Cultural and Organizational Adaptation of the QUOTE Breast Cancer Questionnaire for Italian Breast Units

Background: Quality of care in breast cancer is a widely researched topic, with many objectively measurable indicators of quality in healthcare. However, while there is a large consensus on the importance of patient’s perspective in breast cancer care process, there are only a few tools to measure such subjective indicators, and none of them has been validated for its use in Italy yet. Objectives: The aim of this methodological study was to validate a cultural and organizational adaptation of the quality of care through the patient’s eyes breast cancer (QUOTE-BC) questionnaire for its use in Italian breast units. Methods: The QUOTE-BC questionnaire was translated, adapted for the Italian context and pre-tested on a small sample of breast cancer patients during their hospital stay. The questionnaire was then administered to a large sample of patients from December 2016 to May 2017 in order to further validate it. A visual analogue scale (VAS) was also handed out to assess patients level of satisfaction. Results: A total of 212 patients filled the questionnaire. Confirmatory factor analysis corroborated the five-factor structure of the original questionnaire explaining 80.2% of the total variance. The Cronbach alpha ranged from 0.69 to 0.84 showed a good level of internal consistency. The VAS difference between the groups of patients giving positive and negative answers showed that, in almost all the items, there was a statistically significant difference in patients’ level of satisfaction between the two groups. Conclusions: In this study, we validated the first Italian adaptation of the QUOTE-BC (IT-QUOTE-BC) questionnaire, which represents a valuable tool for supporting clinical and organizational decisions in Italian breast units. Moreover, the routine use of the IT-QUOTE-BC questionnaire in the same breast unit is a tool to verify the improvement in organizational quality change as perceived by the patients.