Scottish Cancer Patient Experience Survey 2015/16

Hospital care as an inpatient

Care as an inpatient means going into hospital for diagnosis or treatment that requires an operation or overnight stay, with 83 per cent of survey respondents being an inpatient at some point in their cancer journey.

In order to understand how cancer patients experienced their stay, the survey asked about their interactions with health professionals (primarily doctors and nurses).

It is important for patients to have confidence and trust in the people looking after them. Such confidence relates to the availability and capacity of staff, the clarity and availability of information and support, and the quality of inpatient care.

How doctors and nurses interact with patients - having enough privacy when discussing their cancer, and being asked what their preferred name was - can help patients to feel they are viewed as more than their cancer diagnosis.

The importance of the quality of care extends beyond the immediate inpatient stay. This is why this section asks cancer patients if they felt they received enough information about their condition prior to discharge, and if they clearly understood who they could contact for support and advice upon discharge.

Hospital doctors

Confidence in hospital doctors

The majority of patients (86%) had confidence and trust in all of the doctors treating them, with 14 per cent having confidence and trust in only 'some of them' (Table 26).

There was some variation in responses from different tumour groups. However, statistical tests concluded that these differences as a whole were not statistically significant.

Table 26: Confidence and trust in hospital doctors

Did you have confidence and trust in the doctors treating you?	n	%
Yes, in all of them	3,378	86%
Yes, in some of them	536	14%
No, in none of them	18	0%
Total	3,932	100%

Family access to doctor

Three quarters of patients (75%) reported that their family or someone else were 'definitely' able to talk to a doctor if they wanted to (Table 27).

There was some variation in responses from different tumour groups. However, statistical tests concluded that these differences as a whole were not statistically significant.

Table 27: Family access to hospital doctor

If your family or someone else close to you wanted to talk to a doctor, were they able to?	n	%
Yes, definitely	2,394	75%
Yes, to some extent	648	20%
No	131	4%
Total	3,173	100%

Hospital nurses

Confidence in hospital nurses

Compared with the equivalent question for doctors, a lower proportion of patients reported that they had confidence and trust in the nurses treating them (77% vs 86%) (Table 28).

Table 28: Confidence and trust in ward nurses

Did you have confidence and trust in the ward nurses treating you?	n	%
Yes, in all of them	3,031	77%
Yes, in some of them	881	22%
No, in none of them	35	1%
Total	3,947	100%

Amongst different tumour groups, only two were statistically different from the all-cancer average. Patients with lung tumours (83%) were more likely to have confidence and trust in all the nurses treating them, whereas patients with brain / central nervous system tumours (51%) were less likely (Figure 22).

Figure 22: % with confidence and trust in all ward nurses, by tumour group

Enough nurses on duty

Seventy-two per cent of patients reported that there were 'always or nearly always' enough nurses on duty to treat them (Table 29). These are more positive results than when the same question was asked in the most recent Scottish inpatient survey ^[6] (72% vs 64%). The inpatient survey includes inpatients with a range of conditions.

Table 29: Enough nurses on duty

In your opinion, were there enough nurses on duty to care for you in hospital?	n	%
There were always or nearly always enough on duty	2,814	72%
There were sometimes enough on duty	866	22%
There were rarely or never enough on duty	203	5%
Total	3,883	100%

Patients with lung and skin tumours (both 81%) were statistically more likely than the all-cancer average to report there always or nearly always being enough nurses on duty. Patients with upper gastrointestinal tumours (61%) were statistically less likely to report this (Figure 23).

Figure 23: % reporting always or nearly always enough nurses on duty, by tumour group

Hospital Doctors and Nurses

Doctors and nurses talking as if patient wasn't there

Around one in five patients reported groups of doctors and nurses talking about them as if they weren't there (Table 30). Although, this was more likely to have happened only 'sometimes' (15%) rather than 'often' (4%).

Table 30: Doctors and nurses talking as if patient wasn't there

Did groups of doctors and nurses talk in front of you as if you weren't there?	n	%
Yes, often	160	4%
Yes, sometimes	579	15%
No	3,179	81%
Total	3,918	100%

There were some differences in how patients from different tumour groups responded to this question. Breast (87%) and gynaecological tumour (86%) patients were both statistically above average in reporting that doctors and nurses did not talk in front of them as if they were not there (Figure 24).

Figure 24: % reporting doctors and nurses did not talk as if they were not there, by tumour group

Doctors and nurses using patient's preferred name

Over a third of patients (35%) reported that not all doctors and nurses asked what name they wanted to be called by, with 15 per cent reporting that 'none' of them did (Table 31).

Table 31: Doctors and nurses using patients preferred name

While you were in hospital did the doctors and nurses ask you what name you prefer to be called by?	n	%
Yes, all of them did	2,539	65%
Only some of them did	765	20%
None of them did	581	15%
Total	3,885	100%

There were a number of statistically significant differences between tumour groups and the all-cancer average. These included patients with breast tumours (55%) being less likely than average to report being asked what name they preferred to be called and lung tumour patients (80%) being above average (Figure 25).

Figure 25: % asked what name they preferred to be called by, by tumour group

Privacy when discussing care and treatment

Eighteen per cent of patients reported that they were not always given enough privacy when discussing their condition or treatment (Table 32).

Table 32: Privacy when discussing care and treatment

Were you given enough privacy when discussing your condition or treatment?	n	%
Yes, always	3,198	82%
Yes, sometimes	559	14%
No	165	4%
Total	3,922	100%

Patients from two tumour groups were statistically different from the all-cancer average in how they responded to this question. Both lung (87%) and

Prostate tumour (86%) patients were more likely to respond that they were 'always' given enough privacy when discussing their condition and treatment (Figure 26).

Figure 26: % given enough privacy when discussing condition or treatment, by tumour group

Worries and fears

Patients were asked whether they found someone on hospital staff to talk about their worries and fears with. Twenty-seven per cent of patients reported that they had no worries or fears.

Of those that did have worries and fears, 18 per cent were unable to find someone to talk to about them. This is a higher percentage than the equivalent question for day case patients / outpatients, where only nine per cent responded that that they were unable to find someone (Table 33).

There was some variation in responses from different tumour groups. However, statistical tests concluded that these differences as a whole were not statistically significant.

Table 33: Worries and fears as inpatient

During your hospital visit, did you find someone on the hospital staff to talk to about your worries and fears?	n	%
Yes, definitely	1,424	50%
Yes, to some extent	907	32%
No	519	18%
Total	2,850	100%

Pain control

Eighty-seven per cent of patients believed that hospital staff 'definitely' did everything they could to help control their pain (Table 34).

There was some variation in responses from different tumour groups. However, statistical tests concluded that these differences as a whole were not statistically significant.

Table 34: Pain control

Do you think the hospital staff did everything they could to help control your pain?	n	%
Yes, definitely	3,075	87%
Yes, to some extent	370	10%
No	95	3%
Total	3,540	100%

Respect and dignity

Eighty seven per cent of patients also felt that they were 'always' treated with respect and dignity (Table 35).

Table 35: Patients treated with respect and dignity

Overall, did you feel you were treated with respect and dignity while you were in hospital?	n	%
Yes, always	3,448	87%
Yes, sometimes	449	11%
No	47	1%
Total	3,944	100%

Patients with brain / central nervous system tumours (69%) were statistically less likely to report that they were treated with respect and dignity than the all-cancer average. Haematological tumour patients (94%) were statistically above the average (Figure 27).

Figure 27: % treated with respect and dignity, by tumour group

Leaving hospital

Information about what do after leaving hospital

Around one in six patients (18%) were not given clear written information about what they should or should not do after leaving hospital (Table 36).

Table 36: Information about what to do after leaving hospital

Were you given clear written information about what you should or should not do after leaving hospital	n	%
Yes	2,944	82%
No	664	18%
Total	3,608	100%

Patients with breast and prostate tumours (both 86%) were statistically more likely than the all-cancer average to report that they were given clear written information about what they should or should not do after leaving hospital. Sarcoma (58%) and urological tumour patients (74%) were both statistically below average (Figure 28).

Figure 28: % given written information about what to do after leaving hospital, by tumour group

Who to contact after leaving hospital

Patients were also asked whether hospital staff had told them who to contact if they were worried about their condition or treatment after they had left hospital. Around one in ten (9%) patients were not told who to contact if they were worried about their condition or treatment after they left hospital (Table 37).

Table 37: Who to contact after leaving hospital

Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital?	n	%
Yes	3,401	91%
No	327	9%
Total	3,728	100%

Only two tumour groups were statistically different from the all-cancer average. Breast tumour patients (95%) were more likely to report being told who to contact if they were worried about their condition and urological tumour patients (81%) were less likely to report being told this (Figure 29).

Figure 29: % told who to contact after leaving hospital, by tumour group