Open Access Highly Accessed Research article

Using patients’ experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both?

Vicki Tsianakas1, Jill Maben1*, Theresa Wiseman2, Glenn Robert1, Alison Richardson3, Peter Madden4, Mairead Griffin5 and Elizabeth A Davies4

Author Affiliations

1 Florence Nightingale School of Nursing and Midwifery, King’s College London, 57 Waterloo Rd, London SE1 8WA, UK

2 The Royal Marsden NHS Foundation Trust, Fulham Road, London SE3 6JJ, UK

3 School of Health Sciences University of Southampton & Southampton University Hospitals Trust, Highfield, Southampton, SO17 1BJ, UK

4 Thames Cancer Registry, King’s College London, 42 Weston Street, London SE1 3QD, UK

5 Guys and St Thomas’ NHS Foundation Trust, St Thomas’ Street, London SE1 9RT, UK

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BMC Health Services Research 2012, 12:271  doi:10.1186/1472-6963-12-271

Published: 22 August 2012



Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process.


One dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified.


There were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’ aspects and were not always sufficiently detailed to identify specific improvement actions.


Our analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience.

Experience-Based Co-Design; Patient questionnaire; Survey; Quality improvement; Patient experience; Breast cancer; Narrative interviews