| The purpose of this dissertation is to determine perceived female patient satisfaction with her hospital stay and to evaluate any physical and psychological adverse experiences from breast cancer surgery (mastectomy (Mx) or lumpectomy with axillary dissection (BCT)). The research utilized New Jersey State Hospital Discharge data (UB-92), survey data from The Johns Hopkins Breast Center, and two survey instruments used in cohort of new breast cancer patients at the Robert Wood Johnson University Hospital in New Brunswick, New Jersey: the SF-36 standardized survey tool plus 8 breast cancer questions, and a newly-designed research questionnaire (Survey X). Despite the low number of complications in the UB-92 data set (n = 27 total), the complication rate of re-hospitalizations after breast cancer surgery decreased after the legislation mandating length of hospital stay coverage by insurance companies after breast cancer surgery passed in New Jersey (NJ). That complication rate prior to the law was 0.07 and 0.36 percent after BCT and Mx, respectively, and 0.018 and 0.13 percent for BCT and Mx after the law, respectively. Based on this physical data, there is no perceived benefit on the physical complications of the law passed in New Jersey in July 1997. The domains of the SF-3b data for the surveyed cohort of New Jersey patients were consistent with the national averages of similarly-aged women. Survey X demonstrated that (1) personality was linked to satisfaction with breast cancer treatment, and (2) mastery level was lower in dissatisfied patients. When a patient feels she has less control, she is less satisfied with her treatment. Furthermore, those feelings of control were linked to interactions with her doctor(s) and nurses, and her knowledge about what to expect after surgery. The Johns Hopkins data revealed similar findings to those obtained from the NJ cohort. Overall, few patients were dissatisfied with their breast cancer surgery regardless of length of hospital stay. A slight trend suggested patients receiving same-day procedures were extremely dissatisfied with their experience. Extrapolation of results observed in the NJ data lends support to not passing a federal law to mandate insurance coverage for minimum hospital stays for breast cancer surgery. |
