Does Adjusting for Social Desirability Reduce Ceiling Effects and Increase Variation of Patient-Reported Experience Measures?

Abstract

Social desirability bias (a tendency to underreport undesirable attitudes and behaviors) may account, in part, for the notable ceiling effects and limited variability of patient-reported experience measures (PREMs) such as satisfaction, communication effectiveness, and perceived empathy. Given that there is always room for improvement for both clinicians and the care environment, ceiling effects can hinder improvement efforts. This study tested whether weighting of satisfaction scales according to the extent of social desirability can create a more normal distribution of scores and less ceiling effect. In a cross-sectional study 118 English-speaking adults seeking musculoskeletal specialty care completed 2 measures of satisfaction with care (one iterative scale and one 11-point ordinal scale), a measure of social desirability, and basic demographics. Normality of satisfaction scores was assessed using Shapiro-Wilk tests. After weighting for social desirability, scores on the iterative satisfaction scale had a more normal distribution while scores on the 11-point ordinal satisfaction scale did not. The ceiling effects in satisfaction decreased from 47% (n = 56) to 2.5% (n = 3) for the iterative scale, and from 81% (n = 95) to 2.5% (n = 3) for the ordinal scale. There were no differences in mean satisfaction when the social desirability was measured prior to completion of the satisfaction surveys compared to after. The observation that adjustment for levels of social desirability bias can reduce ceiling effects suggests that accounting for personal factors could help us develop PREMs with greater variability in scores, which may prove useful for quality improvement efforts.

Patients’ Preference for Participation in Medical Decision-Making: Secondary Analysis of the BEDSIDE-OUTSIDE Trial

“…However, literature has shown that ratings of patient-related experience measures often show ceiling effects with little or no difference. 28 Still, in our study, we found consistent associations of patients’ DCP with patients’ trust in the healthcare team and satisfaction with hospital stay as two different measures of perceived quality of care, suggesting that our finding is clinically relevant.…”

When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy?

“…Specialist discussions of empathetic opportunities did not appreciably lengthen visit durations or alter the patient experience. Specialist discomfort in discussing thoughts and emotions, perceived time barriers, and other hindrances may be lessened with coaching and practice [4,59,66], an area for future investigation. Future research could also benefit from measures with more spread in scores to better identify statistical associations between specific factors and better patient experience.…”

“…There are probably some types of empathetic opportunities that merit longer visits, but in general, there are many parts of the visit that can be shorter (such as clinician expertise transfer), and responding to empathetic opportunities does not add much time if there is a corresponding shortening of "teaching" or "explaining" [75]. Going forward, it would be helpful to have a measure of patient experience that provides enough spread in scores to monitor the impact of improvement initiatives [4,57,76]. Preliminary evidence suggests that refining instruments using patient interviews [63], accounting for personal factors such as social desirability bias [4], or using natural language processing to develop quantitative ratings of patient experience [57] can create a broader, more Gaussian distribution of scores.…”

“…Going forward, it would be helpful to have a measure of patient experience that provides enough spread in scores to monitor the impact of improvement initiatives [4,57,76]. Preliminary evidence suggests that refining instruments using patient interviews [63], accounting for personal factors such as social desirability bias [4], or using natural language processing to develop quantitative ratings of patient experience [57] can create a broader, more Gaussian distribution of scores.…”

Mental Health Among People Presenting for Care of Physical Symptoms: The Factors Associated with Suicidality and Symptoms of Depression and Anxiety are Similar Across Specialties

“…The finding that greater symptoms of depression are associated with specialties other than primary care—with nearly 1 in 3 people presenting for specialty care having a PHQ score of 3 or greater, and about 1 in 25 reporting some suicidality in our setting—reinforces the importance of 1) non-specialists considering potential mental health support when considering specialty referral, 2) coordination of mental and physical health care between non-specialty and specialty care, 3) anticipation by specialists that a notable percentage of their patients will have an illness influenced in important ways by mental and social factors, and 4) training specialist and non-specialists in strategies for both routinely reviewing questionnaires and considering mental health as well as making mental and social health comfortable topics of conversation. The observation that the various thresholds for symptoms of depression or anxiety were associated with relatively similar factors, most associated with socioeconomic disadvantage, 28 , 29 combined with the knowledge that people don’t always complete mental health questionnaires forthrightly, 30 – 32 suggests that any degree of symptoms of depression can spark a helpful discussion that ensures no opportunities for improved mental health are overlooked. The finding that men, older age, and better socioeconomic status (non-safety net insurance) are protective is consistent with a prior study in adults selected to represent major demographic groups in the US that younger age, women, Hispanic ethnicity, and people of color had greater symptoms of depression.…”