Stepwise Implementation of a Specialist Breast Nurse Position and Clinical Pathway: Impact on Patient Satisfaction

Background: Key success factors for significantly improving patient satisfaction on breast cancer care are not well known. Data obtained over a period of 6 years in a breast cancer clinic provide a portrait of the evolution of patient satisfaction on quality of care. Methods: We measured 19 patient satisfaction items and 6 groups of 60 consecutive Primary Operable Breast Cancer patients filled in the (validated) questionnaire. A first group prior and a second group after the implementation of a clinical pathway, a third group after the introduction of a breast cancer nurse following patients systematically only postoperatively, a fourth group having an additional consultation of the breast nurse in the diagnostic and preoperative phase and a fifth and sixth group after implementing education sessions for hospital staff and the Eusoma and other national guidelines. Results: We found that the successive modifications of the care process resulted in an improvement of patient satisfaction for all items and for 16 of the 19 items these improvements were significant. The number of items for which dissatisfaction was higher than 5% diminished from 18 to 3 of the 19 items (group 6 versus group 1). Conclusion: Significant improvements were only achieved by combining the implementation of a clinical pathway, a specialist breast nurse, education sessions and Eusoma and national guidelines. In particular, the role of the specialist breast cancer nurse was found to be of major importance to coordinate the care process and guide patients through the pre- and post-operative phase of their treatment.