Turkey is a country in the size of Texas USA, but it populates 65 million people. The one third of this population lives in the Marmara region that encompasses Istanbul and cities around eastern Marmara Sea, Kocaeli and Bursa. The region is economically most prosperous part of the country and great amount of immigration from rest of the country to this region in the last 40 years makes both Istanbul and the larger Marmara region a melting pot for various cultural and religious groups.
Marmara University Hospital is a 350-bed hospital located in the Anatolian part of the Istanbul and closer to other smaller industrial cities like Izmit and Adapazari. Because of its location in a medium income neighborhood and close proximity to both richer coastal section of town and poorer highland section, it serves to a wide range of patient population with different socio-economic and cultural backgrounds.
Almost all cytostatics are available for Turkish cancer patients. Outpatient cancer care also provided in a similar fashion to western European countries, especially in metropolitan cities of Turkey. On the other hand because of population density in bigger cities and lack of adequate resources for appropriate buildings and scarcity of formally trained Medical Oncologists, the level of service may be below standards of European counterparts. It is not known to what level Turkish patients are satisfied with the care provided and where the pitfalls of the system exists since no group as yet reported the cancer patients' perception of care in a formal fashion in Turkey. We conducted a survey find that out in the outpatient chemotherapy unit of Marmara University Hospital.
The unit was established in a container with 2 beds, situated next to the hospital's parking lot, in 1995. A prefabricated building with 9 beds opened in the same location in January 1997. Since July 2000 serving in its current location, a rented floor from neighboring nursing home building, with 14 bed capacity. The unit serves mainly (70%) to oncology patients but also patients of hematology, pulmonary disease, radiation oncology and rheumatology departments get their infusional therapies there.
Two doctors, three nurses, a psychologist and a secretary are providing the care to the patients. Besides the therapies the patients get, their psychological states, the satisfaction and the trust they have for the unit are also given importance and that's why this study is conducted in this unit.
The American College of Physicians' "Patient Satisfaction Check Up" survey at "Practice Management Center" site was downloaded from Internet and translated into Turkish. Before conducting the survey, a meeting was held with all involved staff to review the purpose of undertaking the survey; determine the process for conducting the survey; determine how many surveys to be distributed and everyone prepared to answer patients' questions regarding the survey. A particular attention paid to involving everyone in the unit who has patient contact. Also everyone was included in the process of choosing the appropriate questions so some of the original questions were either tailored or eliminated on our own initiative, in order to fit to the way the health system is operating in Turkey. The translated form of survey consisted of 33 questions and 2 more questions were added to find out: "the cancer type of the patient" and "for how long he/she has been coming to the chemotherapy unit".
The staff psychologist and the externs who were having their rotations during the time of the study gave the questionnaires to all patients that pass through the unit. Doctors did not give the questionnaires on purpose, to eliminate the biases. Before the questionnaires were given the patients were informed about the purpose of the survey and were assured that their answers would be kept confidential and their names would not be written on their answer sheets.
The study was conducted with 100 consecutive patients who were visiting the unit for their treatment. All of the patients who passed through were given the questionnaires without making any discrimination according to their cancer types, however only the patients from the oncology department were included to avoid any inter-departmental conflict. One hundred percent of the patients accepted to cooperate and there was no refusal. This may partly due to the fact that sampled cohort appreciated our efforts to improve our services which is not a common occurrence in Turkey and also socio-cultural background of Turkish people in general may found it imperative to help when directly asked to.
Responses to the questionnaires scaled from '1' being poor, to '5' being excellent, and then arithmetical mean were calculated to be used in statistical analysis. The data was analyzed using Chi-square test and independent sample tests. The level of significance (alpha) was set to 0.05 for all tests and confidence intervals. SPSS 7.5 for Windows (SPSS, Inc., Chicago, IL) was the statistical software used.