Quality of services and patient reported outcomes for prostate cancer in Tanzania: the role of patients' satisfaction from a cross-sectional study.

Abstract

Background: The increasing global burden of prostate cancer challenges the quality of services in low- and middle-income countries (LMICs) due to infrastructure and limitations in human resources for health. Higher quality of services as perceived by patients, is associated with improved health-related quality of life (HRQoL). This study was designed to assess patients' satisfaction with the quality of services and its association with HRQoL among prostate cancer patients.

Methods: The hospital-based cross-sectional study was conducted among 248 systematically sampled prostate cancer patients under treatment from five tertiary hospitals in Tanzania. The standard patient satisfaction questionnaire and the Expanded Prostate Cancer Index Composite (EPIC) were used to measure HRQoL. Descriptive analysis was used to determine levels and characteristics of patients' satisfaction with quality of services and HRQoL, while regression analysis was conducted to examine the association between patients' satisfaction and HRQoL.

Results: Of the sampled prostate cancer patients, 169 (68.3%) experienced delays in seeking treatment, and a high proportion (85.4%) presented with clinically advanced stage of prostate cancer. Two-thirds of the patients were not satisfied with the quality of services. Key areas of dissatisfaction included long waiting times (75.4%), limited counselling services (77.4%), and a lack of opportunity to discuss their problems with doctors (67.3%). The overall HRQoL score was low (36 out of 60 score), with sexual domain scoring the lowest (5.81%). A unit increase in patient satisfaction was associated with five-times increase in HRQoL β-coefficient 5.25 95%, CI (2.42, 8.08).

Conclusions: Patient satisfaction is a primary driver of health-related quality of life, suggesting that system-level improvements are more vital for patients reported outcomes than biological factors alone. Improving these outcomes requires targeted policy shifts, decentralized care, and stronger financial protections for patients. Key areas of improvements include waiting time and tailored counselling services.