Hospitalization experience and associated factors among Chinese patients with cancer: a cross-sectional study

Abstract

Background

Although hospitalization experience is recognized as critical to patient well-being and nursing quality, its role within Chinese healthcare system remains understudied, particularly among cancer patients. This study aims to capture the associated factors of Chinese cancer patients’ hospitalization experience, with the goal of informing targeted improvements in care delivery.

Methods

A convenience sampling method was employed to survey 351 cancer inpatients from three tertiary hospitals in China from September to November 2024. Data were collected using the Patient-reported Experience Measure for Cancer (PREM-C), the Hospital Service Quality Questionnaire (HSQQ), and the Family APGAR Index (APGAR). The acquired data were analyzed using the Shapiro-Wilk test, univariate analysis, and multiple linear regression.

Results

The mean scores for PREM-C, HSQQ, and APGAR were 92.47 ± 8.62, 82.22 ± 8.05, and 8.26 ± 1.45, respectively. Multiple linear regression analysis indicated four factors associated with cancer patients’ overall hospitalization experience, including payment of medical costs (β = −0.170, p < 0.001), type of cancer (β = 0.128, p = 0.026), quality of hospital services (β = 0.367, p < 0.001), and family function (β = 0.163, p = 0.001).

Conclusion

Patients with higher-quality hospital services, stronger family functioning, or medical insurance report more positive hospitalization experiences. Gynecological cancer patients also report better experiences than those with other cancer types. This study highlights hospital service quality and family functioning as key influences on cancer patients’ hospitalization experience, advocating tailored support for different cancer types.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-03489-9.

Introduction

Cancer is the second-leading cause of death across the globe, and its incidence steadily increases each year [1]. According to the International Agency for Research on Cancer, there were 20 million new cancer cases and 9.7 million cancer-related deaths worldwide in 2022 [2]. Globally, China exhibits the highest cancer incidence and mortality rates [3], which has led to a significant cancer-related social burden. Cancer patients typically require a comprehensive range of acute care, supportive services, and multispecialty collaboration throughout their diagnosis and treatment process [4]. Acute and supportive services encompass diagnostic and ongoing monitoring (such as mammography; ultrasound imaging; and tissue, blood, and urine sample analysis, as well as self-examination), crisis prevention and management, and the management of stress and emotional well-being [5]. Multidisciplinary collaboration constitutes a systematic, multidisciplinary care approach, with the aim of optimizing patient self-management and augmenting survivor-centered, comprehensive care commencing from the point of diagnosis [6]. In the management of cancer patients, effective multidisciplinary collaboration serves as a crucial safeguard for ensuring the quality of nursing, allowing patients to receive high-quality care as well as comprehensive acute and supportive services [4]. However, most healthcare institutions in China primarily focus on disease diagnosis and treatment when providing care to patients, often neglecting the psychological, social, and environmental aspects of patient care [7].

In 2001, the Institute of Medicine put forward patient-centeredness as a crucial indicator of quality in the provision of health services [8]. Patient-centered healthcare emphasizes the importance of caring for the patient as a person with holistic needs, as well as recognizing the social situation in which they are coping with their disease [9]. Patient-centered care can not only enhance health management, treatment adherence, quality of life, patient experience, and satisfaction with healthcare services [10] but also alleviate patients’ stress, the requirement for specialist care, and the frequency of hospitalization [11]. Patient-reported experience has been recommended as the premier standard for assessing the quality of cancer care in health services [12]. Taking patient evaluations as a foundation for improving and perfecting nursing services is a vital strategy for elevating the quality of clinical care. Patient inpatient service experience pertains to the evaluation of the interactions between hospitalized patients and healthcare services, which measures their experiences throughout the hospital care process and is of great significance in guaranteeing the quality of healthcare service provision [13].

Hospitalization experience, as a core evaluation indicator of healthcare service quality, has also received extensive attention from healthcare practitioners in recent years. Previous studies have found that the satisfaction of inpatient experience of cancer patients was influenced by multidimensional factors such as demographic characteristics, quality of healthcare services, and family support. For example, Chen et al. investigated the inpatient experience of 878 patients in public hospitals in Shanghai and found that patients’ sex and expenditures on treatment, doctors’ and nurses service attitudes, and environment had an impact on inpatient experience [14]. This finding aligned with a Korean study demonstrating significant associations between patients’ hospitalization experiences and factors such as communication with physicians/nurses, discussions about treatments, hospital environment, and the convenience of admission procedures [15]. Additionally, family support serves as a critical source of assistance for cancer patients during hospitalization. In the context of treatment and nursing care, families that actively engage with nurses can help patients access cognitive and emotional support, thereby enhancing their hospitalization satisfaction [16]. However, a critical research gap remains in understanding hospitalization experiences specific to Chinese patients with cancer. The severity of cancer and complexity of its treatment often exposed inpatients to physical and psychological burdens, such as pain, anxiety, and functional impairment, that directly undermined their experiences and reduce satisfaction [17, 18]. Moreover, China’s unique healthcare system structure and regional socioeconomic support may generate distinct hospitalization experiences compared to high-income settings, yet the associated factors remain understudied.

Guided by the Stakeholder Theory, this study investigated the perspectives of key stakeholders in shaping cancer patients’ hospitalization experiences. As defined by Freeman, stakeholders are “any group or individual who can affect or is affected by the achievement of an organization’s objectives” [19], and every organization experiences three fundamental impacts within the stakeholder domain—namely, environmental, social, and economic impacts [20]. Based on this theory, stakeholders that influence the inpatient experience of cancer patients can be primarily classified into three categories [19]: ① Environment: This category encompasses both the internal environment, such as the patient’s family, and the external environment, which includes healthcare reform policies and laws, medical technologies, and healthcare institutions. ② Society: This category involves the relationships among different parties, namely those between doctors (or nurses) and patients, among medical staff, and among patients themselves. ③ Economy: This category includes the cost-related payments. The theoretical framework of this study is presented in Fig. 1.

Fig. 1.

Study conceptual framework grounded in the Stakeholder Theory [19]

While hospitalization experience was recognized as crucial to patient well-being and nursing quality, its role within China’s healthcare system remained understudied, especially among cancer patients. Moreover, the associations between socio-demographic/disease characteristics, hospital service quality, and family support are poorly understood. This study aims to characterize the hospitalization experiences of cancer patients in these contexts and identify associated factors, with the goal of informing targeted improvements in care delivery. By understanding positive and negative aspects of the inpatient experience, healthcare providers can take targeted actions to enhance the overall quality of care. Additionally, findings could help with developing more personalized care plans, ultimately leading to better patient outcomes and improved quality of life for cancer patients during their inpatient stay.

Methods

Study design and settings

A cross-sectional survey design was employed to collect data from September to November 2024.

Participants

Cancer patients were recruited from three tertiary grade A general hospitals in Eastern China using the convenience sampling method by two student nurses from the research team. These medical centers, home to numerous specialists in cancer-related disciplines, serve a potential patient population of nearly 140 million, drawing a substantial number of oncology patients from the local region and surrounding cities. The inclusion criteria were as follows: age ≥ 18 years; pathologically confirmed cancer diagnosis (including gynecological, digestive system, urinary system cancers, etc.); documented TNM stage I-IV or undetermined; current hospitalization with cancer therapy in the general cancer treatment wards; hospitalization episodes ≥ 1; basic literacy and verbal communication abilities; voluntary participation in the study. The exclusion criteria were as follows: a history of cognitive impairment or mental illness; critically ill or receipt of palliative care (the populations with distinct care goals compared to other cancer patients, who are typically admitted to intensive care units or palliative care wards within Chinese oncology care system).

Sample size and sampling

G*Power version 3.1.9.7 was used to calculate the sample size. To ensure accurate statistical data, the sample size was calculated using the formula n = () / to calculate sample size [21], where is the critical value of standard normal distribution of 1.96, with two-sided = 0.05; is the population standard deviation value of 0.5; and represents the margin of error value of 4.73, derived from a pilot study involving 52 eligible cancer patients. The calculated sample size was 343. Accounting for a 10% attrition rate, this study ultimately included 376 participants.

Measures

Patient general information questionnaire

This questionnaire was developed by the research team following a review of relevant literature and group discussions to include 12 items: gender, age, marital status, educational level, monthly per-capita family income, residence, medical payment method, frequency of hospital admissions attributed to the present disease, self-care ability, family history of cancer, cancer type and cancer stage.

Hospital service quality questionnaire (HSQQ)

The HSQQ was developed by Chinese scholars Lu et al. to assess the service level of hospital care under the Chinese healthcare system [22]. The questionnaire consists of six dimensions (Medical Technology, Medical Ethics, Service Attitude, Process Management, Medical Expenses, and Medical Treatment Environment) and 20 items, with each item scored using a 5-point Likert scale, with scores ranging from 1 to 5 points [22]. The total possible score for the HSQQ is 100 points, with higher scores indicating greater satisfaction with hospital service quality. The Cronbach’s α coefficient for the HSQQ in its original study was 0.928 [22], while, in this study, the Cronbach’s α coefficient was 0.945.

Patient-reported experience measure for cancer (PREM-C)

The PREM-C was developed and tested by the Olson team in 2023, based on a six-dimensional, patient-centered theoretical framework proposed by the Institute of Medicine encompassing the following items: ① being respectful of patients’ values, preferences, and expressed needs; ② being coordinated and integrated; ③ providing information, communication, and education; ④ ensuring physical comfort; ⑤ providing emotional support that relieves fear and anxiety; and ⑥ involving family members and friends [8]. The PREM-C has been widely used in the United States and Australia to assess inpatient satisfaction and the quality of cancer care services [4]. It examines the inpatient experiences of cancer patients across five dimensions: respect for values, preferences, expressed needs, and physical comfort (F1); emotional, spiritual, and financial needs (F2); involvement of family and friends (F3); coordination and comprehensiveness of care (F4); and information, communication, and education (F5) [4]. The questionnaire consists of 25 items, scored using a visual analog scale ranging from 0 to 100 points. The total score for the questionnaire, as well as for each dimension, is the sum of the item scores divided by the number of items. Higher scores indicate better performance in the corresponding dimensions. The original Cronbach’s α coefficient for the PREM-C in cancer patients was 0.980 [4]. After being granted permission by the original authors, the questionnaire was translated from English into Chinese and back-translated to guarantee language accuracy. Prior to deployment, we confirmed that the items and order of the Chinese PREM-C were consistent with the English PREM-C. Chinese validation of the PREM-C was conducted among 339 cancer patients from October 2023 to April 2024, and the overall Cronbach’s α coefficient for the Chinese PREM-C was 0.980. In this study, the Cronbach’s α coefficient was 0.976.

Family APGAR index (APGAR)

The APGAR, developed by Smilkstein in 1978 and adapted into Chinese by Lü et al. [23, 24], is a questionnaire designed to assess family functioning. The scale includes five items assessing family adaptability, cooperation, growth, emotional support, and intimacy, with a 3-point scoring system ranging from “rarely” to “frequently,” scored 0–2 points, for a total score ranging from 0 to 10 points. Scores of 7–10 points indicate good family functioning, scores of 4–6 points indicate moderate dysfunction, and scores of 0–3 points suggest severe dysfunction. The APGAR has demonstrated good reliability and validity, with an original Cronbach’s α coefficient of 0.830. In this study, the Cronbach’s α coefficient was 0.828.

Data collection

Notices about the study were posted in the oncology units. Any parents who were interested in the study could contact the researchers. After a face-to-face interview to screen for eligibility, participants signed their consent. Participants were invited to complete a 20-minute-long questionnaire before discharge. Print or digital questionnaires were distributed according to patients’ willness. Print questionnaires were administered face-to-face in clinical departments, while digital surveys were distributed and collected via Wenjuanxing, a validated electronic survey platform widely adopted in China. During the completion of the questionnaires, a researcher (YH) was available to answer any questions about the questionnaire. And those unable to complete the survey were assisted by the researcher, who recorded their responses on their behalf. Stringent quality control measures were applied; incomplete questionnaires or those with a completion time of < 20 min were excluded. Data entry was verified concurrently by two researchers (YH and HC) to ensure accuracy, with no duplicates or omissions.

Data analysis

Statistical analysis was performed using SPSS 25.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics were applied to all demographic, HSQQ, APGAR, and PREM-C data. The demographic characteristics of the participants were analyzed descriptively by frequency counts and percentages, and the scores for each questionnaire were expressed as mean ± standard deviation (SD). Normality of the three questionnaires’ scoers were confirmed via the Shapiro-Wilk test. Univariate analysis was employed to identify demographic categorical variables associated with PREM-C scores and dimension scores, including independent samples t-tests and analysis of variance (ANOVA). Pearson correlation analysis was performed to examine associations between other continuous variables and PREM-C scores, as well as dimension scores. Variables demonstrating statistical significance in the univariate analysis (p < 0.05) were further evaluated using multiple linear regression analysis to identify factors influencing cancer patients’ hospitalization experiences. A significance level of p < 0.05 was considered indicative of statistical significance.

Ethical considerations

This study was approved by the ethics committee of Xuzhou Medical University (XZHMUz-24128). Participation in this study was voluntary, and participants had the right to refuse or withdraw at any time without consequence. The identification information of all participants was replaced with digital codes to ensure anonymized data processing throughout the research workflow.

Results

Characteristics of participants

A total of 394 questionnaires were distributed in the study. Of these, 18 could not be retrieved due to patients withdrawing during offline administration or losing online connectivity, resulting in 376 recovered questionnaires. Among the returned surveys, six participants had missing responses, and 19 provided answers with evident response patterns or completed the questionnaire in exceptionally short timeframes, rendering their data invalid. Consequently, a final sample of 351 valid questionnaires was included in the analysis. The valid response rate was 93.35%. The mean age of the 351 patients was 57.45 ± 12.16 years, with an age range of 17 ~ 88 years. Other demographic characteristics are presented in Table 1.

Table 1.

Univariate analysis between demographic characteristics and the PREM-C scores (n = 351)

Variable	N (%)	PREM-C (M ± SD)	PREM-C		F1		F2		F3		F4		F5
			t/F	p	t/F	p	t/F	p	t/F	p	t/F	p	t/F	p
Gender			-1.641)	0.10	-1.881)	0.06	-1.701)	0.09	-0.671)	0.50	-1.801)	0.07	-1.271)	0.20
Male	105 (29.91)	91.32 ± 8.06
Female	246 (70.09)	92.96 ± 8.81
Marital status			4.201)	0.01**	1.871)	0.06	1.301)	0.29	1.691)	0.09	1.521)	0.13	1.671)	0.10
Single	13 (3.70)	96.80 ± 3.46
Married	338 (96.30)	92.31 ± 8.72
Educational level			0.482)	0.62	0.172)	0.84	0.782)	0.46	0.812)	0.45	0.232)	0.80	0.842)	0.43
Primary school and below	123 (35.04)	92.34 ± 7.76
Junior middle school	141 (40.17)	92.97 ± 8.32
High school and above	87 (24.79)	91.85 ± 10.17
Monthly family income per capita (RMB)			0.522)	0.60	1.332)	0.27	0.472)	0.63	0.332)	0.72	0.972)	0.39	0.612)	0.54
< 2000	171 (48.72)	92.81 ± 8.01
2000 ~ 3500	86 (24.50)	92.77 ± 7.73
> 3500	94 (26.78)	91.60 ± 10.32
Residence			0.092)	0.91	0.962)	0.39	0.002)	1.00	0.612)	0.55	0.142)	0.87	0.042)	0.96
Urban	113 (32.19)	92.42 ± 9.30
Suburban	63 (17.95)	92.1 ± 9.13
Rural	175 (49.86)	92.64 ± 8.00
Medical payment method			2.491)	0.02*	4.451)	0.00**	3.531)	0.00**	2.791)	0.01**	4.291)	0.00**	4.351)	0.00**
Medical insurance	325 (92.59)	93.01 ± 7.70
Self-paid / Others	26 (7.41)	85.71 ± 14.83
Hospitalization episodes (times)			1.102)	0.34	1.382)	0.25	1.132)	0.32	1.392)	0.25	1.602)	0.20	0.182)	0.83
1	107 (30.48)	93.27 ± 8.17
2 ~ 4	127 (36.18)	91.63 ± 8.63
≥ 5	117 (33.34)	92.66 ± 9.00
Self-care ability			2.762)	0.07	2.922)	0.06	2.342)	0.10	0.962)	0.38	3.272)	0.04*	2.412)	0.10
Completely independent	158 (40.01)	93.45 ± 6.93
Require partial assistance from others	155 (44.16)	92.08 ± 9.16
Require great assistance from others or be completely dependent	38 (10.83)	90.01 ± 11.76
Family history of cancer			-1.591)	0.12	-1.411)	0.16	-2.681)	0.01**	-2.001)	0.05*	-1.831)	0.07	1.371)	0.17
Yes	29 (8.26)	89.61 ± 10.26
No	322 (91.74)	92.73 ± 8.43
Cancer type			2.742)	0.04*	2.352)	0.07	3.222)	0.02*	1.932)	0.12	3.062)	0.03*	1.902)	0.13
Gynecological cancer	150 (42.70)	93.64 ± 8.47
Digestive system cancers	67 (19.10)	92.23 ± 8.06
Urinary system cancers	37 (10.50)	93.26 ± 6.61
Others	97 (27.70)	90.52 ± 9.60
Cancer stage (TNM)			0.192)	0.95	0.322)	0.86	0.102)	0.98	0.212)	0.94	0.982)	0.42	0.282)	0.90
I	55 (15.70)	92.94 ± 7.82
II	80 (22.80)	92.28 ± 8.66
III	59 (16.80)	92.88 ± 8.53
IV	59 (16.80)	92.75 ± 6.87
Unknown	98 (27.90)	91.95 ± 10.03

1), T value; 2), F value. ^*, p < 0.05; ^**, p < 0.01. Gynecological cancer: Breast cancer, Cervical cancer; Digestive system cancers: Rectal cancer, Gastric cancer, Sigmoid colon cancer, Esophageal cancer, Pancreatic cancer, Liver cancer, Gallbladder cancer; Urinary system cancers: Prostate cancer, Renal cell carcinoma, Adrenal carcinoma, Testicular cancer; Others: Lung cancer, Cutaneous adnexal carcinoma, Brain cancer, Lymphoma, Laryngeal cancer, Nasopharyngeal carcinoma. F1: physical comfort; F2: emotional, spiritual, and financial needs; F3: involvement of family and friends; F4: coordination and comprehensiveness of care; F5: information, communication, and education

PREM-C scores of the participants

The total PREM-C score was 92.47 ± 8.62, with scores for the five dimensions ranked from highest to lowest as follows: F4 (93.41 ± 8.50), F5 (93.09 ± 8.80), F1 (92.72 ± 8.41), F3 (92.61 ± 10.05), and F2 (90.55 ± 11.02). Separately, the total score for HSQQ was 82.22 ± 8.05, and the total score for the APGAR was 8.26 ± 1.45. The scores of three scales were normality (PREM-C: W = 0.857, p > 0.05; HSQQ: W = 0.915, p > 0.05; APGAR: W = 0.843, p > 0.05).

Univariate analyses of factors associated with PREM-C and its dimension scores

Table 1 revealed that marital status, medical payment method, and cancer type were significantly related with the scores of PREM-C (p < 0.05). The univariate analyses of the dimensions revealed that medical payment method emerged as a significant predictor across all five dimensions (all p < 0.05); self-care ability had impacts on with scores on the F4 (F = 3.27, p = 0.04); a family history of cancer demonstrated negative associations with F2 (t = -2.68, p = 0.01) and F3 (t = -2.00, p = 0.05); and positive correlations were observed between cancer type and both F2 (F = 3.22, p = 0.02) and F3 (F = 3.06, p = 0.03).

Pearson correlation analysis of factors associated with the PREM-C and its dimensions scores

Table 2 presents the associations between PREM-C and its dimensions scores and continuous variables (age, the HSQQ score, and APGAR score) according to the Pearson correlation analysis. The results demonstrated significant positive correlations between both the HSQQ score (r = 0.409, p < 0.01) and APGAR score (r = 0.219, p < 0.01), with the total score of PREM-C. Furthermore, Pearson correlation analyses demonstrated significant positive correlations between each of the scores of five dimensions and both the HSQQ score and APGAR score. To facilitate the interpretation and presentation of results, the supplementary material (Supplementary Table) shows the results of the univariate analysis to identify factors associated with PREM-C and its five dimensions.

Table 2.

Correlations between the PREM-C total score, dimensions scores, and the continuous variables (n = 351)

Variables	PREM-C	F1	F2	F3	F4	F5
	r	r	r	r	r	r
Age	-0.024	-0.034	-0.035	-0.014	0.013	-0.022
HSQQ	0.409**	0.416**	0.382**	0.314**	0.346**	0.406**
APGAR	0.219**	0.219**	0.165**	0.211**	0.215**	0.218**

^**, p < 0.01; PREM-C, Patient-Reported Experience Measure for Cancer; HSQQ, Hospital Service Quality Questionnaire; APGAR, Family APGAR Index; F1: physical comfort; F2: emotional, spiritual, and financial needs; F3: involvement of family and friends; F4: coordination and comprehensiveness of care; F5: information, communication, and education

Multiple linear regression of the PREM-C and its dimensions

The results of multiple regression analysis of factors associated with the PREM-C and its dimensions are shown in Table 3. Five variables were incorporated into the PREM-C regression model (F = 15.827, p = 0.000, adjusted R² = 0.229): material status, medical payment method, cancer type, HSQQ, and APGAR. The hospital service quality level exhibited the strongest positive correlation with patient experience (standardized coefficient = 0.364). The family function and the type of disease (gynecological cancers) also showed a positive correlation with inpatient experience, while the self-paid/other of medical payment method was negatively correlated with patient experience. Specifically, the hospital service quality level always exhibited the strongest positive correlation with five dimensions (standardized coefficient ranged from 0.290 to 0.377), and the family function level also positively associated with five dimensions of hospitalization experience of patients. However, the medical payment method (self-paid/others) were negatively correlated with four dimensions (F1, F2, F4, F5). Moreover, gynecological cancer was positively associated with F2 and F4, while urinary system cancer showed a positive association with the F4. Having a family history of cancer was also positively correlated with the F3.

Table 3.

Multiple regression analysis of factors associated with the PREM-C and its dimensions scores (n = 351)

Scale	Variables	β	SE	Standardized β	t	p	adjusted R2
PREM-C	(Constant)	58.865	4.770		12.340	0.000	0.229
	Material status: Married	-2.877	2.164	-0.063	-1.329	0.185
	Medical payment method: Self-paid/Others	-5.478	1.575	-0.167	-3.478	0.001**
	Cancer type (Control: others)	0.000
	Gynecological cancer	2.260	0.995	0.130	2.272	0.024*
	Digestive system cancers	1.671	1.207	0.076	1.385	0.167
	Urinary system cancers	2.217	1.477	0.079	1.501	0.134
	HSQQ	0.290	0.038	0.364	7.627	0.000**
	APGAR	0.940	0.280	0.161	3.362	0.001**
Physical comfort (F1)	(Constant)	57.409	4.062		14.134	0.000	0.229
	Medical payment method: Self-paid/Others	-5.693	1.525	-0.178	-3.733	0.000**
	HSQQ	0.301	0.037	0.387	8.192	0.000**
	APGAR	0.885	0.272	0.155	3.253	0.001**
Emotional, spiritual, and financial needs (F2)	(Constant)	46.455	5.741		8.091	0.000	0.186
	Medical payment method: Self-paid/Others	-5.925	2.067	-0.141	-2.866	0.004**
	Family history of cancer: Yes	2.544	1.937	0.064	1.314	0.190
	Cancer type (Control: others)	0.000
	Gynecological cancer	3.296	1.307	0.148	2.522	0.012*
	Digestive system cancers	2.795	1.586	0.100	1.762	0.079
	Urinary system cancers	2.952	1.932	0.082	1.528	0.127
	HSQQ	0.352	0.050	0.345	7.043	0.000**
	APGAR	0.839	0.367	0.112	2.284	0.023*
Involvement of family and friends (F3)	(Constant)	53.375	5.338		10.000	0.000	0.149
	Medical payment method: Self-paid/Others	-3.654	1.916	-0.095	-1.907	0.057
	Family history of cancer: Yes	4.810	1.798	0.132	2.675	0.008**
	HSQQ	0.270	0.046	0.290	5.848	0.000**
	APGAR	1.124	0.342	0.165	3.289	0.001**
Coordination and comprehensiveness of care (F4)	(Constant)	62.225	4.345		14.320	0.000	0.181
	Medical payment method: Self-paid/Others	-5.454	1.643	-0.168	-3.319	0.001**
	Self-care ability (Control: Completely independent)	0.000
	Require partial assistance from others	-0.120	0.892	-0.007	-0.134	0.893
	Require great assistance from others or be completely dependent	-0.857	1.465	-0.031	-0.585	0.559
	Cancer type (Control: others)	0.000
	Gynecological cancer	2.209	1.015	0.129	2.176	0.030*
	Digestive system cancers	0.971	1.233	0.045	0.788	0.431
	Urinary system cancers	3.051	1.507	0.110	2.025	0.044*
	HSQQ	0.236	0.039	0.300	6.087	0.000**
	APGAR	0.942	0.285	0.163	3.299	0.001**
Information, communication, and education (F5)	(Constant)	56.806	4.280		13.272	0.000	0.219
	Medical payment method: Self-paid/Others	-5.814	1.607	-0.173	-3.618	0.000**
	HSQQ	0.307	0.039	0.377	7.928	0.000**
	APGAR	0.932	0.287	0.156	3.251	0.001**

^*, p < 0.05; ^**, p < 0.01. APGAR, Family APGAR Index; HSQQ, Hospital Service Quality Questionnaire; SE: Standardized error

Discussion

This is the first study to examine hospitalization experience in cancer parents in China. Participants in this study had positive overall positive hospitalization experience. The hospital service quality, medical payment method, family function, and type of cancer were associated with cancer patients’ inpatient experience. Although the effect sizes for the results of the analyses are small, this study suggests that clinical staff can use the PREM-C to identify inefficiency in nursing and cancer patients who have negative inpatient experiences.

Chinese cancer patients reported relatively high satisfaction with their inpatient nursing experiences, reflecting the emphasis placed by Chinese healthcare system on patient-centered care philosophy [25]. Hospital service quality as the primary determinant influencing the hospitalization experiences of cancer patients. An Ethiopian study highlighted significant associations between physician-provided services, accommodation quality, and availability of meal services with patient satisfaction levels [26]. Shan et al. also found that positive staff attitudes and ward environment were positively associated with patient satisfaction [27]. However, a comparative analysis of healthcare systems across Bangladesh, India, and China revealed that over half of chronic disease patients expressed dissatisfaction with care quality in all three nations, despite China demonstrated superiority in medical infrastructure development [25]. This phenomenon could be attributable to Chinese heavy disease burden, coupled with patients’ predominant preference for resource-intensive tertiary hospitals [28]. Such patterns drove overutilization of medical infrastructure, imposing excessive workloads on clinical personnel that exacerbate occupational burnout and inadvertently compromise patient-centered care delivery during hospitalization [29, 30]. Thus, future researchers should note that when designing a well-functioning healthcare service system for cancer patients, the phenomenon of role overload among healthcare providers must not be overlooked.

Futhermore, this study obeserved that enhanced hospital service quality was significantly correlated with comprehensive improvements in hospitalization experience of cancer patients, including heightened physical comfort, better fulfillment of emotional, spiritual, and financial needs, increased engagement of family and friends, more coordinated holistic nursing practices, and superior level of information sharing, communication, and education during hospitalization. Beneberu et al. also found that when hospitals implemented a patient-centered care model to improve service quality, most patients felt respected and engaged in care-related decision-making, and their physical and emotional comfort was also preserved [31]. Therefore, it indicated that healthcare administrators, in the process of optimizing hospital service quality, can integrate the five dimensions of PREM-C into patient-centered strategies to enhance patients’ inpatient experience.

Compared with self-pay patients, patients with medical insurance reported better hospitalization experiences. This association can be attributed to the universal coverage of national health insurance, which has helped mitigate economic burdens for the majority of cancer patients. The finding aligned with results from prior investigations [32, 33]. The study found that the payment methods for treatment costs significantly influenced most dimensions of cancer patients’ hospitalization experiences, which demonstrated that the economic burden imposed by cancer was significantly associated with the inpatient satisfaction. Under comparable care quality, self-pay patients experience greater financial strain, which might disrupted their perception of nursing service quality and thereby impacted satisfaction with their hospitalization experiences [34]. Li et al. found that the average hospitalization expenses for breast cancer patients in China have been steadily increasing, with the greatest rise observed among self-paid patients [35]. The high self-paid expenses could exert a negative impact on the health of cancer patients [36]. Through face-to-face interviews with Italian cancer patients 5–10 years post-diagnosis, Baili et al. found that patients with lower quality of life incurred higher out-of-pocket expenses [37]. The negative impact of self-paid medical expenses on the quality of life of cancer patients may disrupt the fulfillment of their physical and psychological needs and their engagement in the nursing process, thereby leading to a decrease in satisfaction with the hospitalization experience. The study by Palmer et al. demonstrated that stressors were more prevalent among hospitalized patients without medical insurance, mediating an increased risk of patient anxiety [38]. Uninsured individuals were more likely to experience conflicts with healthcare providers, which might stem from providers’ biases toward patients of lower socioeconomic status, ultimately leading to poorer hospitalization experiences [39, 40].

This study found that higher levels of family functioning were associated with better hospitalization experiences among cancer patients, which may stem from the fact that high levels of family functioning can provide effective support for cancer patients during hospitalization [41]. A Chinese study found that a positive family belief system can guide cancer patients to maintain an optimistic attitude [42], and another Indonesian study also found an association between better family support and lower levels of anxiety in cancer patients [43]. It possibly could be that people in Asian cultures tend to have a stronger sense of belonging to their families. This study provided a culturally specific contextual perspective for understanding family support systems to help patients transition through hospitalization, and future intervention studies should consider the strengths of the family to improve the hospitalization experience, especially for those under the complex stresses of cancer treatment. Our study also demonstrated that high family functioning may enhance the five dimensions of cancer patients’ hospitalization experience. This phenomenon may be attributed to that a good family support system provided comprehensive physical and emotional care, creating a secure emotional environment for patients while enhancing their treatment adherence, such as assisting with disease self-management and facilitating effective communication with the healthcare team [44–46]. It highlighted the complementary role of family systems in clinical care paradigms. Thus, future intervention research should incorporat family-related strategies to improve the satistaction of patients’ hospitalization experience.

Compared with other cancer patients, gynecological cancer patients reported a better inpatient experience, especially the dimension of emotional, spiritual, and financial needs, as well as the coordination and comprehensiveness of care. This might be because the mortality rate of gynecological cancers is lower than that of other malignancies such as liver and lung cancer, resulting in relatively lighter disease burden and psychological stress for patients [2]. Progress in developing treatments and advances in supportive care has led to an increase in the 5-year survival rate to 70% ~ 90% among patients diagnosed with early breast cancer or cervical cancer in China [47], which have been managed as chronic diseases [48]. The prolongation of the survival period of patients enhances their confidence in combating their disease, allowing them to maintain physical and emotional stability over a longer period. Gynecological cancer patients were predominantly cared for by female nurses during hospitalization. This practice may foster shared gender identity between patients and caregivers, facilitating implementation of standardized care protocols and promoting coordinated and comprehensive clinical care practices. This alignment in gender identity is posited to more effectively address patients’ emotional needs, thereby potentially enhancing their positive appraisals of the hospitalization experience [49]. This suggests that future intervention studies should not ignore the interaction between cancer type and the gender role of patients and health care providers [50].

Study limitations

A few factors may have impacted the study results. First, this study was conducted in three tertiary hospitals in eastern China, where both the economic and medical standards are higher than in the country’s central and western regions. Therefore, the findings may not be universally applicable. Second, this study employed a convenience sampling method in its survey. Future studies are recommended to employ stratified sampling methods, incorporating a broader range of cancer types while ensuring the representation of the sample. Third, this study used a cross-sectional design, which does not capture dynamic changes in individual patients’ inpatient experiences over time. Future studies are recommended to employ a longitudinal design to dynamically assess the hospitalization experiences of cancer patients.

Implication for nursing practice

First, healthcare managers should carry out humanistic care training for clinical nurses, especially oncology nurses, to strengthen their emotional connections with patients, improve their communication skills, and enhance coping abilities. Meanwhile, nurse managers can boost nurses’ awareness and competence in compassionate communication, enabling them to provide humanistic care covering cultural, spiritual, and emotional support, which meets patients’ multidimensional needs and improves the nurse–patient relationship. Second, clinical nurses should also focus on the needs of family members of cancer patients, enhancing health guidance and psychological support for family caregivers to strengthen the family system’s emotional support and caregiving efficacy, thereby improving patients’ hospitalization experience. Third, nursing administrators should offer medical insurance-related education programs for cancer patients to enhance their willingness to enroll in medical insurance, thereby reducing their medical expense burden.

Conclusion

Cancer patients in China generally had a positive overall inpatient experience. Patients who experience higher-quality hospital services, own greater family functioning, or have medical insurance were more likely to report the more positive hospitalization experience. Additionally, gynecological cancer patients tend to report better hospitalization experiences compared with those diagnosed with other cancer types. This study provided a perspective on the Chinese sociocultural context, enabling healthcare providers to deepen their understanding of cancer patients’ hospitalization experiences. Future research could further explore how sociocultural factors influence these experiences across diverse global settings, enhancing the generalizability of findings. This study further underscores the critical roles of hospital service quality and family functioning in shaping cancer patients’ hospitalization experiences, advocating for the development of tailored support strategies for different cancer patient subgroups. Future researchers can design multisectoral interventions integrating hospital and family resources to facilitate comprehensive cancer management during hospitalization.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

Wenjuan Gao: Conceptualization of revised analysis; Drafting key sections; Formal analysis, Writing - review & editin, final approval. Youyou Hu: Validation, Formal analysis, Investigation, Data curation, Writing original draft. Huayi Chu: Validation, Formal analysis, Investigation, Data curation. Doudou Yu: Validation, Formal analysis, Investigation. Keyi Tang: Validation, Formal analysis, Investigation. Xiuwen Chen: Validation, Formal analysis, Investigation. Ying Zhu: Conceptualization, Methodology, Validation, Writing-review & editing. Jing Han: Conceptualization, Methodology, Validation, Funding acquisition, Writing e -review & editing, Supervision, Project administration.

Funding

This study was funded by the National Natural Science Foundation of China (grant number: 72204209).

Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Declarations

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee of Xuzhou Medical University (XZHMUz-24128). All participants signed an informed consent form, and those who attended the program would receive a gift after each session. They were also made aware of their right to withdraw their participation at any time. All participants were anonymous.

Informed consent

Informed consent was obtained from all participants prior to their inclusion in the study.

Competing interests

The authors declare no competing interests.