Patient Expectations and Preferences in the Spinal Surgery Clinic

Tabibian, Borna E.; Kuhn, Elizabeth N.; Davis, Matthew C.; Pritchard, Patrick R.

doi:10.1016/j.wneu.2017.07.018

Cited by 23 publications

(5 citation statements)

References 26 publications

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“…Aligning expectations with likely outcomes may improve patient satisfaction, the patient-provider relationship, and potentially patient recovery. [37][38][39] Interestingly, patients with previous episodes of the same pain expected and defined success as higher absolute levels of burden remaining in each domain, but these corresponded to similar percent reductions in burden compared to patients without previous episodes of the same pain. This finding suggests that while patients do modify their goals and expectations somewhat based on prior experiences, their definitions of successful and expected treatment outcomes still correspond to substantial improvements.…”

Section: Discussionmentioning

confidence: 95%

Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes

Flynn

Gordee

Kuchibhatla

et al. 2021

Academic Emergency Medicine

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Objectives: Musculoskeletal pain is a common emergency department (ED) presentation, and patient-centered care may improve quality of life, treatment satisfaction, and outcomes. Our objective was to investigate the expectations, definitions of success, and priorities of ED patients with musculoskeletal pain. Methods: We conducted a cross-sectional survey of the demographic, clinical, and psychosocial characteristics of adult ED patients (n = 210) with musculoskeletal pain. Patients completed the Patient-Centered Outcomes Questionnaire to quantify usual, desired, expected, and successful levels of pain and interference with daily activities, fatigue, and emotion from 0 (none) to 100 (worst imaginable). They also reported the importance of improvement in each domain. Cluster analysis identified subgroups by importance ratings. Patients were asked their willingness to try various pharmacologic and nonpharmacologic treatments. Fully completed surveys were analyzed (n = 174). Results: Most patients desired 100% resolution in each domain and defined treatment success as substantial (median = 63.2%-76.5%) reductions but expected only moderate (median = 45%-53.7%) improvements across all domains. Patients with previous pain episodes had similar desired levels but less stringent definitions of success and expectations for improvement. Cluster analysis identified three patient subgroups by importance ratings of each domain: (1) multiple domains important (n = 118) with high importance attached to all four domains, (2) pain and function important (n = 34) with high importance primarily for pain and interference with daily activities, and (3) only pain important (n = 22). Regardless of subgroup, there was a high willingness to use a variety of pharmacologic and nonpharmacologic treatments. Discussion: ED patients with musculoskeletal pain have expectations and goals that include addressing impairments in function, improving quality of life, and reducing pain.

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Section: Discussionmentioning

confidence: 95%

Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes

Flynn

Gordee

Kuchibhatla

et al. 2021

Academic Emergency Medicine

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“…In our model a patient's intrinsic characteristics, including individual demographics, disease diagnosis, and overall health status establish patient preferences a priori. 10,34,37 The patient then forms expectations prior to the visit based on available information in 4 major extrinsic categories: their doctor's characteristics, 9,42 the reputation of the practice or institution, 8,20 their own prior experience with the doctor/institution, and their chief complaints. 39 These expectations, in a multifactorial fashion, influence the interpretation of 4 major domains of experience during the visit: their interaction with the doctor, their interaction with the staff, the logistics of the visit itself, and the resolution of their chief complaints.…”

Section: Integrated Model Of Patient Satisfactionmentioning

confidence: 99%

The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice

Zakare-Fagbamila

Park

Dickson

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEMost clinics collect routine data on performance metrics on physicians for outpatient visits. However, the relationship of these metrics with patient experience is unclear. The goal of this study was to investigate the relationships between the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS), the standard patient experience survey, and clinic performance metrics to understand the determinants of patient satisfaction and identify targets for improving patient experience.METHODSThe authors performed a retrospective single-institution cohort review of spine surgeon metrics over 15 months including demographics, waiting-room times, in-room times, lead times, timely note closure, timely MyChart responses, and monthly patient volume. Kruskal-Wallis tests and mixed-model regression were used to determine the predictors of 3 domains of patient satisfaction—Global, Access, and Communication.RESULTSOver 15 months, 22 surgeons conducted 27,090 visits. The average clinic visit total time was 85.17 ± 25.75 minutes. Increased wait times were associated with poor Global (p = 0.008), Access (p < 0.001), and Communication scores (p = 0.003) in univariate analysis. Every 10-minute increase in waiting time was associated with a 3%, 9.8%, and 2.4% decrease in Global, Access, and Communication scores, respectively. Increased in-room time was also an independent predictor of poor Access scores (p < 0.001). In multivariate analysis, increased wait times were negative predictors of Global (p = 0.005), Access (p < 0.001), and Communication (p = 0.002) scores.CONCLUSIONSExcessive waiting-room time significantly impacts unexpected dimensions of the patient experience and impacts communication with patients. Understanding the complex relationship between the factors that inform the patient experience will help target effective interventions to improve clinic efficiency and patient satisfaction.

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“…Did the interviewed surgeons overlook a global societal change [32]? The timeless doctor-patient relationship has recently undergone drastic changes: strengthening of patients' rights, Internet and social networks, societal transformations in the relationship to authority and knowledge [30]. The surgeon, heir to macho heroes, historically carries a particular aura and a tradition of powerful ego [8].…”

Section: A Changing Relationshipmentioning

confidence: 99%

Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practice—a qualitative study

Guillain

Moncany²,

Hamel

et al. 2020

Acta Neurochir

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Background The judicialization of medicine can lead to professional disenchantment and defensive attitudes among surgeons. Some quantitative studies have investigated this topic in spine surgery, but none has provided direct thematic feedback from physicians. This qualitative study aimed to identify the impact of this phenomenon in the practice of spine neurosurgeons. Methods We proposed a qualitative study using grounded theory approach. Twenty-three purposively selected private neurosurgeons participated. Inclusion took place until data saturation was reached. Data were collected through individual interviews and analyzed thematically and independently by three researchers (an anthropologist, a psychiatrist, and a neurosurgeon). Results Data analysis identified five superordinate themes that were based on items that recurred in interviews: (1) private practice of spinal surgery (high-risk surgery based on frequent functional symptoms, in an unfavorable medicolegal context);(2) societal transformation of the doctor-patient relationship (new societal demands, impact of the internet and social network);(3) judicialization of spine surgery (surgeons' feelings about the frequency and motivation of the complaints they receive, and their own management of them); (4) coping strategies (identification and solutions for "at risk" situations and patients); and (5) professional disenchantment (impact of these events on surgeons' daily practice and career planning). Selected quotes of interviews were reported to support these findings. Conclusions Our study highlights several elements that can alter the quality of care in a context of societal change and the judicialization of medicine. The alteration of the doctor-patient relationship and the permanent pressure of a possible complaint encourage surgeons to adopt defensive attitudes in order to minimize the risks of litigation and increased insurance premiums. These phenomena can affect the quality of care and the privacy of physicians to the extent that they may consider changing or interrupting their careers earlier.

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Patient Expectations and Preferences in the Spinal Surgery Clinic

Cited by 23 publications

References 26 publications

Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes

Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes

The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice

Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practice—a qualitative study

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