Bowel cancer diagnosis experiences as a predictor of overall care rating: evidence from the English Cancer Patient Experience Survey

Objective: To investigate whether and which negative diagnosis-related experiences of patients newly diagnosed with colorectal cancer (CRC) are associated with a poorer overall rating of care, to help prioritise interventions. Methods: A secondary data analysis was conducted using the English National Cancer Patient Experience Survey 2018. Analysis was restricted to responses by patients with CRC diagnosed within 12 months of survey, through pathways other than population screening. Nine diagnosis-related questions were selected (six objective and three feelings-based). The primary analysis used multivariable logistic regression to predict poorer overall care rating from negative experience responses to the six objective questions, adjusted for confounders. The sensitivity analysis additionally included the three feelings-based questions. Predictors of poorer overall rating with a significance level at p<0.01 were retained in the final models. Results: 4069 CRC patient survey responses were analysed. In the primary analysis, negative experiences were reported between 4% (aEnough information about diagnostic test') and 21% (Given written information about your cancer type') of respondents. In multivariable analysis, all six objective questions were predictive of poorer overall rating, with ORs ranging from 1.6 to 3.5. In the multivariable sensitivity analysis, eight of nine negative experiences were predictive. Conclusion: Negative experiences reported on diagnosis-related questions were almost always associated with a higher likelihood of a poorer overall care rating. To reduce negative diagnostic experiences, the most apt interventions to incorporate into workflows may be informing patients to bring someone to their diagnosis consultation and routine provision of tumour-specific information relevant to patient circumstances.