Prevalence and Sources of Patients' Unmet Expectations for Care

Kravitz, Richard L.; Callahan, Edward J.; Paterniti, Debora A.; Antonius, Deirdre; Dunham, Marcia; Lewis, Charles E.

doi:10.7326/0003-4819-125-9-199611010-00004

Cited by 184 publications

(159 citation statements)

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“…Surveys on patient expectations have a potential to improve patient care because identification of expectations have been shown to enable individualized patient care, address areas for increased patient education and pre-surgical preparation, and promote shared decisionmaking when faced with numerous reasonable treatment options that appear vastly different or complex [19,32]. This study was intentionally designed to apply standard techniques of qualitative methodology so that expectations were those that participants expressed voluntarily whether they were fundamental and obvious in the process of medical data collection, or personally private and not readily apparent to their surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…The design of this investigation was modeled after prior surveys that assessed expectations for other common orthopaedic conditions [5,10,16,19,[21][22][23][24]. The study was a prospective cohort validation study and was performed in the clinical practices of four different orthopaedic hand surgeons in one institution.…”

Section: Methodsmentioning

confidence: 99%

“…Two items with weighted kappa values between 0.58 and 0.59 were retained because they were frequently endorsed (with 75% and 73% frequency) and were unique and specific to arthritis of the hand relative to previous expectations survey items [16][17][18][19]. These were survey items 13 and 17: ''Complete activities without having to slow down or stop to take a break'' (weighted kappa = 0.58) and ''Carry out tasks without depending on other people'' (weighted kappa = 0.59).…”

Section: Phase 2 Assembling the Draft Survey And Testing The Survey mentioning

confidence: 99%

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Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Kang

Hashmi

Nguyen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Although patient expectations associated with major orthopaedic conditions have shown clinically relevant and variable effects on outcomes, expectations associated with thumb carpometacarpal (CMC) arthritis have not been identified, described, or analyzed before, to our knowledge. Questions/purposes We asked: (1) Do patients with thumb CMC arthritis express characteristic expectations that are quantifiable and have measurable frequency? (2) Can a survey on expectations developed from patientderived data quantitate expectations in patients with thumb CMC arthritis? Methods The study was a prospective cohort study. The first phase was a 12-month-period involving interviews of 42 patients with thumb CMC arthritis to define their expectations of treatment. The interview process used techniques and principles of qualitative methodology including open-ended interview questions, unrestricted time, and study size determined by data saturation. Verbatim responses provided content for the draft survey. The second phase was a 12-month period assessing the survey for test-retest reliability with the recruitment of 36 participants who completed the survey twice. The survey was finalized from clinically relevant content, frequency of endorsement, weighted kappa values for concordance of responses, and intraclass coefficient and Cronbach's alpha for interrater reliability and internal consistency. Results Thirty-two patients volunteered 256 characteristic expectations, which consisted of 21 discrete categories. Expectations with similar concepts were combined by eliminating redundancy while maintaining original terminology. These were reduced to 19 items that comprised a one-page survey. This survey showed high concordance, interrater reliability, and internal consistency, with weighted kappa values between 0.58 and 0.78 (95% CI, 0.39-0.78; p \ 0.001); intraclass correlation coefficient of 0.94 (95% CI, 0.94-0.98; p\0.001), and Cronbach's alpha values of 0.94 and 0.95 (95% CI, 0.91-0.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Phase 2 Assembling the Draft Survey And Testing The Survey mentioning

confidence: 99%

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Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Kang

Hashmi

Nguyen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…6 Nonetheless, doctors do not always meet their patients' expectations, sometimes for good reason. [7][8][9][10] For example, the physician may not believe that further action is needed.…”

Section: Designmentioning

confidence: 99%

Older Patients Perceptions of “Unnecessary” Tests and Referrals

et al. 2008

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CONTEXT: Unnecessary exposure to medical interventions can harm patients. Many hope that generalist physicians can limit such unnecessary exposure.OBJECTIVE: To assess older Americans' perceptions of the need for tests and referrals that their personal physician deemed unnecessary. DESIGN:Telephone survey with mail follow-up in English and Spanish, conducted from May to September 2005 (overall response rate 62%).STUDY PARTICIPANTS: Nationally representative sample of 2,847 community-dwelling Medicare beneficiaries. Main analyses focus on the 2,319 who had a personal doctor ("one you would see for a check-up or advice if you were sick") whom they described as a generalist ("doctor who treats many different kinds of problems").MAIN OUTCOME MEASURE: Proportion of respondents wanting a test or referral that their generalist suggested was not necessary using 2 clinical vignettes (cough persisting 1 week after other flu symptoms; mild but definite chest pain lasting 1 week).RESULTS: Eighty-two percent of Medicare beneficiaries had a generalist physician; almost all (97%) saw their generalist at least once in the past year. Among those with a generalist, 79% believed that it is "better for a patient to have one general doctor who manages most of their medical problems" than to have each problem cared for by a specialist. Nevertheless, when faced with new symptoms, many would want tests and referrals that their doctor did not think necessary. For a cough persisting 1 week after flu symptoms, 34% would want to see a lung specialist even if their generalist told them they "probably did not need to see a specialist but could if they wanted to." For 1 week of mild but definite chest pain when walking up stairs, 55% would want to see a heart specialist even if their generalist did not think it necessary. In these same scenarios, even higher proportions would want diagnostic testing; 57% would want a chest x-ray for the cough, and 74% would want "special tests" for the chest pain.CONCLUSIONS: When faced with new symptoms, many older patients report that they would want a diagnostic test or specialty referral that their generalist thought was unnecessary. Generalists striving to provide patient-centered care while at the same time limiting exposure to unnecessary medical interventions will need to address their patients' perceptions regarding the need for these services.KEY WORDS: geriatrics; patient perceptions; tests and referrals; shared decision making.

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“…The contributions of cultural anthropologists are found in the rnethodologic approaches utilized in qualitative research. However, it has only been in the last decade that qualitative research has emerged in prominent journals as a methodology of choice among a wide variety of scientists and clinicians (2)(3)(4) as well as a complementary method to quantitative research (5).…”

mentioning

confidence: 99%

Qualitative research: Contributions to scientific inquiry and patient care

Robbins¹

1998

Arthritis & Rheumatism

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Prevalence and Sources of Patients' Unmet Expectations for Care

Cited by 184 publications

References 0 publications

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Older Patients Perceptions of “Unnecessary” Tests and Referrals

Qualitative research: Contributions to scientific inquiry and patient care

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