J Canc Educ

DOI 10.1007/s13187-010-0057-2

“Waiting and the Waiting Room: How Do You Experience

Them?” Emotional Implications and Suggestions
from Patients with Cancer
Chiara Catania & Tommaso De Pas & Ida Minchella &
Filippo De Braud & Daniela Micheli & Laura Adamoli &
Gianluca Spitaleri & Cristina Noberasco &
Alessandra Milani & Maria Giulia Zampino &
Francesca Toffalorio & Davide Radice &
Aron Goldhirsch & Franco Nolè

Received: 2 October 2009 / Accepted: 22 January 2010

# Springer 2010

Abstract Waiting can increase discomfort. The goal of this
study was to identify moods and fears of cancer patients
while in a waiting room and to capture their concrete
suggestions for an anthropocentric transformation of wait-
ing itself. A 15-item questionnaire was given to 355
patients who came to our Out-patient Oncology Clinic.
Eighty-three percent of patients felt that waiting has an
emotional cost, 35% were upset by talking about their
condition with others while waiting, and 26% suffered a
C. Catania (*) : T. De Pas : F. De Braud : G. Spitaleri :
C. Noberasco : A. Milani : F. Toffalorio
Division of Clinical Pharmacology and New Drugs,
European Institute of Oncology,
Milan, Italy
e-mail: chiara.catania@ieo.it
major emotional impact seeing other sick people and
witnessing their clinical decline. Eighty-nine percent of
patients suggested that alternative activities, such as meet-
ings with professionals, doctors, and psychologists, be
organized during the waiting period; 65% suggested fun
activities (music therapy, drawing courses, library, TV).
Most patients asked to have the freedom to leave the
waiting room. This option, feasibly by means of IMs/
“beepers,” would limit their sense of having a lack of
freedom or being robbed of their time. This study
highlighted the complexity and heterogeneity of emotional
implications that waiting causes in patients with cancer and
collected many patients' suggestions about how to create a
constructive, free, and personalized waiting period, over-
coming the boredom, distress, and psychological suffering
it causes.

I. Minchella : D. Micheli : L. Adamoli : M. G. Zampino : F. Nolè Keywords Waiting . Waiting room . Cancer . Patient
Unit for Medical Care,
European Institute of Oncology,
Milan, Italy
Introduction
A. Goldhirsch
Division of Medical Oncology,
European Institute of Oncology,
Waiting is a common human experience. Everybody
Via Ripamonti, 435, experiences waiting for good or bad things at some time
20141 Milan, Italy in their lives. People also experience waiting for events
they consider difficult. Waiting is a universal experience
D. Radice
Epidemiology and Biostatistics,
that everyone can describe in some personal way in relation
European Institute of Oncology, to their own lives. It is a particularly vivid experience for
Milan, Italy people, such as cancer patients, who are critically ill.

Waiting has been associated with a diminished satisfaction
with health care services [1, 2]. It has also been described
as a distressing doubt and uncertainty [3, 4] that is isolating,
troubling [5], and frustrating [6]. Some people say that
waiting is “like living inside a time bomb” [7]. Some
researchers have been told by families in critical care
waiting rooms that they experience feelings such as
numbness, hope for improvement, fear, lack of control,
sensations of powerlessness, and the perception that they
are walking around like robots.
There are no studies in the literature investigating the
feelings of patients with cancer while waiting for treatment/
visits, nor are there studies evaluating how it is perceived;
most importantly, there are no studies evaluating patients'
suggestions on how to make waiting a less negative
experience.
Our medical team believed that waiting and “waiting
rooms” might have a complex impact on the emotional state of
patients with cancer and might increase their discomfort and
worsen their psychophysical well-being. Patients may feel at a
loss and at the mercy of others or under uncontrollable
circumstances. Especially in the setting of a cancer ward,
waiting is a moment in which one's thoughts, fears, and
doubts may return, taking on enormous proportions.
At present, waiting is only considered a necessary evil;
neither physicians nor health organizations can control or
transform it into a “useful weapon.” Actually, at present, the
time spent waiting is wasted, i.e., it is not spent in a useful
way. We believe that it is possible to build a well-organized
and comfortable waiting room, one that makes waiting
itself a constructive experience and helps patients to
overcome the boredom and distress that this situation may
cause.
The goal of this study was to investigate whether or not
our physicians' perceptions agreed with that of the patients,
to identify moods and fears of cancer patients while in a
waiting room, and to capture their concrete suggestions for
an “anthropocentric” transformation of waiting itself.
Material and Methods
Subjects
Questionnaires were handed out to 355 consecutive patients
coming to our Out-patient Oncology Clinic for visits and/or
treatment. Patients from the Out-patient Oncology Clinic
were given the questionnaire by nurses, either at the
moment of blood sampling or during treatment. Eligibility
requirements for this study included the ability to provide
informed consent and cancer disease.
Medical oncologists, nurses, two lawyers (one of them a
patient), and one architect helped to design this study.
J Canc Educ
Completed questionnaires were used to evaluate patients'
perception of waiting and what can be done to help them to
make this situation less difficult emotionally, and overall,
how the time can be used more constructively.
Questionnaires
The drafting of the questionnaire was carried out in two steps.
Firstly, physicians and nurses orally interviewed 30
patients with malignant tumors to elicit their fears, prejudices,
and perceptions during their wait. We also evaluated the
satisfaction questionnaires filled in by patients.
Secondly, based on the results of the first step, we
created a questionnaire with 13 multiple-choice questions,
two open-ended questions, and an additional question
which was on “trade off”(how many hours of their life
they were willing to sacrifice waiting just to be treated in
the place they think is best).
Questionnaires were developed by a multidisciplinary
team which included medical oncologists, nurses, a
philosopher, a literature graduate, and two lawyers.
Domains were developed based on oral interviews and the
satisfaction questionnaires which were filled in by patients.
The questionnaire was anonymous. It was handed to
patients by our nurses at blood sampling or at treatment.
After filling it in, the patients put their questionnaires in a
large, sealed plastic box in the treatment hall. All of the 355
questionnaires that we handed out were completed.
Patient questionnaires were broadly classified into four
major domains (16 questions):
– Domain 1: Evaluation of the waiting period: Q1, Q3,
and Q4.
– Domain 2: Evaluation of patient perception regarding
length of waiting and waiting room: how it is
considered (physiological, boring, distressing, useless,
etc.): Q2, Q6, Q12, Q13, and open question 1
(Appendix 3).
– Domain 3: Suggestions on how to make the waiting
period more constructive (meetings with the treatment
team, psychologists, drawing courses, music therapy,
etc): Q5, Q7, Q8, Q10, and Q11.
– Domain 4: Suggestions on how to structurally
change the waiting room: Q9 and open question 2
(Appendix 3).
– Domain 5: Trade-off question.
Statistical Methods
Frequency distribution of answers were tabulated, overall
and by gender, and for selected key questions (3, 5, 7, 8,
and 11), they were tested for association with sex using a
Cochran–Mantel–Haenszel test for trend or Fisher's exact
J Canc Educ
test where appropriate. Age at administration date was
described using summary statistics (counts, mean, standard
deviation, median, min, and max) and the difference
between males and females at compilation date was tested
using a Wilcoxon two-sample two-sided test. Age and
gender were also considered for association with answers
using a logistic regression analysis (question 5), a multino-
mial logit model (question 3, unordered answers), or an
ordinal logistic regression (questions 7, 8, and 11, ordered
answers). Results are presented as odds ratios (OR) with
their 95% confidence intervals (95% CI). In all regression
analyses, male sex was arbitrarily considered the reference
category for gender. Age was tested for differences between
males and females across all answers, for the same selected
questions as above, using either the Kruskal–Wallis or the
Wilcoxon two-sample two-sided test where appropriate.
Box and whiskers plots for age trend across all answers by
gender were produced for questions 7, 8, and 11.
Results
The instruments used are shown in Appendix 1, 2, and 3
(questionnaire) and Appendix 2 (trade off).
Domain 1: Evaluation of the Waiting Period
Fifty-six percent of patients found waiting long (44%) or
too long (12%) (Q1), even when asked whether they would
have chosen to be treated elsewhere had they known that
the waiting period would last 3–5 h, 84% of them answered
no (Q4). But, when asked: “how would you define
waiting?,” half the patients found it boring (50%) and only
17% found it distressing, while 27% found it physiological
distressing.
Domain 2: Evaluation of Patient Perception Regarding
Length of Waiting and Waiting Room:
How it is Considered (Physiological Distressing,
Boring, Distressing, Useless, Etc.)
The question: “what is the emotional cost of waiting in a
waiting room,” was answered: low by 55%, high/very
high by 28%, and none by 17% of patients (Q2). Only
24% of patients found it comforting/very comforting to
talk about their illness with other patients experiencing a
similar situation and 43% of them found it mildly
comforting, while another 31% did not find it comforting
in the least (Q6). Therefore, more than half of the patients
found it comforting (a little, a lot) to talk about their
clinical condition with other patients, but there were 30%
of the patients who were not willing to discuss their illness
with other people (Q13); 62% of patients were not upset
by talking about their condition with others while waiting,
whereas 35% of patients were upset a little/a lot (Q12).
When asked: “In your opinion, what has the greatest
emotional impact while waiting?,” half the patients
answered that it was seeing other sick people and their
clinical decline, for 25% of them, it was waiting itself,
while for 13%, it was the crowded waiting room (open
answered N1).
Domain 3: Suggestions on How to Make the Waiting
Period More Constructive (Meetings with the Treatment
Team, Psychologists, Drawing Courses, Music
Therapy, Etc.)
Three hundred fifteen patients would like alternative
activities to be organized during the waiting period
[structured meetings with specialists (31%), psychologists
(24%), PE courses (12%), music therapy courses (23%),
and drawing courses (10%)] in order to make the waiting
period less boring and less distressing as well as more
useful and more constructive (Q5). Sixty-five percent
(46% very; 19% very much) of the patients suggested
alternative activities during the waiting period (music,
library, TV, meetings with doctors or psychologists, music
therapy or PE courses as well as a possibility to leave the
waiting room during this period; Q7). Seventy-eight
percent of patients would have liked to have a beeper
and to be called back at the time of their visit; 71% would
like to find a bookshelf with books and magazine in the
waiting room (Q10). More than half of the patients (55%:
very 35%, very much 20%) believe the hospital should
offer alternative activities to make them feel like human
beings living in the real world, not just sick people, e.g., a
hairdresser, a restaurant, some shops, music therapy, or PE
courses (Q11).
Domain 4: Suggestions on How to Structurally Change
the Waiting Room: Q9, Open Question 2
A favorite color for the waiting room was suggested: 22%
of patients prefer light blue, 18% go for green, and 16% for
yellow; only 11% of patients have no preferences (Q9).
When asked: “What would you change in the waiting
room if you had the chance to…,” 40% of patients would
have liked more comfortable chairs and more comfortable
surroundings, 16% of patients suggested different rooms for
different activities (for patients who want to chat, for those
who want to read or listen to music, for those who need to
work, for people who are in worse condition, etc), 14% of
them asked to organize alternative activities, 13% would
like amusing activities, 7% asked to be able to leave during
the waiting period, while another 7% do not require
anything (open question 2).
 J Canc Educ

Table 1 Age (in years) by gender (question 3, OR=2.36, 95% CI=1.08, 5.17) for females vs.
Gender Counts (%) Age (years) males (Table 3). Females also seemed to have a signifi-
cantly better attitude towards treatment when presented
Mean ± SD Median Min, Max with a waiting room set up for a variety of activities
(question 5, p=0.021; Table 2). However, this result is not
Female 264 (87.7) 52.5±11.5 51.4 27, 83
really sound, since the effects of age and gender are not
Male 37 (12.3) 62.9±9.6 65.2 44, 77
significant—as shown by their respective odds ratios (OR=
Wilcoxon two-sample two-sided p<0.001 0.96, 95% CI=0.93, 1.00 for age and OR=2.35, 95% CI=
0.84, 6.52 for gender; Table 3). Frequency distribution of
answers to questions 7, 8, and 11 was not significantly
Domain 5: Trade-Off Question associated with gender (Table 2), only age—as shown by
the odds ratios in Table 3 (for questions 7, 8, and 11: OR=
The trade-off question, asking patients how much of their 1.02, 95% CI=1.00, 1.04, OR=1.03, 95% CI=1.01, 1.05,
time they would be willing to sacrifice in order to be treated and OR=1.03, 95% CI=1.01, 1.05, respectively). Further-
in our institute, was answered “any amount of time, more, Table 4 and Fig. 1 revealed that there was a
because it is always worthwhile” in 85% of cases, while significant trend in younger females to have a more positive
the question “would you have chosen to be treated attitude toward spaces set up with extra activities (e.g.,
elsewhere, had you known you would wait 3–5 h?” was higher ordinal answers to questions 7, 8, and 11 were
answered “No” in 84% of cases (303 patients). significantly associated with lower age values). These
figures do not apply to males.
Exploratory Analysis According to Gender and Sex

Three hundred one subjects answered the questionnaire, the Discussion

majority of them females (87.7%). Females at study entry
(e.g., questionnaire administration date) were significantly
younger than males (p<0.001; Table 1). There was a
significant tendency to consider the waiting time boring or
distressing for females, when compared to males (question
3, p=0.017; Table 2). Even if females were younger than
males, this result is not associated with age, only gender
Cancer is an extreme situation which cannot be modified
and which goes beyond our psychological capacity to
contain it. Cancer is an existential experience involving
the patient's emotions; it creates a break with the past and
discontinuity in the flow of life [8, 9]. Cancer diagnosis
has a huge psychological, physical, and relational impact

Table 2 Frequency distribution

of answer to selected questions Question Answers Gender, n (column %)
by gender
Female Male p valuea

Question no. 3 Boring/distressing 182 (70.5) 17 (47.2) 0.017

Useless 12 (4.7) 3 (8.3)
Physiological 64 (24.8) 16 (44.4)
Question no. 5 Yes 240 (93.0) 29 (80.6) 0.021
No 18 (7.0) 7 (19.4)
Question no. 7 Not in the least 14 (5.4) 4 (11.1) 0.059
A little 66 (25.4) 11 (30.6)
A lot 122 (46.9) 17 (47.2)
Very much 58 (22.3) 4 (11.1)
Question no. 8 Not in the least 13 (5.0) 2 (5.4) 0.055
A little 31 (12.0) 10 (27.0)
A lot 92 (35.5) 14 (37.8)
Very much 123 (47.5) 11 (29.7)
Question no. 11 Not in the least 10 (3.9) 0 0.423
a
Cochran–Mantel–Haenszel test A little 55 (21.5) 11 (29.7)
for trend for questions 7, 8, and A lot 129 (50.4) 19 (51.3)
11 and Fisher's exact test for Very much 62 (24.2) 7 (18.9)
questions 3 and 5
J Canc Educ

Table 3 OR estimates for answers to selected questions

Question Effect OR (95% CI) p value

Question no. 3 Age 1.00 (0.97, 1.02) 0.779

Female vs. male 2.36 (1.08, 5.17) 0.031
Question no. 5 Age 0.96 (0.93, 1.00) 0.058
Female vs. male 2.35 (0.84, 6.52) 0.102
Question no. 7 Age 1.02 (1.00, 1.04) 0.038
Female vs. male 0.91 (0.45, 1.86) 0.801
Question no. 8 Age 1.03 (1.01,1.05) 0.005
Female vs. male 0.53 (0.26, 1.06) 0.073
Question no. 11 Age 1.03 (1.01, 1.05) 0.003
Female vs. male 0.79 (0.40, 1.56) 0.497

on patients. Everything becomes more difficult; even

small problems, such as sitting in a “waiting room”
(which, in itself, is indispensable and somewhat inescap-
able) become huge. In a cancer unit waiting room, you

Table 4 Summary statistics of age (in years) at compilation by

answer to selected questions by gender

Answer Age (years), mean ± SD

Female Male

Question no. 3 Boring/distressing 52.6±12.0 64.2±8.6

Useless 49.9±10.1 58.9±13.9
Physiological 53.1±10.8 62.6±10.5
p valuea 0.633 0.801
Question no. 5 Yes 51.8±11.1 62.0±9.8
No 56.6±12.7 65.3±9.8
p valuea 0.126 0.308
Question no. 7 Not in the least 60.5±10.0 72.0±4.6
A little 54.9±10.6 63.7±11.4
A lot 51.8±12.0 61.2±7.3
Very much 48.5±10.2 64.7±12.2
p valuea 0.001 0.162
Question no. 8 Not in the least 60.8±10.1 69.9±4.2
A little 55.1±12.0 62.9±10.6
A lot 53.7±11.3 64.0±9.3
Very much 50.0±11.0 60.0±9.9
p valuea 0.001 0.486 Fig. 1 Box and whisker plots for age by answers by gender
Question no. 11 Not in the least 58.4±13.2 (no obs)
A little 55.5±10.9 65.4±11.4
A lot 52.7±11.0 63.0±8.1
Very much 50.0±11.0 59.3±11.3
meet the eyes of other sick people, at different stages and
p valuea <0.001 0.480
seriousness of their disease, who need different kinds of
treatments which have different side effects. During
a
Between answers within gender Kruskal–Wallis or Wilcoxon test waiting periods, the meeting and clashing of these

different worlds and ways of facing one's illness may
cause anxiety, depression, and anguish.
In this study, therefore, we tried to identify moods and
fears of patients with cancer while in a waiting room and
to capture their concrete suggestions for an “anthropo-
centric” transformation of waiting itself.
We confirmed that waiting has a major impact on
patients with cancer.
A significant percentage of patients interviewed found
waiting long or too long boring, distressing, and physio-
logically troubling and reported a high/very high emotional
cost of waiting in a waiting room. More than half of the
patients found it comforting to talk about their clinical
condition with other patients, but a significant percentage
(30%) were not willing to discuss their illness with other
people. Half of the patients, when asked what has the
greatest emotional impact while waiting, answered that it
was seeing other sick people and their clinical decline, and
for 25%, it was waiting itself.
Having confirmed the complexity and heterogeneity of
the emotional implications that waiting causes—a feeling
that time is being wasted during these distressing periods—
we believe that it is the duty of the care team to help
patients with cancer to use the time spent waiting for visits
or treatment in a constructive manner.
Therefore, we asked the patients themselves to give us
suggestions about how to use the waiting period more
constructively.
About 90% of the patients wanted alternative activities
to be organized. They suggested that our team organize
activities that might help them to achieve a higher
awareness of their disease, activities such as meetings with
professionals, doctors, and psychologists. Moreover, 65%
of the patients suggested having the opportunity to be
involved in fun activities like music therapy or drawing
courses, to have access to a library, to be able to watch TV,
or to visit a chapel to pray.
Interestingly, most of the patients also asked to have
freedom of choice in regards to whether to stay in the
waiting room or to go elsewhere when their surroundings
became too distressing. This option is feasible, simply by
calling patients back by means of IMs or “beepers,” and
would limit their sense of having a lack of freedom or being
robbed of their time.
Our results may be of major interest for cancer centers
treating a high number of younger patients, especially
females. In fact, even though the majority of the subjects
answering our questionnaire were females, the exploratory
analysis of our results showed a significant tendency to
consider the waiting time more boring or distressing for
females, when compared to males. It also found a
significant trend in younger females to adopt a more
positive attitude towards spaces organized with extra
J Canc Educ
activities and to appreciate the possibility of being able to
leave the waiting room during the lag time before their
appointment.
Patients also asked for the waiting room, and for the
hospital itself, to lose its “sick people's atmosphere”—
where disease means fatigue, anxiety, and anguish—and to
acquire a more “human” appearance in which a person
being treated for an illness does not feel that it is
necessarily his/her illness. As a matter of fact, many
suggestions regarding a structural change to the waiting
room were gathered in the questionnaires, and more than
half of the patients believed that the hospital should offer
alternatives, such as a hairdresser, a restaurant, or some
shops, to make them feel like human beings living in the
real world.
Our results are consistent with the “life sound
experience” which has been described in the literature.
It allows patients to experience a different dimension
from the reality of hospital life and to assess the impact
of programs on improving the patient's state of anxiety. In
order to give a different meaning to the time spent in the
hospital, the patients who participated in this study were
invited, together with their families and friends, as well as
their oncology team, to have a cup of tea or a soft drink
while listening to music or to chat, joke, or celebrate
birthdays. The patients had the possibility to write their
comments, impressions, or suggestions in a notebook. The
results showed a statistical difference in anxiety levels 2 h
before participation and 2 h after participation in the
program [10].
From our study, the difference between the needs and
requirements of how to use the waiting time, and how the
waiting room itself should be organized, came to light. We,
therefore, believe it is important to build a waiting room
which is “free and personalized,” one which permits every
individual patient to be able to find what they would expect
to find.
This study offers a lot of information, never before
investigated, about problems relating to waiting and to the
waiting room itself, confirming the complexity and hetero-
geneity of the emotional implications it causes.
Furthermore, collecting a number of suggestions from
patients with cancer lays the foundation for an “anthropo-
centric” transformation of the waiting room and of waiting
itself, so as to create a constructive waiting period which
would help them to overcome the boredom, distress, and
psychological suffering it causes.
Conflict of Interest Statement All authors disclose any actual or
potential conflict of interest including any financial, personal, or other
relationship with other people or organization within that could
inappropriately influence their work.
J Canc Educ

Appendix 1

Anthropocentric revolution of the waiting room: human-

tailored waiting.

355 interviewed patients

(01 June 2007 -30 June 2007)

1) In your opinion, waiting in our waiting room is:

N. %

o Short 6 2
o Acceptable 145 41
o Long 160 44
o Too long 42 12
o Blank 2 1

Question 1

12% 1% 2%
Short
41% Acceptable
Long
Too long
44%
Blank

2) What is the emotional cost of waiting in our waiting room?

N. %

o None 59 17
o A little 199 55
o High 78 23
o Very high 16 5
o Blank 3 1

Question 2

5% 1% 17% None
22% Some
High
Very high
Blank
55%
 J Canc Educ

3) How would you define waiting?

N. %

o Distressing 61 17
o Boring 176 50
o Useless 20 6
o Physiological 92 26
o Blank 6 2

Question 3

2% 17%
26%
Distressing
Boring
Useless
6% Physiological

50% Blank

4) Would you have chosen to be treated elsewhere, had you known that, for organizational
reasons, you had to wait 3-5 hours for your treatment (because at present it is impossible
to shorten treatment preparation time)?

N. %

o Absolutely not 301 84

o Maybe 41* 12
o Almost certainly 7 2
o Certainly 2 ** 1
o Blank 4 1

* 1 pt specified “only if treatment were the same”

** 1 pt specified “if the other centre was as qualified as this”

Question 4
1%
12% 2% 1% Absolutely not
Maybe
Almost certainly
Certainly
Blank
84%
J Canc Educ

5) Try imagining a waiting room and a Hospital organized with different activities.

Would you like to take part in one of these meeting (344 answers evaluated)?

Yes 315 (92%)

No 29 (8%)

a) Meetings with specialists 31%

b) Meeting with psychologists 24%
c) PE courses 12%
d) Music therapy courses 23%
e) Drawing courses 10%
Question 5

10%
Meetings with specialists
31%
23% Meetings with psychologists
PE courses
Music therapy courses
Drawing courses
12% 24%

Do you have other suggestions on courses and/or alternative activities (68 answers evacuate)?

N. %

Movies, hairdresser, PC 29 43

Alternative activities 24 35
(Yoga, massages, music therapy)

Course on how to cope with illness 12 18

(group meetings among patients, courses on proper diet)

More comfortable chairs 3 4

4%

35%

43%

18%

alternative activities (Yoga, massages, music therapy)

course on how to cope with illness (group meetings among patients, courses on
proper diet)
movies, hairdresser, PC
 J Canc Educ

6) While waiting, does it comfort you to talk about your situation with other patients living
similar experiences?

N. %

o Not in the least 110 31

o A little 154 43
o A lot 70 20
o Very much 14 4
o Blank 5 1
o Other 2 1
(I wouldn't know/It’s all the same to me)

Question 6
4% 1% 1%
20% 31% Not in the least
A little
A lot
Very much
Blank

43% Other

7) While waiting, would you like to be entertained by listening to music, reading magazines, or
watching videos?

N. %

o Not in the least 23 6

o A little 95 27
o A lot 160 46
o Very much 69 19
o Blank 4 1
o Other(already brings something to read) 4 1

Question 7
Not in the least
1%
1% 6%
19% A little
27%
A lot

Very much

Blank

46% Other (altready brings

something to read)
J Canc Educ

8) While waiting, would you like to be able to leave the waiting room (go to the cafeteria, the
garden, the chapel, the restaurant) and be called back when it is time for your visit or treatment
(e.g.: patients would be an IMed when it is their turn)?

N. %

o Not in the least 18 5

o A little 48 14
o A lot 129 36
o Very much 152 42
o Blank 6 2
o Other (they already do) 2 1

Question 8

2% 1% 5%
14%
Not in the least
42%
A little
A lot
Very much
Blank
36%
Other (altready do it)

9) Do you like the color of the waiting room?

N. %

o Not in the least 62 17

o A little 176 50
o A lot 81 23
o Very much 3 1
o Blank 33 9

Question 9

9%
1% 17%

Not in the least

23%
A little
A lot
Very much
Blank
50%
 J Canc Educ

Which color would you prefer? (131 answers evaluated)

Blue 22%
Green 18%
Yellow 16%
Doesn’t matter 11%

What color would you prefer?

11%
22%

Blue
Green
Yellow
16%
Doesn't matter
18%

10) Would you like a bookshelf with books, magazine, etc in the waiting room?

N. %

o Not in the least 13 4

o A little 73 21
o A lot 177 49
o Very much 79 22
o Blank 13 4

Question 10

4% 4%
22% 21% Not in the least
A little
A lot
Very much
Blank
49%
J Canc Educ

11) In your opinion, should the waiting room and the Hospital have “extra-hospital” spaces
(such as a hairdresser’s, some shops, courses on drawing, PE, music therapy, etc.?) where people
coming for treatment can feel they are in the real world and not just sick people?

N. %

o Not in the least 69 19

o A little 83 24
o A lot 122 35
o Very much 72 20
o Blank 8 2
o Other (doesn’t need any of those) 1 0

Question 11

2% 0%
20%
19% Not in the least

A little

A lot

Very much
24% Blank
35%
Other (doesn't need
any of those)

12) While waiting, does it distress you to discuss your situation with other patients living similar
experiences?

N. %

o Not in the least 219 62

o A little 78 22
o A lot 30 8
o Very much 18 5
o Blank 8 2
o Other 2 1
Would rather avoid it 1
Finds it useless 1

Question 12

5% 2% 1%
8% Not in the least
A little
A lot
Very much
22%
62% Blank
Other
 J Canc Educ

13) While waiting, would you like to meet other people who have lived a similar experience and
talk to them?

N. %

o Not in the least 100 28

o A little 123 35
o A lot 98 28
o Very much 19 5
o Blank 12 3
o Other 3 1

Depends on their character 1

Only if everything went well 1
Don’t care 1

Question 13

5% 3% 1%
28%
Not in the least
28% A little
A lot
Very much
Blank

35% Other
J Canc Educ

Appendix 2

TRADE OFF QUESTION

We guess being treated in our institute is very important to you, and that you think it is crucial to
continue your therapy serenely (even when things are not going as well as you would like).
Needing to quantify the importance of being treated at the IEO, we are going to ask you a
theoretical question: in order to be treated in what you consider to be the ideal place, how many
hours of your life would you be willing to spend at the Institute (knowing the wait can be long).

N. %

o Not even an hour of my life 4 1

o Half a day of my life 10 3
o A week of my life 9 3
o Month of my life 5 1
o Any length of time necessary
because it is always worthwhile 303 85

o Blank 24 7

Not even an hour of my life

Trade off question
7% 1% 3% 3%
1% Half a day of my life

A week of my life

A month of my life

85% Any length of time necessary: it's

always worthwhile

Blank
 J Canc Educ

Appendix 3

Open questions:

1) In your opinion, what has the highest emotional impact been while waiting in a waiting room?
(239 answers evaluated)

N. %

Seeing so many sick people 121 50

Waiting 60 25
Too many people 31 13
Environment/furniture 16 7
Nothing 11 5

Vedere tante persone

7% 5%
malate
13% Attesa

50%
Troppa folla

25% Ambiente/arredo

Nulla
J Canc Educ

2) If you could change something in our waiting room, what would you change/add to make
waiting less distressing (if it is) and why?
(256 answers evaluated)
N. %

More comfortable furniture 100 40

(more comfortable chairs, windows facing outside)

Different facilities 42 16

Alternative activities 36 14
(Meetings with professionals, music therapy courses)

Entertainment activities 33 13
(maxi-screen, cable radio, TV)

Being able to leave 18 7

Nothing 19 7

Shortening waiting time 8 3

7% 3%
7%
40%
13%

14%
16%
Arredo piu` confortevole
Costruzione di ambienti differenti
Organizzazione di attivita` alternative
Attivita` di svago
Nulla
Potersi allontanare
Riduzione dei tempi di attesa

References
1. Bruce TA, Bowman JM, Brown ST (1998) Factors that influence
patient satisfaction in the emergency department. J Nurs Care
Qual 13(2):31–37
2. Rondeau KV (1998) Managing the clinic wait: an important
quality of care challenge. J Nurs Care Qual 13(2):11–20
3. Bunzel B, Wollenek G, Grundbock A (1992) Psychosocial
problems of donor heart recipients adversely affecting quality of
life. Qual Life Res 1:307–313
4. Ruppert SD (1992) Wives' perceptions of situational experiences
during critical care hospitalization: a phenomenological study.
(Doctoral dissertation, Texas Woman's University, 1992). Diss
Abst Int 54:01B169
5. Bright MJ, Craven JL, Kelly PJ (1990) Assessment and
management of psychosocial stress in lung transplant candidates.
Health Soc Work 15:125–132
J Canc Educ
6. Dube L, Schmitt BH, Leclerc F (1991) Consumers' affective
response to delays at different phases of service delivery. J Appl
Soc Psychol 21:810–820
7. Suszycky LH (1988) Psychosocial aspects of heart transplanta-
tion. Soc Work 33:205–209
8. Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S,
Schemale AM et al (1983) The prevalence of psychiatric disorders
among cancer patients. JAMA 249:751–757
9. Ell K, Sanchez K, Vourlekis B, Vourlekis PJ, Dwight-Johnson M,
Lagomasino I, Muderspach L et al (2005) Depression correlates of
depression, and receipt of depression care among low-income
women with breast or gynecology cancer. J Clin Oncol 23:3052–
3060
10. Aitini E, Sempreboni A, Aleotti P, Zamagli D, Cavazzini G,
Barbieri R et al (2007) Anxiety levels in cancer patients and
“life sound” experience. Tumori 93:75–77