BACKGROUND: Taking patient centeredness into account is important in healthcare. The European Cancer Consumer Quality Index (ECCQI) is a validated tool for international benchmarking of patient experiences and satisfaction. This study aimed to further validate the ECCQI in larger and more uniform groups of high volume tumours such as breast and prostate cancer. A second objective was the verification of the influence of cultural factors of the country to determine its possible use in international benchmarking. METHODS: Data from two survey studies in eight European countries were combined. Socio-demographic correlations were analysed with Kruskall-Wallis and Mann-Whitney tests. Cronbach's alpha was calculated to validate internal consistency. Influences of masculinity (MAS), power distance (PD) and uncertainty avoidance (UA) were determined by linear regression analysis in a general model and subgroup models. RESULTS: A total of 1322 surveys were included in the analysis (1093 breast- and 348 prostate cancer patients). Cronbach's alpha was good (α ≥ 0.7) or acceptable (0.5 ≤ α ≤ 0.7) in 8 out of 9 questionnaire categories, except in the category 'Safety' (α = 0.305). Overall ECCQI scores ranged from 22.1 to 25.1 between countries on a 1-35 scale (categories had a 1-4 scale). In certain subcategories such as 'Organisation' (range 2.2 vs 3.0) and 'Supervision & Support' (range 3.0 vs 3.8) a large difference was observed between countries. Differences in 'Overall opinion' were however small: mean scores of 3.7 vs 3.9, whereas median scores were all the maximum of 4.0. Power distance was positively associated with higher patient satisfaction scores whereas Uncertainty avoidance was negatively associated with these scores. Masculinity was only associated with patient satisfaction scores in lower educated patients. We found the highest impact of culture on overall scores in Hungary and Portugal and the lowest in Romania. CONCLUSIONS: The ECCQI shows high internal consistency in all categories except 'Safety'. Especially in separate categories and overall ECCQI scores the questionnaire showed discriminative value. This study showed a positive correlation of power distance and a negative correlation for uncertainty avoidance in some countries. When using the ECCQI for international benchmarking these two dimensions of culture should be taken into account.

Departement of Urology Jeroen Bosch Hospital Den Bosch The Netherlands

Department of Comprehensive Cancer Care Faculty of Medicine Masaryk University Brno Czech Republic

Department of Comprehensive Cancer Care Masaryk Memorial Cancer Institute Brno Czech Republic

Department of Health Technology and Services Research technical Medical Centre Faculty of behavioural management and social sciences University of Twente Enschede The Netherlands

Department of Research and Development Netherlands Comprehensive Cancer Organisation Utrecht The Netherlands

Helsinki University Hospital Comprehensive Cancer Center Helsinki Finland

Rijnstate Hospital Arnhem The Netherlands

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Ouwens M, Hermens R, Hulscher M, Vonk-Okhuijsen S, Tjan-Heijnen V, Termeer R, et al. Development of indicators for patient-centred cancer care. Support Care Cancer. 2010;18(1):121–130. doi: 10.1007/s00520-009-0638-y. PubMed DOI PMC

Institute of Medicine . Committee on health Care in America: crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.

Booij JC, Zegers M, Evers PM, Hendriks M, Delnoij DM, Rademakers JJ. Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients. BMC Cancer. 2013;13:203. doi: 10.1186/1471-2407-13-203. PubMed DOI PMC

Wessels H, de Graeff A, Wynia K, de Heus M, Kruitwagen CL, Teunissen SC, et al. Are health care professionals able to judge cancer patients’ health care preferences correctly? A cross-sectional study. BMC Health Serv Res. 2010;10:198. doi: 10.1186/1472-6963-10-198. PubMed DOI PMC

Wind A, Roeling MP, Heerink J, Sixma H, Presti P, Lombardo C, et al. Piloting a generic cancer consumer quality index in six European countries. BMC Cancer. 2016;16(1):711. doi: 10.1186/s12885-016-2752-9. PubMed DOI PMC

World Cancer Fund . Worldwide cancer data; Global cancer statistics for the most common cancers. 2018.

GLOBOCAN . Cancer tomorrow (Incidence, Males, Prostate cancer, Females, Breast cancer) 2018.

Napier AD, Ancarno C, Butler B, Calabrese J, Chater A, Chatterjee H, et al. Culture and health. Lancet. 2014;384(9954):1607–1639. doi: 10.1016/S0140-6736(14)61603-2. PubMed DOI

Mackenbach JP. Cultural values and population health: a quantitative analysis of variations in cultural values, health behaviours and health outcomes among 42 European countries. Health Place. 2014;28:116–132. doi: 10.1016/j.healthplace.2014.04.004. PubMed DOI

Hofstede G, Hofstede GJ, Minkov M. Cultures and Organisations: software of the mind. Intercultural cooperation and its importance for survival. New York: McGraw-Hill; 2010.

Verma A, Griffin A, Dacre J, Elder A. Exploring cultural and linguistic influences on clinical communication skills: a qualitative study of international medical graduates. BMC Med Educ. 2016;16(1):162. doi: 10.1186/s12909-016-0680-7. PubMed DOI PMC

Morrow G, Rothwell C, Burford B, Illing J. Cultural dimensions in the transition of overseas medical graduates to the UK workplace. Med Teach. 2013;35(10):1537–1545. doi: 10.3109/0142159X.2013.802298. PubMed DOI

Venaik S, Brewer P. Avoiding uncertainty in Hofstede and GLOBE. J Int Bus Stud. 2010;41(8):1294–1315. doi: 10.1057/jibs.2009.96. DOI

Borisova LV, Martinussen PE, Rydland HT, Stornes P, Eikemo TA. Public evaluation of health services across 21 European countries: the role of culture. Scand J Public Health. 2017;45(2):132–139. doi: 10.1177/1403494816685920. PubMed DOI

Hofstede G. Dimensionalizing cultures: the Hofstede model in context. Online Read Psychol Cult. 2011;2(1):8.

Meeuwesen L, van den Brink-Muinen A, Hofstede G. Can dimensions of national culture predict cross-national differences in medical communication? Patient Educ Couns. 2009;75(1):58–66. doi: 10.1016/j.pec.2008.09.015. PubMed DOI

Sixma HJ, De Boer D, Delnoij D. Handboek CQ-index ontwikkeling: richtlijnen en voorschriften voor de ontwikkeling van een CQ-index meetinstrument. Utrecht: NIVEL; 2008.

Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334. doi: 10.1007/BF02310555. DOI

Streiner LD, Norman GR. Health measurement scales: a practical guide to their development and use. 4. Oxford: Oxford University Press; 2008.

Helgason S. International benchmarking experiences from OECD countries. In Procedings of the Danish ministry of finance conference on international benchmarking. Copenhagen: The Stationery Office; 1997.

GBD 2016 Healtcare Access and Quality Collaborators Measuring performance on the Healthcare Acces and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study. Lancet. 2018;391:2236–2271. doi: 10.1016/S0140-6736(18)30994-2. PubMed DOI PMC

Décieux JP, Mergener A, Neufang KM, Sischka P. Implementation of the forced answering option within online surveys: do higher item response rates come at the expense of participation and answer quality? Psihologija. 2015;48(4):311–326. doi: 10.2298/PSI1504311D. DOI

EU Science Hub . 2020 Cancer incidence and mortality in EU-27 countries. 2020.