Pitfalls in the statistical examination and interpretation of the correspondence between physician and patient satisfaction ratings and their relevance for shared decision making research

Oliver Hirsch,Christina Albohn-Kühne,Heidemarie Keller,Norbert Donner-Banzhoff,Tanja Krones

doi:10.1186/1471-2288-11-71

Oliver Hirsch, Christina Albohn-Kühne + Show 3 more

Open Access

https://doi.org/10.1186/1471-2288-11-71

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Abstract

BackgroundThe correspondence of satisfaction ratings between physicians and patients can be assessed on different dimensions. One may examine whether they differ between the two groups or focus on measures of association or agreement. The aim of our study was to evaluate methodological difficulties in calculating the correspondence between patient and physician satisfaction ratings and to show the relevance for shared decision making research.MethodsWe utilised a structured tool for cardiovascular prevention (arriba™) in a pragmatic cluster-randomised controlled trial. Correspondence between patient and physician satisfaction ratings after individual primary care consultations was assessed using the Patient Participation Scale (PPS). We used the Wilcoxon signed-rank test, the marginal homogeneity test, Kendall's tau-b, weighted kappa, percentage of agreement, and the Bland-Altman method to measure differences, associations, and agreement between physicians and patients.ResultsStatistical measures signal large differences between patient and physician satisfaction ratings with more favourable ratings provided by patients and a low correspondence regardless of group allocation. Closer examination of the raw data revealed a high ceiling effect of satisfaction ratings and only slight disagreement regarding the distributions of differences between physicians' and patients' ratings.ConclusionsTraditional statistical measures of association and agreement are not able to capture a clinically relevant appreciation of the physician-patient relationship by both parties in skewed satisfaction ratings. Only the Bland-Altman method for assessing agreement augmented by bar charts of differences was able to indicate this.Trial registrationISRCTN: ISRCT71348772

Highlights

The correspondence of satisfaction ratings between physicians and patients can be assessed on different dimensions
We have found only one study in which the Bland-Altman method was applied to data in the area of shared decision making
Marginal homogeneity test After crosstabulating the corresponding patient and physician ratings on item level, the inspection of the contingency tables revealed that the categories “neither nor”, “disagree”, and “totally disagree” were rarely used

Summary

Introduction

The correspondence of satisfaction ratings between physicians and patients can be assessed on different dimensions. Weng [4] states that studies have found low correlations between physicians’ self-ratings of their performance and the ratings of this performance by evaluators like patients, nurses, or peers. She suggests that physician ratings of the patient-physician relationship may largely be influenced by their patients’ symptoms, their functional status, and their prognosis. The correlation of patients’ and physicians’ overall satisfaction was significant, but rather small (r = .28) This is confirmed by a study of Bjertness et al [6], who found a higher satisfaction of patients with their treatment in a mental health outpatient clinic compared to their physicians.

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