2.1. Participants
Our study was conducted with the approval of the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee (dated 15.08.2018, decision 446). All individuals included in the study were given detailed information about the purpose, method, and duration of the study. In addition, patients were signed with an "Informed Consent Form". The identities of the participants were kept strictly confidential and only aggregate data were reported.
Power analysis was applied to calculate the required sample size. As a result of the calculation made using G-power analysis, the minimum sample number required for 95% reliability and 80% power was determined as 220. Our study is multidisciplinary care center in Turkey Istanbul Medipol University Hospital Complex of Hematology-Oncology section referencing between the years 2018-2020, the results of clinical and radiographic examinations are diagnosed with cancer and was conducted on patients who volunteered to participate in the study. Adult individuals over the age of 18 who received radiotherapy and/or chemotherapy treatment due to the primary tumor at different stages of the disease were included in the study. Individuals who do not have sufficient mental and speaking capacity in terms of understanding and answering the questionnaires and who have psychological morbidity were excluded from the study.
2.3. Questionnaire
A demographic form prepared by the researchers was filled in as the first step. In this form, it included questions giving information about the age, gender, marital status, education level, systemic disease, and diagnosis of the cancerous individual. In addition, a total of three questionnaires were conducted: EORTC QLQ-INFO25, EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30) and inpatient satisfaction module EORTC Cancer In-Patient Satisfaction with Care Questionnaire (IN-PATSAT32) survey. In the EORTC QLQ-C30 and EORTC IN-PATSAT32 surveys both in Turkey and standardization it has been translated before they were surveyed [10, 11].
EORTC QLQ-INFO25 is a 25-item questionnaire with information about the disease (4 items), medical tests (3 items), treatment (6 items), other services (4 items) and 8 additional topics. In addition to the survey, there are questions about self-help, different areas of care, receiving written and/or digital information, satisfaction with the information received, the desire to receive more or less information, and the usefulness of the information received. Response format is made according to 4-point Likert scale (1-nothing, 2-some, 3-quite, 4-very much). Items 52, 53, 54 and 55, which question whether they are satisfied with the level of information they receive and whether they want more information, have a two-way answer as Yes/No. Patients who respond positively to questions about requests for more or less information are asked to provide more detailed information on the subject. The scores of these items are converted linearly to 0-100 scale according to the EORTC guide [12]. The EORTC QLQ-INFO25 questionnaire was translated from English to Turkish using the translation / reversal method and was then translated back to English by a different translator who did not see the original version of the questionnaire. In 10 consecutive interviews with oncology patients, the questionnaire was tested for understanding and clarity, and no changes were made afterwards. The Turkish version of the questionnaire was approved by the EORTC translation unit after careful evaluation of the data from the pilot test.
The EORTC QLQ-C30 scale has three subtitles and 30 questions: general well-being, functional difficulties, and symptom control. Functional scales; physical, role, cognitive, emotional, and social functions; Symptom scales are assessed by weakness, pain, and nausea-vomiting. There are also questions related to dyspnea, insomnia, loss of appetite, constipation, diarrhea, and financial difficulties. The first 28 of the 30 questions in the scale are four-point Likert type (None: 1, A little: 2, Quite: 3, A lot: 4 points). General health in question 29 and general quality of life in question 30 are scored from 1 to 7 (1: very bad and 7: excellent). High scores of functional scale and general health status scale of patients; low symptom scale score indicates that the quality of life is high. Scores are calculated by converting the scores of the answers given to the questions to 100 [13].
The EORTC IN-PATSAT32 questionnaire is an internationally valid 32-item questionnaire that evaluates the quality of hospital care during oncology patients' stay in the hospital. The 32 items in the survey are also five-point Likert type (Bad: 1, Not bad: 2, Good: 3, Very good: 4, Excellent: 5 points). The first 11 questions are doctors, 12-22. questions nurses, 23-31. The questions generally question the hospital services and the care system, while the 32nd question questions the hospital stay in general. High score indicates that the quality of hospital care has increased, and low score indicates that the quality of hospital care has decreased [14].
2.4. Statistical analysis
The data were analyzed with SPSS 25.0 version. Categorical and continuous variables were studied using frequencies and mean ± standard deviations. In the study, multivariate statistics were used statistically. Kolmogorov-Smirnov and Shapiro-Wilk tests were used for normality evaluation. Factor analysis for validity, Cronbach’s Alfa, which is the internal consistency coefficient for reliability, was calculated. While making the correlation analysis between the scales, nonparametric test (Mann-Whitney test), parametric test (Student t test), and Anova tests were applied for the differences between the groups.