Investigation of satisfaction and quality of day surgery treatment for breast cancer
The aim of this study was to investigate the degree of patient satisfaction amongst women with breast cancer undergoing day surgery treatment.
Ullevål University Hospital treats the majority of breast cancer patients in Norway, over 500 cases each year. In May 2000 the ”sentinel node” technique was introduced. That same year the Ullevål hotel for patients opened and one of the wards closed; after which day surgery treatment for breast cancer was introduced. Many health professionals were skeptical the introduction due to the risk of reduced physical and psychological following-up. Anesthetists demanded that patients were accompanied 24 hours after surgery by an adult. The procedure means that patients can choose to return home the same day as the surgery or stay at the hotel for a few days following the operation. On the first day the patients are seen at the hospital by a doctor and given both verbal as well as written information about breast cancer and its treatment. After the operation, they can meet doctors, nurses, and other patients who have undergone the same procedure in weekly meetings. They are also provided with contact details of nurses specializing in cancer care for further support. Three weeks postoperatively they are seen by their surgeon for a check-up.
An investigation in 2001 to see what the patients thought about day surgery as treatment for breast cancer showed that over 90% of the patients were very satisfied with this arrangement. In September 2002, a new day surgery ward opened. About sixteen patients are operated weekly. In June 2003, we started a new investigation to study the satisfaction and quality of day surgery treatment for breast cancer. We wanted to know what the patients thought of this arrangement and especially to see into what improvements can be made. After the operation all the patients were given a questionnaire containing thirty-three questions. Most of them returned the questionnaire with the answers at their three week postoperative follow-up. I have also done a small qualitative investigation with interviews of ten of the operated women.
74 of total 123 questionnaires were returned, consequently 60,2%. The average age of the women was 57 years. 72% of patients had a mastectomy and the others a breast conserving operation. 77% of all women were operated using the sentinel node technique and the remaining women had an axillary clearance, removing all the nodes of the axilla. In general, the results from the questionnaires and interviews were very positive. The women were very satisfied with the written as well as the verbal information provided about breast cancer treatment. Many of the women did not seek extra information about breast cancer in books or on the Internet. Many of the women knew of someone who had been through the same disease. The women said that it was good to have the opportunity to choose between the methods of treatment. However, some women also preferred to hear what the doctor recommended. They were less satisfied with long length of waiting time especially at the consultation office, and the information regarding complications of the treatment. They also thought that three weeks is too long to wait for the pathology result. Many women said these were the three most negative aspects of the day surgery treatment process. Some of the women did not feel well enough to leave the hospital so early after the operation and some of them would have preferred to stay at the hospital a few more hours. A few weeks after the operation all of the women reported that they were very pleased to be able to leave hospital so early. None of the women had any problems with arranging for someone to accompany them the first day after the operation. The women said that they felt much better after the operation than they expected. The patients were very satisfied when a doctor or nurse called them after they had come home. Some complications such as serom, infection and/or bleeding occurred, but all of these women were satisfied with the help they got at the hospital. 44 of the women contacted the nurses specializing in cancer care . All of these women were satisfied with the help they received. 98% of the operated women recommend day surgery treatment for breast cancer. The women also encourage other women around them to go through screening mammography.
In conclusion, the survery found that breast cancer managed by the day surgery technique is a very good arrangement, both for the hospital and the patients. In other words, it provides for both effective patient care as well as efficiency.
Supervisor: Ellen SchlichtingDepartment of Gastroenterology. Ullevål University Hospital.