Validation of a French hospitalized patients' satisfaction questionnaire: the QSH-45.

OBJECTIVE: To develop a generic French self-administered instrument for measuring hospitalized patients' satisfaction based on the patient's point of view: the questionnaire for satisfaction of hospitalized (QSH) patients. DESIGN: The development was supervised by a steering committee and undertaken through three standard steps. Item generation was derived from 95 face-to-face interviews, performed in hospitalized patients and in patients scheduled to be admitted. The item reduction led to a 69-item questionnaire. The validation process was based on validity, reliability and some aspects of external validity. SETTING: Medical, surgical and obstetrical departments (n = 187) of public hospitals (n = 11) from different French regions (n = 3). PARTICIPANTS: Eligible patients were adult subjects hospitalized for at least 24 h. MAIN OUTCOME MEASURES: QSH, sociodemographic data, hospitalization department, visual analogue scales of satisfaction. RESULTS: The final version of QSH contained 45 items describing 9 dimensions, leading to 2 composite scores (staff and structure index). The factor structure accounted for 71% of the total variance. Internal consistency was satisfactory (item-internal consistency over 0.40; Cronbach's alpha coefficients ranged from 0.76 to 0.96). The scalability was satisfactory with inlier-sensitive fit (INFIT) statistics inside an acceptable range. Scores of dimensions were strongly positively correlated with visual analogue scale scores (all P < 0.001). External validity showed statistical associations between QSH scores and age or department. Participation rate was 91%. CONCLUSIONS: The availability of a reliable and valid French questionnaire concerning hospitalized patients' satisfaction, exclusively generated from patients' interviews, enables patient feedback to be incorporated in a continuous quality health-care improvement strategy.

The place of patient satisfaction in quality assessment of lung cancer thoracic surgery.

STUDY OBJECTIVES: To compare the quality of non-small cell lung cancer (NSCLC) surgical care with patient satisfaction. DESIGN: Prospective study. SETTING: Academic hospital departments of thoracic oncology and surgery. PATIENTS AND METHODS: Patients presenting with recently diagnosed NSCLC and eligible for front-line thoracic surgery were eligible. Patient satisfaction was assessed using the Questionnaire of Satisfaction of Hospitalized Patients. Quality of surgical care was evaluated using an original score built accordingly to British Thoracic Society guidelines. Univariate analysis used parametric (Pearson correlation, t test) and nonparametric tests (Mann-Whitney U test) according to test conditions. Probability of survival was estimated using the Kaplan-Meier method. RESULTS: Seventy patients (mean age, 63.7 years) were included. Lobectomy was performed in 62 cases, and pneumonectomy was performed in 8 cases. In all, 28 patients had a postoperative complication. One-year survival rates for patients with stage I-II and stage IIIA NSCLC were 84% and 58%, respectively. Mean patient satisfaction was 78 +/- 13/100 and 69 +/- 13/100 for global staff and structure index, respectively (+/- SD). Mean score for quality of surgical care was 88.7/100 (range, 51 to 100). The absence of postoperative complication was significantly related to a high level of satisfaction regarding the structure (r = 0.30, p < 0.05). Other features of patient satisfaction did not show a significant correlation with the quality of the preoperative selection process or the surgical procedure itself (r < 0.20). CONCLUSIONS: Considering the lack of significant correlation, the present study does not support a shortcut between quality of care and patient satisfaction. Nonetheless, patient satisfaction should be integrated into rather than substituted for the quality of health-care assessment, which also needs further development.

Reliability and validity of the VSP-A, a health-related quality of life instrument for ill and healthy adolescents.

PURPOSE: To report the preliminary validation results of a generic self-administered measure for adolescents the VSP-A (Vecu et Sante Percue de l'Adolescent). METHODS: The validation survey of the 37-item VSP-A involved 1938 adolescents: 1758 adolescents attending school (90.7%) and 180 inpatient youths (9.3%) with medical, surgical, or psychiatric conditions; mean age was 14.8 years (SD = 2.1; range = 10-17) and 1018 (52.5%) were girls. Ten dimensions scores were computed: psychological well-being, body image, physical well-being, vitality, friends, parents, teachers, school performance, medical staff, and a global HRQL index. Construct validity was tested using inter-item correlations, item-dimension correlations, and principal component analysis. The unidimensionality of the scales was studied using Rasch rating scale model and the internal consistency of the scales using Cronbach alpha. Known group comparisons were performed and effect sizes computed to assess the clinical validity and sensitivity of the instrument. RESULTS: VSP-A, completed in less than 15 minutes, is consistent (Cronbach alpha = 0.74-0.91). Content and construct validity are good. Factorial validity, item-internal consistency, item-discriminant validity, and inter-dimension correlations support the item grouping in 10 dimensions. The results of the comparison of the VSP-A scores according to external criteria (sociodemographics, health status) show they are in accordance with the literature and previous works. CONCLUSIONS: These preliminary results support the reliability and validity of the VSP-A as a multidimensional adolescent report of HRQL in healthy and patient populations. The next phase of the research consists of testing the sensitivity to changes of the VSP-A.

[Stem cells and therapeutic cloning, medical perspectives under discussion]. / Cellules souches et clonage thérapeutique, des perspectives médicales en débat.

Innovative biotechnical progress over the past few years regards stem cells and therapeutic cloning, which open promising medical horizons for many presently incurable diseases. THE CURRENT DEBATE: The research work in France has been stalled because of the prohibitions listed in the so-called "bioethical" laws of 1994. The ongoing revision of these laws is based on a certain number of ethical questions and launches a disputable parlementary debate. Other than reproductive cloning and research on the embryo, the possibilities provided by stem cells and therapeutic cloning should be emphasized and the different positions advanced specified, showing an evolution in the laws in France. ABUSIVE LEGISLATIVE PROHIBITIONS: The proposed law, which maintains the prohibition for research on the embryo, with a 5-Year dispensation, and which explicitly prohibits therapeutic cloning, is not in keeping with the widening of in this field expected by research teams. Many scientists and physicians, supported by patients' associations, are aware of the importance of therapeutic progress attached to such research. They should not be stalled in their studies by the prohibitions maintained in the new law.