cancer care?

Number of positive responses = number of “Always” responses for these questions:

• Q68. How often were your care providers familiar with your medical history?
• Q69. How often were your care providers aware of your test results?
• Q71. How often did you know who to ask when you had questions about your health problems?
• Q72. How often did you know what the next step in your care would be?

Number of positive responses = number of “Never” responses for this question:

• Q70. How often were you given confusing or contradictory information about your health or treatment?

Respect for Patient Preferences Dimension

Number of positive responses = number of “Yes, completely” responses for these questions:

• Q9. Were you involved in decisions about your care as much as you wanted?
• Q10. Did your care providers take your family or living situation into account in planning for your treatment?
• Q57. Did you feel comfortable talking with your care providers about complementary, alternative, or nontraditional therapies?
• Q73. Did you feel you could trust your care providers with confidential information?
• Q74. Did your care providers treat you with dignity and respect?

Number of positive responses = number of “Right amount” responses for this question:

• Q11. How much opportunity did your care providers give your family or friends to be involved in your care and treatment?

Physical Comfort Dimension

Number of positive responses = number of “Yes, completely” responses for all questions

• Q38. Did a care provider tell you how to manage any side effects of IV chemotherapy?
• Q39. Do you think your care providers did everything they could to help you with your IV chemotherapy side effects?
• Q45. Did a care provider tell you how to manage any side effects of radiation therapy?
• Q46. Do you think your care providers did everything they could to help you with your radiation therapy side effects?
• Q48. Do you think your care providers did everything they could to control your pain or discomfort?

Information, Communication, Education Dimension

Number of positive responses = number of “Yes, completely” responses for all questions

• Q7. Did someone discuss different treatments for your cancer with you?
• Q8. Were you given enough information about therapies for treating cancer?
• Q13. If you had questions about clinical trials or new treatments for your cancer, did you feel comfortable talking with the staff about them?
• Q15. If you had to wait for your first consultation appointment with your care providers, did someone explain why?
• Q17. Did your care provider explain why you needed tests in a way you could understand?
• Q18. After the tests were done, did someone explain the results in a way that you could understand?
• Q49. Did you get enough information about possible changes in your physical appearance?
• Q52. Did you get enough information about your nutritional needs?
• Q54. Did you get enough information about possible changes in your work or usual activities?
• Q55. Did you get enough information about possible changes in your energy/fatigue level?

Access to Care Dimension

Number of positive responses = number of “Yes, completely” responses for these questions:

• Q16. If you had to travel for any tests or treatments, did your care providers consider your travel concerns when planning for your treatment?
• Q37. If you had to wait for IV chemotherapy, do you think the staff did everything they could to make you feel comfortable?
• Q44. If you had to wait for your radiation therapy treatment, do you think the staff did everything they could to make you feel comfortable?
• Q86. In the past 6 months, did you receive all of the services you thought you needed for your cancer treatment?

Number of positive responses = number of “No” responses for this question:

• Q14. After you knew what your treatment was going to be, do you feel you had to wait too long to get your first appointment for treatment?

Number of positive responses = number of “Never” responses for these questions:

• Q36. How often did you wait longer than expected for your chemotherapy treatment?
• Q43. How often did you wait longer than expected for your radiation treatment?

N/A

• Included in the analysis are patients who, at the time of the survey, had received cancer services in the previous six months
• Patients may not remember all of the elements of care that occurred in the previous six months (recall bias)
• Palliative care patients may not be well represented in the survey results
• In CY 2014, a total of 7188 individuals responded to the survey, for an overall response rate of 51.8%
• In CY 2015, a total of 6701 individuals responded to the survey, for an overall response rate of 48.3%

​Percent of positive responses to selected questions based on three dimensions of care – communication, self-management and support for shared decision-making by Regional Cancer Centre (RCC) and select partner sites, Ontario, FY 14/15 – FY 15/16

Figure 2

CCO identified Person-Centred Care (PCC) as one of five areas of strategic focus in its new Corporate Strategy. Continuing to drive improvement in the cancer and chronic kidney disease health systems by advancing PCC, CCO’s committed to:

1. Actively partnering with Ontarians in identifying, designing, planning and improving healthcare services;
2. Developing and implementing programs and resources that drive the adoption of PCC approaches to service delivery; and
3. Embedding expectations for evidence-based, person-centred, quality care into our performance improvement approaches

The adoption of a model of PCC requires a different conceptualization of how patients, those going through screening programs, family members, caregivers and providers are engaged and work with healthcare providers. PCC is an approach to the planning, delivery and evaluation of healthcare that involves mutually beneficial partnerships between healthcare providers, patients, and families to:

1. Give patients a voice in the design, delivery and evaluation of the care they receive; and
2. Enable patients to be more active in their care experience to deliver better outcomes and greater value through wiser use of resources.

Measuring PCC as part of our quality index is a signal to our stakeholders the importance of PCC as a quality indicator for our cancer system.

​PCC and patient decision-making are priorities for Ontario’s Health Care System under the Excellent Care for All Act (1). Through this Act and Ontario’s Action Strategy, patient and PCC has been established as a provincial priority (2). Community engagement and public participation are the cornerstone of health care planning, evaluation, and research. Patient engagement has been shown to lead to greater physical, psychological, and overall health benefits (3). A recent systematic review of the literature by the United Kingdom National Health Service (NHS) has shown that there is an increased need for patient and public involvement to inform and enhance the range of user activities within NHS health services (4). Research by Davies et al. suggests that organizations need to develop a culture supportive of patient centered care and quality improvement capacity that aligns the professional receptiveness and leadership with the technical expertise to data (5). Hence, other countries also recognize the importance of PCC and patient decision-making. Within Ontario, very little work has been done with the regional cancer programs to understand the extent to which PCC is measured, implemented and whether this is a corporate priority for the regional cancer programs. At the World Health Organization, research by Coulter et al. has shown that involving patients at the macro, micro and meso level in decisions not only empowers the patient but endorses shared decision-making between the patient and health care provider (6). PCC is a philosophy that sees patients as equal partners in planning, developing and assessing care to make sure it is most appropriate for their needs. This involves patients and their families being at the heart of all decisions. Services are reoriented to be user-focused, to promote control, independence and autonomy for the patient and the carers and family, to provide choice and be based on a collaborative team philosophy. It takes service users’ needs and views into account and builds relationships with family members. Key components of PCC include compassion, dignity and respect. These may be demonstrated via shared decision making, supporting self-management and proactive communication. PCC can occur on an individual basis, whereby patients engage clinicians in decisions about their health and care, or a collective group basis whereby the public are involved in decisions about the design and delivery of services.

http://www.health.org.uk/public/cms/75/76/313/4697/Helping%20
measure%20person-centred%20care.pdf?realName=lnet6X.pdf

1. Institute of Medicine (2001). Crossing the Quality Chasm: A new Health System for the 21st Century. National Academy Press.
2. Legislative Assembly of Ontario (2010). Excellent Care for All Act, 2010. SO 2010, c 14, http://health.gov.on.ca/en/pro/programs/ecfa/legislation/
   act_regs.aspx
3. Davies E and Cleary P. (2005). Hearing the patient’s voice? Factors affecting the use of patient survey data in quality improvement. Quality & Safety in Health Care, 14, 428-432.
4. Coulter A, Fitzpatrick R, Cornwell J (2009). Measures of patients’ experience in hospital: purpose, methods and uses. London: The King’s Fund. [http://www.kingsfund.org.uk/publications/measures.html].
5. Goodrich J, Cornwall J (2008). Seeing the person in the patient. The Point of Care review paper, London: The King’s Fund. [http://www.healthissuescentere.org.au/documents/items/
   2010/05/319001-upload-0001.pdf].
6. Davies E, Shaller D, Edgman-Levitan S, Safran DG, Oftedahl G, Sakowski J, Cleary P (2008). Evaluating the use of a modified CAHPS survey to support improvements in patient-centered care: lessons from a quality improvement collaborative. Health Expect, 11(2):160-176.
7. Vingerhoets E, Wensing M, Grol R (2001). Feedback of patients’ evaluations of general practice: a randomized trial. Qual Saf Health Care; 10: 224-28.
8. National Institute for Health Research (2014). Commissioning Brief: New research on use and usefulness of patient experience data. Health Services and Delivery Research Programme, National Health Service (NHS).
9. Tasa K, Baker R, Murray M (1996). Using patient feedback for quality improvement. Qual Manage Health Care, 4:55-67.

Geissler K, Friedberg M, SteelFisher G, Schneider E (2012). Motivators and Barriers to Using Patient Experience Reports for Performance Improvement. Med Care Res and Review, 70(6): 621,635.

​The following calculation will be used for each question mentioned in this template:

Rate= Number of Positive Responses/ Number of Responses X100%

Crude rate by: RCC and select partner sites

Unit of Rate: Per 100 patients

Survey questions selected for this indicator are based on three dimensions of care- communication, self-management and support for shared decision-making in the Ambulatory Oncology Patient Satisfaction Survey (AOPSS):

• Q7. Did someone discuss different treatments for your cancer with you?
• Q8. Were you given enough information about therapies for treating cancer?
• Q9. Were you involved in decisions about your care as much as you wanted?
• Q10. Did your care providers take your family or living situation into account in planning for your treatment?
• Q11. How much opportunity did your care providers give your family or friends to be involved in your care and treatment?
• Q60. Do you feel your doctor(s) listened carefully to you?
• Q61. Do you feel your other care provider(s) listened carefully to you?
• Q63. Did your care providers give your family or someone close to you all the information they needed to support you in your care and recovery?
• Q72. How often did you know what the next step in your care would be?
• Q84. How informed were you about the plan for your care when your treatment was completed?

N/A

Percentage

Ambulatory Oncology Patient Satisfaction Survey (AOPSS) – National Research Corporation Canada (NRCC)

Time frame: annual data for FY 2014/15 and FY 2015/16

The following data from the selected period will be reported:

FY 2014: April 1, 2014 to March 31, 2015 data

FY 2015: April 1, 2015 to March 31, 2016 data

Regional Cancer Centre and select partner sites

• Number of responses = sum of number of “Yes, completely” responses, number of “Yes, somewhat” responses, and number of “No” responses for the following questions:
• Did someone discuss different treatments for your cancer with you?
• Were you given enough information about therapies for treating cancer?
• Were you involved in decisions about your care as much as you wanted?
• Did your care providers take your family or living situation into account in planning for your treatment?
• Did your care providers give your family or someone close to you all the information they needed to support you in your care and recovery?

• Number of responses = sum of number of “Always” responses, number of “Usually”, number of “Sometimes” and number of “Never” responses for the following questions:
• Do you feel your doctor(s) listened carefully to you?
• Do you feel your other care provider(s) listened carefully to you?
• How often did you know what the next step in your care would be?

• Number of responses = sum of number of “Too much” responses, number of “Right amount” and number of “Not enough” responses for the following question:
• How much opportunity did your care providers give your family or friends to be involved in your care and treatment?

Number of responses = sum of number of “Very informed” responses, number of “Somewhat informed”, number of “Not at all informed” and number of “My treatment is not completed” responses for the following question:

• How informed were you about the plan for your care when your treatment was completed?

• Subset of Denominator:
• Number of positive responses= number of “Yes, completely” responses for the following questions:
• Did someone discuss different treatments for your cancer with you?
• Were you given enough information about therapies for treating cancer?
• Were you involved in decisions about your care as much as you wanted?
• Did your care providers take your family or living situation into account in planning for your treatment?
• Did your care providers give your family or someone close to you all the information they needed to support you in your care and recovery?

• Number of positive responses= number of “Right amount” responses for the following question:
• How much opportunity did your care providers give your family or friends to be involved in your care and treatment?

Number of positive responses = number of “Always” responses for the following questions:

• Do you feel your doctor(s) listened carefully to you?
• Do you feel your other care provider(s) listened carefully to you?
• How often did you know what the next step in your care would be?

Number of positive responses = number of “Very informed” responses for the following question:

• How informed were you about the plan for your care when your treatment was completed?

Exclusions:

1. The numbers of the following responses, for the given questions, are not included in the calculation (numerator or denominator):
• “Family or friends were not involved”
• How much opportunity did your care providers give your family or friends to be involved in your care and treatment 
• “I did not want them to be involved” and “I did not have family or support persons to be involved”
• Did your care providers give your family or someone close to you all the information they needed to support you in your care and recovery?
2. Deceased patients
3. Patients less than 18 years of age
4. Patients who do not have confirmed cancer diagnosis

Patients who received only inpatient services

N/A

• Included in the analysis are patients who, at the time of the survey, had received cancer services in the previous six months
• Patients may not remember all of the elements of care that occurred in the previous six months (recall bias)
• Palliative care patients may not be well represented in the survey results

• ​In FY 2014, a total of 7188 individuals responded to the survey for an overall response rate of 51.8%