Seeking patient feedback an important dimension of quality in cancer care

LWW/JNCQ NCQ200075 August 17, 2010 13:58 Char Count= 0
J Nurs Care Qual
Vol. 25, No. 4, pp. 344–351
Copyright c 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Seeking Patient Feedback
An Important Dimension of Quality
in Cancer Care
Meghan L. Richard, MSc, RN; Monica P. Parmar, MSc, RN;
Paula P. Calestagne, BA; Lynne McVey, MSc, RN
A patient satisfaction survey was conducted with ambulatory cancer patients to identify areas that
they consider priorities for change. Wait times and telephone contact with healthcare providers
were the 2 areas of lowest satisfaction. Despite previous interventions to improve wait times,
it is consistently the lowest ranked item for patient satisfaction. A subset of patients who were
followed by a nurse navigator was more satisfied with wait times than those who were not followed
by a nurse navigator. Key words: cancer patients, outpatients, patient satisfaction, quality
improvement, questionnaires
PATIENT SATISFACTION is a core element
in the measurement of quality of care at
the level of a health system.1
Increasingly, as
patient-centered care becomes a focus for hos-
pitals, healthcare systems, and government
bodies, the measurement of patient satisfac-
tion is gaining in importance.1,2
By measuring
patient satisfaction, healthcare teams are able
to ensure that quality improvement initiatives
are pertinent and valued by the patients who
are using their services. Because expertise in
the measurement of patient satisfaction is de-
veloping throughout North America,1
the re-
peated and sequential measurement of patient
satisfaction over time is becoming recognized
as essential to the evaluation of the perfor-
Author Affiliations: Segal Cancer Centre
(Mss Richard, Parmar and McVey), Jewish General
Hospital (Mss Richard, Parmar, Calestagne and
McVey), the Hospital Quality Program
(Mss Calestagne and McVey); and McGill University
(Ms McVey), Montreal, Quebec, Canada.
No external funding was received for this project.
The authors thank Dr Gerald Batist and Antoinette
Ehrler. They also thank Dr Nancy Feeley, Dr Margaret
Purden, Abbie Mason, and Michèle Lefort for their sup-
port in the development of the manuscript.
Corresponding Author: Lynne McVey, MSc, RN, Se-
gal Cancer Centre, Jewish General Hospital, Pavilion
B, Room 103, 3755 Côte-Ste-Catherine Rd, Montreal,
Quebec, Canada H3T 1E2 (lynne.mcvey@mcgill.ca).
mance of a healthcare system. In keeping with
this trend, the current patient satisfaction sur-
vey was the most recent in a sequence of sev-
eral surveys within a comprehensive cancer
care center (CCC).
Few studies have examined satisfaction
with cancer care services.3–5
Variables shown
to influence patient satisfaction with can-
cer care services include wait times, avail-
ability and frequency of contact with health-
care providers, and presence of a nurse who
is known to the patient.4
Greater under-
standing of how to alter the waiting expe-
rience and how the presence of a nurse
navigator influences satisfaction with cancer
care services is needed. This study aimed
to add understanding to the measurement
of patient satisfaction in a CCC and to pro-
vide data to inform quality improvement
initiatives that would result in greater satisfac-
tion with care for cancer patients.
LITERATURE REVIEW
Cancer is the leading cause of death in the
province of Quebec, Canada.6
Patient advo-
cacy has been strengthened since 2002 by the
creation of a provincial coalition of concerned
citizens who are mobilized to influence the
government to improve both the chances
of survival and the quality of life of people
Copyright © 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
344

Seeking Patient Feedback: Dimension of Quality in Cancer Care 345
living with cancer.7
This coalition has been
successful in mobilizing the government to
create a publicly funded provincial program
to evaluate all cancer care activities within the
healthcare system.6
Recent efforts on the part
of the government have focused on measur-
ing the overall quality of the healthcare sys-
tem and aligning improvement work across all
healthcare facilities, enabling healthcare lead-
ers to acquire data and evaluate the overall
performance of the system on core dimen-
sions of quality and value.
Patient satisfaction
Patient satisfaction is identified as a core
dimension1
of a proposed model, Whole Sys-
tems Measures, currently being piloted at the
CCC and evaluated for implementation by the
provincial government Ministry of Health and
Social Services. Patient satisfaction may be
defined as “. . .an individual patient or fam-
ily visitor’s subjective perspective on medi-
cal services received . . . adopted as one of
the indicators of care quality.”8(p122)
There is
consensus that patient satisfaction is an im-
portant outcome that must be evaluated and
measured,9
reflecting the shift toward patient-
centered care within numerous healthcare
associations such as the Conseil Québécois
d’agrément, Accreditation Canada, the Insti-
tute of Medicine, and the public at large.7,10–12
Tracking patient satisfaction along the di-
mensions of responsiveness, assurance, empa-
thy, and environmental characteristics allows
healthcare organizations to conduct qual-
ity improvement initiatives with a patient-
centered approach.13
Patient satisfaction is
recognized as a core element of the mea-
surement of quality.1
Incorporating patient
satisfaction survey results into care leads
to an improved understanding of patient
expectations2
and can lead to improved
health outcomes,14
such as decreased symp-
tom discomfort and better emotional health.15
Evidence demonstrates that patient-
centered nursing interventions lead to higher
satisfaction rates; therefore, organizations
have an ethical obligation to measure patient
satisfaction and to act on the results.2
Surveys
are vital tools in assessing consumer views,
and feedback from patients offer an organiza-
tion a direction for improvement.16
There is a need to evaluate patient sat-
isfaction with cancer care because of the
diversity of patients, complex healthcare
needs, and the increased survivorship of this
population.17
Key areas have been identified
within the context of cancer care that com-
monly influence patient satisfaction. These
include the demographic characteristics of pa-
tients, interpersonal aspects of care, patient-
centered care, wait times, continuity of care,
and the physical environment.2,3,5,18,19
In the
context of cancer care, literature related to
patient satisfaction is limited, supporting the
need for further investigation into this health-
related outcome.3,5
The complexity of physical, psychosocial,
and spiritual needs of cancer patients has
been addressed by the province of Quebec
through the development of the nurse navi-
gator role. Nurse navigator interventions fo-
cus on patient-centered care, which has been
linked to increased patient satisfaction.2
The
nurse navigator is meant to guide the patient
and the family through the illness trajectory
and includes assessment and management of
needs and symptoms, patient education, sup-
port to patients and their families, and ensur-
ing continuity of care.20
Interventions by the
nurse navigator are supported by the McGill
model of nursing relating to the dimensions
of health, the person, their family, and the
environment.21
Because of the limited number of studies on
patient satisfaction with cancer care, a need
exists for further evaluation of patient satisfac-
tion with the overall goal of improving satis-
faction levels within specific clinical settings.
Findings of these studies inform quality im-
provement initiatives that may be generaliz-
able to other CCCs.22
PATIENT SATISFACTION IN THE CCC
Ongoing patient satisfaction surveys have
guided the quality improvement initiatives
at an urban university teaching hospital in

346 JOURNAL OF NURSING CARE QUALITY/OCTOBER–DECEMBER 2010
Montreal, Quebec.4
The CCC at this hospital
provides a wide range of services, including
chemotherapy treatment, radiotherapy treat-
ment, nursing, and psychological services, de-
livered by interdisciplinary teams. Surveys oc-
cur on an ongoing basis, and in-depth analysis
of the survey results is completed regularly for
comprehensive review.
Several patient satisfaction surveys in the
CCC led to similar results. Repeat findings re-
garding dissatisfaction with wait times were
found despite numerous interventions to ad-
dress this problem. Limited resources and
high demand for conducting surveys in areas
of the hospital outside the CCC forced longer
intervals between consecutive surveys than
desired. The results of 2 patient satisfaction
surveys (2003 and 2005) and a patient focus
group (2006) informed the selection of ques-
tions in the current survey. The patient satis-
faction literature suggests the use of context-
specific questions and of questions evaluating
patients’ perceptions of safety in healthcare
institutions.10,23
It is important to note that be-
tween 2003 and 2008, the volume of cancer
patients in the CCC increased by more than
35%.
Cancer care patients are a vulnerable popu-
lation with specific needs. The purpose of this
patient satisfaction survey was to add under-
standing to the measurement of patient sat-
isfaction, evaluate the care provided in the
CCC, and understand aspects of care that are
priorities for improvement according to pa-
tients. The current survey was guided by the
following questions: (1) Are cancer patients
satisfied with the many aspects of care and
ambulatory services provided by the CCC?
and (2) How important are the various ser-
vices and aspects of care to cancer patients?
METHODS
A cross-sectional survey design was used;
participants were recruited from a CCC re-
ceiving more than 3000 ambulatory patient
visits within a 1-month period. The inclusion
criteria were as follows: registration as an ac-
tive patient and/or a family member at the
CCC; expressed ability to complete the sur-
vey in French or English; and age 16 years or
more. Cancer care inpatients, patients who
had previously completed the survey during
the distribution period, and patients on their
first visit to the CCC were excluded from the
study.
The survey consisted of 21 bilingual vali-
dated questions provided in a bank of ques-
tions available in Androfact (Agili-T Health
Solutions, Inc, St-Laurent, Quebec, Canada).
Androfact patient satisfaction software has
been used repeatedly within this hospital and
throughout Quebec and Canada.24
Content
validity of the Androfact bank questions was
established by a panel of experts and fur-
ther validated by 3600 patients in Quebec,
Canada, to ensure relevance, thoroughness,
and clarity.24
To maintain consistency, the
content of the question bank was not changed
significantly.
An interdisciplinary team met regularly to
select survey items on the basis of previ-
ous patient satisfaction surveys, anecdotal ev-
idence from clinicians, and Canadian accred-
itation requirements. The final item list for
the survey included the following: diagnostic
tests, interpersonal aspects, safety, informa-
tion and education, medication, support, wait
and consultation time, and the physical envi-
ronment. Five demographic questions asked
were as follows: who completed the question-
naire (ie, patient or family member), age of
patient, gender of patient, knowledge of sup-
port programs, and whether the patient had a
nurse navigator. Participants rated both their
satisfaction and importance levels on each of
the 21 items on a 4-point Likert-type scale.
Space also was provided to encourage par-
ticipants to share additional comments and
concerns. The survey was piloted with both
English and French patients at the CCC for
suitability, relevance to their experience, flu-
idity, readability, and timeliness.
Volunteers were trained by the Patient Sat-
isfaction Program coordinator on how to re-
cruit participants for the patient satisfaction
survey. Volunteers approached ambulatory
CCC patients in the designated waiting areas

and introduced the patient satisfaction survey.
Participants had the right to refuse to partici-
pate and were told that their anonymity would
be preserved and that results of the survey
would be used to guide improvements in qual-
ity of care and service delivery. By completing
and returning the survey, implied consent was
assumed. They were given the option of com-
pleting surveys on site or returning the sur-
veys by mail and were also provided with a
contact number that they could call with ad-
ditional questions or concerns. This patient
satisfaction survey was approved by both the
hospital Research Ethics Committee and the
McGill University Scientific Review prior to
commencement.
Statistical analyses were performed using
the Androfact 5.2 software. The Likert scale
values for both satisfaction and importance
were converted to percentage values. Ques-
tions not completed by the patient were ex-
cluded from the analysis. The percentage val-
ues attained for satisfaction and importance
were combined to calculate weighted satisfac-
tion, also known in the literature as the prior-
ity indices.4,23
RESULTS
Surveys were distributed to 570 ambula-
tory cancer patients between May 12, 2008,
and June 13, 2008. The nonprobability con-
venience sample consisted of 276 partici-
pants (response rate = 48%), with an almost
equal representation of men (n = 136, 49.3%)
and women (n = 128, 46.4%); 12 individuals
chose not to respond to this question. The ma-
jority of the participants, 84.1% (n = 232),
were between the ages of 45 and 84 years,
and approximately 10% (n = 28) of the par-
ticipants were between the ages of 18 and 44
years. The majority of the surveys (n = 200,
72.5%) were completed by the patient alone;
the remaining surveys were completed with
the assistance of a family member.
The patient satisfaction survey results
were measured against the quality stan-
dards published by the local Regional Health
Board.25
According to these standards, patient
satisfaction rates between 90% and 100% are
considered excellent, 80% and 90% accept-
able, 65% and 80% passable, 50% and 65% in-
sufficient, and less than 50% are considered
unacceptable. The Regional Health Board has
set 80% as the benchmark for patient sat-
isfaction survey results within its participat-
ing healthcare facilities,25
which is also the
standard utilized by the CCC. When the re-
sults of the current patient satisfaction sur-
vey were compared with the local Regional
Health Board criteria, 11 of the 21 items mea-
sured on the survey were within the excel-
lent range, 9 of the items were within the ade-
quate range, 1 item was considered passable,
and no items were defined as insufficient or
unacceptable.
Overall, responses on the 21-item survey in-
dicated that patients were very satisfied. The
average patient satisfaction score for men and
women was 89.5% and 89.8%, respectively.
The average satisfaction score for all the items
equalled 89.3% and ranged from 70.9% to
98.7%. The patients were most satisfied with
the following items: recommending the hos-
pital to family and friends (98.7%), receiving
information about when and where to go to
have treatments (97.1%), and feeling safe dur-
ing care and treatments at the clinic (96.5%).
Conversely, items with the lowest weighted
satisfaction rates were length of time spent
in the waiting room (70.9%) and the ability
to contact by telephone someone to answer
questions regarding a health problem (79.9%).
The most important aspects of care to par-
ticipants were as follows: information pro-
vided by the team on the results of tests
(98.3%), information on why diagnostic tests
were necessary (98.2%), and feeling safe dur-
ing care and treatments in the clinic (97.9%).
However, participants indicated that items re-
lating to food availability, length of wait times,
and confidentiality in the waiting room as
the least important aspects of care within the
CCC.
The findings of this patient satisfaction sur-
vey identified 2 prioritized areas of decreased
patient satisfaction and high importance to
patients: length of wait times and telephone

contact regarding a health concern. Patients
who were followed by a nurse navigator were
more satisfied with the length of time spent
in the waiting room than those who were
not followed by a nurse navigator. There were
103 patients followed by a nurse navigator;
72.5% were satisfied with the length of time
spent in the waiting room compared with
66.2% for patients without a nurse navigator
(n = 77).
DISCUSSION
The results of this survey were consistent
with other patient satisfaction surveys within
the literature26
and within the CCC itself.4
Overall, patients were highly satisfied with
the care and services received in the CCC on
dimensions including physical environment,
diagnostic tests, safety, information and ed-
ucation, medication, support, and interper-
sonal aspects of care. Interestingly, patients
reported similar dissatisfaction levels on wait
times and telephone contact with a health-
care provider as those on previous surveys
in the CCC. The demographic characteris-
tics of the respondents were similar to the
Canadian cancer population in both age27
and
gender.28
Wait times in the CCC
Wait times were the area of lowest satisfac-
tion at the CCC. This corresponds to previ-
ous surveys in the area despite attempts to
improve this aspect of the clinic experience.
Wait times are recognized as a key access is-
sue within the Canadian healthcare system
in general; however, for the cancer popula-
tion, the problem is more acute.29
Increased
survivorship of cancer patients is leading to
increased volumes and extended wait times
in ambulatory care settings,17
which has also
been noted in the CCC.
Cancer patients have a unique trajectory
of care because they are followed by a pri-
mary treating team and supportive and/or
palliative care service, and they may require
other services because of previous comor-
bid conditions. Furthermore, the treatment
of cancer requires extensive intervention,
often including concomitant chemotherapy,
radiotherapy, symptom management, and
surgery. This leads to multiple appointments
and treatments, which can be burdensome to
patients and their families.
The literature shows that the waiting expe-
rience of cancer patients may lead to varying
levels of anxiety, distress, and boredom.17,30,31
Other studies suggest that the experience of
anxiety and unoccupied time may lead to the
perception of increased wait times.17,31
In ad-
dition, throughout the cancer trajectory, most
patients have physical discomfort and psycho-
logical distress due to numerous symptoms
and uncertainty relating to the cancer experi-
ence, which may also affect their perception
of the waiting experience.
As stated, the previous 2 surveys found low
patient satisfaction levels with wait times de-
spite interventions aimed at improving this as-
pect of service delivery. Interventions were
focused on system changes to decrease ac-
tual wait times as well as perceptual inter-
ventions aimed at improving the experience
of the wait. Examples included moving to a
newly renovated facility with larger waiting
rooms, more light, and improved aesthetic ap-
peal; the development of an online scheduling
system to coordinate appointments and ser-
vices; centralizing administrative staff by pro-
gram and tumor site to enhance efficiency;
and increasing the availability of patient edu-
cational materials and support services during
the wait time.
Unfortunately, despite previous interven-
tions aimed at improving the waiting expe-
rience and decreasing the length of time
spent in the waiting room, patient satisfaction
scores remained low on this item in the cur-
rent survey. It is hypothesized that dissatisfac-
tion with wait times continues because of the
increasing volume of cancer patients to the
CCC. Between 2003 and 2008, the number of
ambulatory clinic visits to the CCC increased
by more than 35%. The CCC alongside the
Ministry of Health and Social Services is priori-
tizing decreasing wait times in the province of
Quebec for cancer patients, using the Whole

Systems Measures model. Performance on this
indicator will be compared across the CCC
and reported to the government for compari-
son with other healthcare facilities. Research
demonstrates that utilization of Whole Sys-
tems Measures in this way leads to improved
results for patients.1
Further changes related to the operations
of the CCC may lead to measurable improve-
ments because system disorganization has
been implicated in increasing wait times.17
Another CCC was successful in reducing wait
times by 27 minutes through the use of “lean
manufacturing principles”focused on increas-
ing efficiency, improving outcomes, and min-
imizing waste within a system. An example
includes making sure that all information on
patients is available to the healthcare
providers prior to their appointments.32
Implementation of these principles applied
simultaneously with Whole Systems Mea-
sures has been shown to lead to better
results.1
Interestingly, although low satisfaction lev-
els with wait times were reported, patients
who were linked with a nurse navigator had
greater satisfaction levels than those who
were not linked to a nurse navigator. This may
be related to the patient-centered aspects of
the role including support, education, and ad-
vocacy, which have been highlighted as im-
portant to patients and their families during
the experience of waiting.17,19,33
Telephone contact with a healthcare
provider in the CCC
Another major issue according to patients
is the ability to reach someone by telephone
who is able to answer questions related to
health concerns. The literature supports the
use of quality improvement initiatives to en-
hance patients’ health information seeking
behavior by ensuring patients have multiple
sources and appropriate contact information,
providing support and accessibility, and link-
ing patients and families to resources.34,35
For ambulatory cancer patients, being at
home may be anxiety provoking if they are
worried about symptoms and complications
they cannot manage alone. Having the abil-
ity to contact someone by telephone is
critical. Nurses in the CCC often provide this
link between the hospital and the patient.
They advocate for the patient, encourage the
patient to come to the hospital in the case
of changes of status, and provide support to
families.
Within the CCC, we have attempted to
provide ambulatory patients with support
through connections to nurse navigators, pri-
mary nurses, and on-call oncologists. De-
spite this, one patient commented, “Because
of answering machines, in case of emer-
gency [it is] very difficult to get to some-
one outside [of] working hours.” Although
it seems that this current system is not sat-
isfactory to all patients, it is not clear ex-
actly where it fails. Part of this may be
due to the fact that with limited resources
not all cancer patients are assigned a nurse
navigator. It is important to explore this
item further to create appropriate interven-
tions. The results of this survey demonstrate
further the need to lobby the government
for funding for additional nurse navigators
to provide the same level of support for all pa-
tients and their families. Further investigation
comparing satisfaction with care for patients
assigned a nurse navigator to those without is
warranted.
Limitations
The current survey had a lower response
rate than previous surveys in the area. Little is
known about nonrespondents who may not
be represented in the current results; there-
fore, findings may not be generalizable to the
entire patient population of the CCC.
CONCLUSION
Cancer patients have unique needs; there-
fore, measuring their care satisfaction pro-
vides valuable information. Although patients
have reported high levels of satisfaction on
many dimensions of care, lower satisfaction
on wait times persists. Nurse navigators mit-
igate dissatisfaction with wait times.

REFERENCES
1. Martin LA, Nelson EC, Lloyd RC, Nolan TW. Whole
System Measures [IHI Innovation Series white pa-
per]. Cambridge, MA: Institute for Healthcare Im-
provement; 2007. http//www.IHI.org.
2. Wolf DM, Lehman L, Quinlin R, et al. Effect of patient-
centered care on patient satisfaction and quality of
care. J Nurs Care Qual. 2008;25(4):316-321.
3. Thomas BC, Groff SL, Tsang K, Carlson LE. Patient
ethnicity: a key predictor of cancer care satisfaction.
Ethn Health. 2009;14(4):351-358.
4. Gourdji I, McVey L, Loiselle C. Patients’ satisfaction
and importance ratings of quality in an outpatient
oncology center. J Nurs Care Qual. 2003;18(1):
43-55.
5. Sitzia J, Wood N. Patient satisfaction with cancer
chemotherapy nursing: a review of the literature. Int
J Nurs Stud. 1998;35(1-2):1-12.
6. Santé et Services sociaux Quebec. Actualités.
http://www.msss.gouv.qc.ca/sujets/prob sante/
cancer/index.php?accueil. Accessed November 25,
2009.
7. Coalition Priorite Cancer au Quebec. Déclaration.
http://www.coalitioncancer.com/declaration.php.
Published 2009. Accessed November 25, 2009.
8. Tzeng H, Yin C. Patient satisfaction versus quality.
Nurs Ethics. 2008;15(1):121-124.
9. Gabriel G, Lah M, Barton M, Au G, Delaney G,
Jalaludin B. Do cancer follow-up consultations create
anxiety? J Psychosoc Oncol. 2008;26(1):17-30.
10. Accreditation Canada. Quality improvement.
http://www.accreditation.ca/en/content.aspx?pageid
=640&terms=quality+improvement. Accessed July
24, 2009.
11. Conseil Québecois d’agrément. Agrément:
Définition de l’agrément. http://www.agrement-
quebecois.ca/site.asp?page=element&nIDElement
=2257. Accessed July 24, 2009.
12. Corrigan J, Kohn L, Donaldson M, Maguire S, Pike
K. Crossing the Quality Chasm: A New Health Sys-
tem for the 21st Century. Washington, DC: National
Academies Press; 2001.
13. Sajid M, Baig M. Quality of healthcare: an absolute
necessity for public satisfaction. Int J Healthc Qual
Assur. 2007;20(6):545-548.
14. McGill SJ. Soars for scores: a quality improvement
strategy for increasing patient satisfaction on an
orthopedic inpatient unit. Acad Med-Surg Nurses
Newslett. 2009;18(2):12-14.
15. Tzeng HM, Yin CY. Are call light use and response
time correlated with inpatient falls and inpatient
dissatisfaction? J Nurs Care Qual. 2009;24(3):232
-242.
16. Johnson M, Langdon R, Lian Y, Stewart H, Kelly P.
Comprehensive measurement of maternal satisfac-
tion: the modified Mason survey. Int J Nurs Pract.
2008;8(3):127-136.
17. Rondeau K. Managing the clinic wait: an impor-
tant quality of care challenge. J Nurs Care Qual.
1998;13(2):11-20.
18. Groff S, Carlson L, Tsang K, Potter B. Cancer pa-
tients’satisfaction with care in traditional and innova-
tive ambulatory oncology clinics. J Nurs Care Qual.
2008;23(3):251-257.
19. Saultz JW, Albedaiwi W. Interpersonal continuity of
care and patient satisfaction: a critical review. Ann
Fam Med. 2004;2(5):445-451.
20. Plante A, Joannette S. Montérégie Comprehensive
Cancer Care Centre: integrating nurse navigators in
Montérégie’s oncology teams: one aspect of imple-
menting the Cancer Control Program; part 1. Can
Oncol Nurs J. 2009;19(1):13-18.
21. Gottlieb LN, Gottlieb B. The developmental/health
framework with the McGill model of nursing. Adv
Nurs Sci. 2007;30(1):43-57.
22. Casarett D, Karlawish J, Sugarman J. Determining
when quality improvement initiatives should be
considered research proposed criteria and po-
tential implications. JAMA. 2000;283(17):2275
-2280.
23. Gesell S, Gregory N. Identifying priority actions
for improving patient satisfaction with outpatient
cancer care. J Nurs Care Qual. 2004;19(3):226
-233.
24. Agili-T, Inc. Androfact: Driving Quality Improve-
ment Through Continuous Patient Feedback. St-
Laurent, Quebec, Canada: Agili-T Inc; 2007.
25. Neill G, Tremblay M, Vegiard S, Lavoie A, Moisan K.
Enquête sur la satisfaction des usagers à l’égard des
services de santé et des services sociaux du Québec,
2006-2007: Description et méthodologie. Quebec
City, Quebec, Canada: Institut de la statistique du
Québec; 2007.
26. Sandoval G, Brown A, Sullivan T, Green E. Factors that
influence cancer patients’ overall perceptions of the
quality of care. Int J Qual Healthc. 2006;18(4):266-
274.
27. Louchini R, Beaupré M, Demers A, Goggin P,
Bouchard C. Trends in cancer prevalence in Quebec.
Chronic Dis Can. 2006;27(3):110-124.
28. Statistics Canada. Canadian Cancer Registry
Database. http://www40.statcan.gc.ca/101/cst01/
hlth61-eng.htm. Published 2008. Accessed Novem-
ber 15, 2008.
29. Health Canada. Healthcare system: waiting times
in Canada 2008. http://www.hc-sc-gc.ca/hcs-
sss/qual/acces/wait-attente/index-eng.php. Ac-
cessed November 15, 2008.
30. Cooper L, Foster J. The use of music to aid patient’
s relaxation in a radiotherapy waiting room. Radiog-
raphy. 2008;14(3):184-188.
31. Gates J. An inquiry-aesthetics of art in hospitals. Aust
Fam Phys. 2008;37(9):761-763.

32. Butcher L. Douglas W. Blayney, MD, on finding
new business models to replace the existing ones
now threatening medical oncology practices. Oncol
Times. 2008;30(13):10-11.
33. Kutash M, Northrop L. Family members’ experiences
of the intensive care unit waiting room. J Adv Nurs.
2007;60(4):384-388.
34. Loiselle C, Lambert S, Cooke A. The searching, pro-
cessing, and sharing of breast cancer information by
women diagnosed with the illness. Can J Nurs Res.
2006;38(3):82-104.
35. Mattioli J, Repinski R, Chappy S. The meaning
of hope and social support in patients receiving
chemotherapy. Oncol Nurs Forum. 2008;35(5):822-
829.

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