Identifying priorities for improvement of the quality of personal care in patients undergoing radiotherapy for prostate cancer

Background: We previously developed a questionnaire to assess the quality of personal care in prostate cancer radiotherapy. Patients are asked to rate the importance of 143 elements of their care and to rate the quality of their care for each element. In order to improve the quality of care delivered to patients, the elements of care most in need of improvement must be identified. Objective: To develop a method of integrating ratings of importance and ratings of quality to identify elements of care that should become targets for quality improvement. Methods: We surveyed 108 patients undergoing radiotherapy for prostate cancer. We developed 3 methods to identify elements of care to target for quality improvement that were important to the patient(s) and suboptimal in quality. Spearman correlation was used to compare ranking of priorities across all 3 methods. Generalized estimating equations were used to assess the statistical ability of the methods to discriminate between priorities for quality improvement. Results: Integrating importance and quality ratings identified different priorities than using quality ratings alone. Two of the integrated methods identified priorities for quality improvement and their ranks similarly (r=0.91, pu003c0.0001). All methods identified elements related to communication of information about the disease and its treatment as priorities. Conclusions: Two methods produced similar results although one is easier to understand and theoretically superior since the ratings for importance and quality are linked for each individual. Further consultation with stakeholders will determine how to use these results as part of a quality improvement program.