We designed the PSCC to be a simple and easy to administer tool to assess satisfaction with cancer-related care for individuals from diverse cultural and socioeconomic populations. An important goal for developing the PSCC was to ensure the measure assesses experiences common to all patients regardless of whether or not they were navigated. This approach is expected to ensure the applicability and relevance of this measure to people from comparable racial, ethno-cultural and socioeconomic backgrounds.
The results of our structural analysis and psychometric validation revealed a parsimonious and reliable one-component solution for the PSCC. This measure provides a milieu-specific patient-oriented approach for assessing perceived relevance and satisfaction with cancer care for individuals from diverse racial, ethno-cultural and socioeconomic backgrounds. The PSCC demonstrates high construct validity. The degree to which the items of the PSCC constitutes a coherent set that assess the underlying construct of patient satisfaction with cancer care was demonstrated by high indices of internal consistency and reliability.
The PSCC differs from previous generic scales in that it focuses on satisfaction with cancer-related care rather than the broader concept of health care in general or the narrower concept of cancer treatment for a particular, cancer, disease stage or location (hospital or ambulatory).37-40
The PSCC addresses the broad domain of cancer-related care including diagnostic testing in addition to treatment rather than focusing on particular or specific aspects of cancer care.41-43
The limitations of these findings merit comment. First, we adapted and modified items from existing instruments, but we did not conduct cognitive interviewing.44
However, a pilot study of the questionnaire revealed no problem that would have indicated a need to modify questionnaire items to help improve participants’ understanding or interpretation of the items. In addition, the PSCC scale was administered orally in order to minimize effects of low literacy; therefore, it is not certain that similar results would be obtained from participants who self-administer the scale.
Second, consistent with previous satisfaction measures, we observed significant skewing or tendency towards the higher end of satisfaction.45
Whether this represents truly favorable experiences or reflects low expectations is unknown.3
We did not specifically query patients about expectations. For many patients, their abnormal screening/diagnosis may have been their first experience with cancer-related care. Thus, they may have used a priori
general healthcare experiences to form their expectations, which could explain the trend towards the higher end of reported satisfaction. This could also be representing a social desirability response bias related to interview format. 46
Further studies are needed to help determined if this finding will remain if patients responded anonymously and whether this ceiling effect will affect the sensitivity of the scale.
Furthermore, about 80 percent of the sample were women. Further studies are needed to confirm generalizability of the PSCC to men. Also, the PSCC accounted for 60 percent of the variance in patient satisfaction. Follow-up studies are needed to identify plausible factors that could account for the unexplained portion of this variance.
Lastly, we did not assess the responsiveness of the measure to change and/or how well it matches clinical impression. That is, we do not know how well the PSCC will capture differences in health care processes. Some aspects of care such as interpersonal processes may have a much greater impact on satisfaction than technical aspects.46-48
The strengths of the study include psychometric assessment of the PSCC measure with medically underserved and underrepresented individuals from racial/ethnic minorities and lower socioeconomic populations across different types of health care systems (e.g. community health centers, Veteran Administration, and University and community-based oncology practices). The development of the PSCC represents an initial attempt to develop and assess the validity and reliability of a context-specific measure of satisfaction with cancer-related care that is applicable to underserved and traditionally underrepresented racial/ethnic minorities and lower income individuals who face a variety of barriers to cancer care.
Validation of this PSCC measure will facilitate examination of the impact of patient navigation on cancer-related care.12
Further studies should examine the predictive validity of the PSCC for treatment-related outcomes within longitudinal research settings. Our analyses showed divergent and convergent capabilities of the PSCC. Additional studies that examine divergent and convergent characteristics of the PSCC with other relevant psychometrically valid and reliable health measures will provide evidence of the strength of the PSCC and further inform the underlying structure and validity of this measure for cancer patients. This scale, the PSCC, should prove useful for evaluation of PN not only in the participating nine sites of the NCI funded Patient Navigation Research Program, but in other cancer navigation programs as well.