Unmet expectations for care and the patient-physician relationship

Bell, Robert A.; Kravitz, Richard L.; Thom, David H.; Krupat, Edward; Azari, Rahman

doi:10.1046/j.1525-1497.2002.10319.x

Cited by 204 publications

(168 citation statements)

References 35 publications

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“…'Shared decision-making process' might have been related to positive outcomes because patients who perceived greater involvement in the decision-making process experienced a greater sense of control over their illness [28] or greater coping efficacy [29] or because their expectations for care were more likely to be met [33]. 'Medical decision' could have been related to positive outcomes because the patient perceived that the doctor played a part in the decision.…”

Section: Discussionmentioning

confidence: 99%

Doctor-patient concordance during HIV treatment switching decision-making

et al. 2010

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The aim of the study was to explore levels of doctor-patient concordance during the making of decisions regarding HIV treatment switching and stopping in relation to patient health-related outcomes. MethodsAdult patients attending five HIV clinics in the United Kingdom were requested to complete the study questionnaire, which included a Concordance Scale, and measures of symptoms [Memorial Symptom Assessment Short Form (MSAS) index], quality of life (EuroQol), satisfaction, adherence and sexual risk behaviour. Clinical health measures (HIV viral load and CD4 cell count) were also obtained. A total of 779 patients completed the questionnaire, giving a response rate of 86%; of these 779 patients, 430 had switched or stopped their HIV treatment and were thus eligible for inclusion. Of these patients, 217 (50.5%) fully completed the Concordance Scale. ResultsConcordance levels were high (88% scored between 30 and 40 on the scale; score range 10-40). Higher concordance was related to several patient outcomes, including: better quality of life (P 5 0.003), less severe and burdensome symptom experience (lower MSAS-physical score, P 5 0.001; lower MSAS-psychological score, P 5 0.008; lower MSAS-global distress index score, P 5 0.011; fewer symptoms reported, P 5 0.007), higher CD4 cell count (at baseline, P 5 0.019, and 6-12 months later, P 5 0.043) and greater adherence (P 5 0.029). ConclusionsHigh levels of doctor-patient concordance in HIV treatment decision-making are associated with greater adherence and better physical and psychological functioning. More research is needed to establish a causal relationship between concordance and these outcomes.

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Section: Discussionmentioning

confidence: 99%

Doctor-patient concordance during HIV treatment switching decision-making

et al. 2010

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“…There is mixed evidence regarding the relationship between reports about care and the extent to which health care providers meet patient expectations for tests, medications or referrals. 7,8 Some studies suggest that there is an inconsistent relationship between the amount of care delivered and patients' assessments of care, 9 while still others find that higher-intensity care is related to more negative patient experiences. 10 Regardless, providers who are aware of patient expectations are better positioned to fulfill patients' well-founded requests and to negotiate with patients regarding requests that are likely to yield limited clinical benefit.…”

Section: Patient Surveys Do Not Provide Valid Information Aboutmentioning

confidence: 99%

Should Health Care Providers be Accountable for Patients’ Care Experiences?

Price

Elliott

Cleary³

et al. 2014

J GEN INTERN MED

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Measures of patients' care experiences are increasingly used as quality measures in accountability initiatives. As the prominence and financial impact of patient experience measures have increased, so too have concerns about the relevance and fairness of including them as indicators of health care quality. Using evidence from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, the most widely used patient experience measures in the United States, we address seven common critiques of patient experience measures: (1) consumers do not have the expertise needed to evaluate care quality; (2) patient "satisfaction" is subjective and thus not valid or actionable; (3) increasing emphasis on improving patient experiences encourages health care providers and plans to fulfill patient desires, leading to care that is inappropriate, ineffective, and/or inefficient; (4) there is a trade-off between providing good patient experiences and providing high-quality clinical care; (5) patient scores cannot be fairly compared across health care providers or plans due to factors beyond providers' control; (6) response rates to patient experience surveys are low, or responses reflect only patients with extreme experiences; and (7) there are faster, cheaper, and more customized ways to survey patients than the standardized approaches mandated by federal accountability initiatives.

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“…It is common for doctors not to write a prescription or make a referral which patients were expecting, 1,2 and these unmet expectations are associated with increased patient dissatisfaction. [3][4][5] Conversely, where a doctor does fulfil expectations, for example by giving a prescription that a patient wants even when it is not needed, it may be to maintain a good relationship with the patient. 6 However, instances where the doctor gives a prescription that is unwanted are just as much a failure to meet the expectations as those where the doctor refuses the patient's request for one.…”

Section: Introductionmentioning

confidence: 99%