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 Table of Contents  
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 157-160

Quality of health care service in pain clinics in Mansoura, Egypt: a cross-sectional comparative study

1 Department of Anaesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
2 Department of Surgical Oncology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
3 Department of Community and Public Health, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Date of Submission18-Jul-2019
Date of Acceptance08-Jan-2020
Date of Web Publication27-Jun-2020

Correspondence Address:
MD Nevert A Abdel Ghaffar
Departments of Anaesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura 35516
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_63_19

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Background Patient satisfaction is an essential parameter for health care service evaluation. The authors evaluated the quality of the health care services and treatment satisfaction among patients with cancer with chronic pain.
Materials and methods The authors conducted our study in Oncology Center Mansoura and Mansoura University Hospitals from April 2019 till September 2019. The authors enrolled 259 patients who were subjected to Patient Satisfaction Questionnaire Short Form, pain treatment satisfaction scale, and numerical rating scale.
Results Regarding Patient Satisfaction Questionnaire, patients were generally satisfied in the Oncology Center (P<0.001). Moreover, technical quality, accessibility, and convenience were better in the Oncology Center (P<0.001). Patients were more satisfied with the financial aspects in Mansoura University Hospital (P<0.001). Regarding pain treatment satisfaction scale, patients were more satisfied about medication characteristics in the Oncology Center (P<0.001).
Conclusion General satisfaction, technical quality, accessibility, convenience, and medication characteristics were better in the Oncology Center. Patients were more satisfied with the financial aspects in Mansoura University Hospital.

Keywords: cancer, health care, pain, patient satisfaction

How to cite this article:
Abdel Ghaffar NA, Abdel Ghaffar MA, El Ghaffar AA. Quality of health care service in pain clinics in Mansoura, Egypt: a cross-sectional comparative study. Res Opin Anesth Intensive Care 2020;7:157-60

How to cite this URL:
Abdel Ghaffar NA, Abdel Ghaffar MA, El Ghaffar AA. Quality of health care service in pain clinics in Mansoura, Egypt: a cross-sectional comparative study. Res Opin Anesth Intensive Care [serial online] 2020 [cited 2020 Sep 20];7:157-60. Available from: http://www.roaic.eg.net/text.asp?2020/7/2/157/287997

  Introduction Top

Patient satisfaction has become an important aspect in the health services evaluation. It is equally important for the medical results and economical costs of the provided services [1]. Cancer is a common health problem frequently associated with pain that deserves patient satisfaction services [2]. Assessment of patients’ satisfaction in this sector of diseases is a cornerstone for optimum pain management.

Patient satisfaction is defined as a personal evaluation of the experienced care [3].

There are many questionnaires to assess patient satisfaction for health care service and treatment. For health service assessment, Patient Satisfaction Questionnaire Short Form (PSQ-18) is a commonly used one with high reliability [4]. However, for treatment assessment, Pain Treatment Satisfaction Scale (PTSS) is routinely applied [5].

It is well known that any health care system needs continuous evaluation both by the care givers and patients to improve the quality of service. Of course, it is a continuous process with much variability. Despite many international studies being conducted about satisfaction in patients with cancer [6],[7],[8], our study is the first in Delta region, Egypt. From this point, we evaluated the quality of health care services and treatment satisfaction among patients with cancer attending the outpatient pain clinics in two university-affiliated hospitals in Mansoura, Egypt.

  Materials and methods Top

Study design and participants

We conducted a cross-sectional comparative study in the outpatient pain clinic of Oncology Center Mansoura University (OCMU) and Mansoura University Hospital (MUH). These hospitals serve Delta Region, which encompasses 10 governorates, with 41% of the total Egyptian population. The study was approved by the Institutional Research Board (Code No: R.19.04.480) and registered in ClinicalTrials.gov (NCT04048473). A total of 259 patients with cancer with chronic pain were included from April 2019 till September 2019. All patients were oriented, alert, spoke and read Arabic, and had no communication problems or physical conditions that might interfere with the interview. Informed written consents were obtained from all patients. During the study, participants answered the questions while they were waiting for their medical consultation.

Sample size calculation

Sample size was calculated using Power Analysis and Sample Size software program (PASS) version 15.0.5 for windows 2017 (NCSS LLC, Utah, United States), with PSQ as the primary outcome. An effect size of 0.5 was set as the target difference between the study groups. A sample size of 105 patients in each group was needed to achieve 95% power in the proposed study using two-sided two-sample equal-variance t-test with a significance level of 5%. To the best of our knowledge, no previous studies were conducted on the same population to assess satisfaction scores among patients with cancer.

We assessed health service quality using PSQ-18 (ranged from strongly agree=1, agree=2, uncertain=3, disagree=4, and strongly disagree=5). It included seven domains: general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with the doctor, and accessibility and convenience [4]. Moreover, we evaluated the treatment satisfaction using PTSS (ranged from 0=dissatisfied to 100=satisfied). It included 39 items grouped into five dimensions: satisfaction with current pain medication in two subscales: medication characteristics (three items) and efficacy (three items); adverse effects of medication (12 items); effect of current pain medication (eight items); medical care (eight items); and information about pain and its treatment (five items). [9] Pain intensity was measured using numerical rating scale. It is an 11-point scale, where 0=no pain and 10=worst imaginable pain. Type of cancer, duration of pain, and visit duration were recorded.

Study outcomes

  1. Primary outcomes were PSQ-18.
  2. Secondary outcomes were PTSS and pain intensity in the present, average, and the worst pain.

Statistical analysis

We used SPSS version 20 (IBM Corporation, Armonk, NY, USA). We tested data normality using Kolmogorov–Smirnov test. Normally distributed data were expressed as mean and standard deviation and compared using Student’s t-test, whereas non-normally distributed data were expressed as median and range (minimum–maximum) and compared using Mann–Whitney test. Categorical variables were expressed as numbers and percentage and compared using χ2-test. P value less than or equal to 0.05 was considered statistically significant.

  Result Top

Both groups were similar regarding age, sex, types of cancers, and the duration of pain (P<0.05). Duration of clinic visit was longer in MUH (P=0.008) ([Table 1]).
Table 1 Differences in participants’ characteristics, types of cancers, duration of pain, and duration of clinic visit

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Regarding PSQ-18, patients were generally satisfied in OCMU than MUH (P<0.001). Moreover, technical quality, accessibility, and convenience were better in OCMU (P<0.001). However, patients were more satisfied about the financial aspects in MUH than OCMU (P<0.001, [Table 2]).
Table 2 Patient Satisfaction Questionnaire Short Form between Mansoura University Hospital and Oncology Center Mansoura

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Patients were more satisfied about the medication characteristics in OCMU than MUH (P<0.001) ([Table 3]).
Table 3 Pain Treatment Satisfaction Scale between Mansoura University Hospital and Oncology Center Mansoura

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There was no significance in numerical rating scale (present, average, and worst) between MUH and OCMU ([Figure 1]).
Figure 1 Boxplot graph for numerical rating scale.

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  Discussion Top

Increasing attention has been paid for assessment of patient satisfaction to health care service among patients with cancer. Choosing the appropriate methods for its assessment is a challenge. There were many national reports about patients’ satisfaction with health care services [10], nursing care [11], patients’ expectations [12], clients attending out-patient clinics [13], and patients’ adherence to treatment [14].

This study was conducted to evaluate the quality of provided health care services and treatment satisfaction among patients with cancer with chronic pain in outpatient pain clinics in Mansoura, Egypt, using both PSQ-18 and PTSS.

In our study, general satisfaction and technical quality were proved to be better in OCMU. This observation could be explained by availability of medications and easy access for radiological interventions for pain management within the same place that markedly improved the quality of service. Moreover, OCMU included emergency care service for follow-up patients at any time, which is considered a great advantage for OCMU when compared with other local institutes. On reviewing literature, Biondi et al. [15] reported that hospital resource may be positively related to patient satisfaction.

On the contrary, the patients were more satisfied with the financial aspect of the provided services in MUH than OCMU. In MUH, patients received their care completely free except for pain clinic tickets, whereas in OCMU, many patients were required to pay either by own self or insurance funded to cover some aspects of treatment protocols. Our findings were supported by Barbaret et al. [16] who proved that the financial aspect of the provided service is a very important requirement for satisfaction of patients with cancer even if the service is partially covered by insurance.

With regards to PTSS, patients were more satisfied in MUH about the medication characteristics than OCMU. This could be explained by less frequent clinic visits in MUH where patients received their monthly medication requirements in the same visit while in OCMU, two visits per month were needed that add more burden to both patients and their families. On reviewing international reports, Evans et al. [9] evaluated patients satisfaction to their treatment by using PTSS and reported that all dimensions were well discriminated except medication characteristics and explained by its dependency on the severity of pain. Furthermore, Wong et al. [5] assessed 178 patients with chronic pain and concluded that within PTSS only medical characteristic was statistically related to medical adherence.With regards to previous national studies, El-Awady [13] assessed patients’ satisfaction in outpatient clinics in Ain-Shams University Hospitals and reported 45.8% of the patients were unsatisfied by prescribed drugs due to their unavailablility in the outpatient pharmacy of the hospital. Moreover, Gadallah et al. [14] evaluated patients’ satisfaction among those with rheumatoid arthritis at the same hospital and found that adherence to therapy was strongly associated with free treatment in the hospital.

  Conclusion Top

General satisfaction, technical quality, accessibility and convenience and the medication characteristics were superior in Oncology Center. In Mansoura University Hospital, patients were more satisfied by the financial aspects.

We recommend usage of PSQ-18 and PTSS in regular assessment of health care service to make patients with cancer more satisfied and to offer a better medical care.


The manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Aspinal F, Addington-Hall J, Hughes R, Higginson IJ. Using satisfaction to measure the quality of palliative care: a review of the literature. J Adv Nurs 2003; 42:324–339.  Back to cited text no. 1
Boyle P, Levin B. World cancer report 2008. World Health Organization: IARC Press, International Agency for Research on Cancer; 2008.  Back to cited text no. 2
Brédart A. Assessment of satisfaction with cancer care: development, cross-cultural psychometric analysis and application of a comprehensive instrument. University of Amsterdam (Thesis); 2001.  Back to cited text no. 3
Marshall GN, Hays RD. The Patient Satisfaction Questionnaire Short-Form (PSQ-18). Rand Santa Monica, CA: USA; 1994.  Back to cited text no. 4
Wong WS, Chen PP, Chow YF, Wong S, Fielding R. The reliability and validity of the Cantonese version of the pain treatment satisfaction scale (ChPTSS) in a sample of Chinese patients with chronic pain. Pain Med 2015; 16:2316–2323.  Back to cited text no. 5
Brédart A, Razavi D, Delvaux N, Goodman V, Farvacques C, Van Heer C. A comprehensive assessment of satisfaction with care for cancer patients. Support Care Cancer 1998; 6:518–523.  Back to cited text no. 6
Bredart A, Robertson C, Razavi D, Batel-Copel L, Larsson G, Lichosik D et al. Patients’ satisfaction ratings and their desire for care improvement across oncology settings from France, Italy, Poland and Sweden. Psycho-oncol J Psychol Soc Behav Dimens Cancer 2003; 12:68–77.  Back to cited text no. 7
Bergenmar M, Nylén U, Lidbrink E, Bergh J, Brandberg Y. Improvements in patient satisfaction at an outpatient clinic for patients with breast cancer. Acta Oncol (Madr) 2006; 45:550–558.  Back to cited text no. 8
Evans CJ, Trudeau E, Mertzanis P, Marquis P, Peña BM, Wong J et al. Development and validation of the Pain Treatment Satisfaction Scale (PTSS): a patient satisfaction questionnaire for use in patients with chronic or acute pain. Pain 2004; 112:254–266.  Back to cited text no. 9
Gadallah M, Zaki B, Rady M, Anwer W, Sallam I. Patient satisfaction with primary health care services in two districts in Lower and Upper Egypt. Eastern Mediterr Heal Journal 2003; 9:422–430.  Back to cited text no. 10
Zahr LK, William SG, Ayam EH. Patient satisfaction with nursing care in Alexandria, Egypt. Int J Nurs Stud 1991; 28:337–342.  Back to cited text no. 11
Mostafa MM. An empirical study of patients’ expectations and satisfactions in Egyptian hospitals. Int J Health Care Qual Assur 2005; 18:516–532.  Back to cited text no. 12
El-Awady MY. Satisfaction of clients attending out-patient clinics at Ain Shams University Hospitals. J Egypt Public Health Assoc 1999; 74:263–274.  Back to cited text no. 13
Gadallah MA, Boulos DNK, Dewedar S, Gebrel A, Morisky DE. Assessment of rheumatoid arthritis patients: adherence to treatment. Am J Med Sci 2015; 349:151–156.  Back to cited text no. 14
Biondi EA, Hall M, Leonard MS, Pirraglia PA, Alverson BK. Association between resource utilization and patient satisfaction at a tertiary care medical center. J Hosp Med 2016; 11:785–791.  Back to cited text no. 15
Barbaret C, Brosse C, Rhondali W, Ruer M, Monsarrat L, Michaud P et al. Financial distress in patients with advanced cancer. PLoS One 2017; 12:e0176470.  Back to cited text no. 16


  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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