Preferences, predictions and patient enablement: a preliminary study

Carl J Brusse,Laurann E Yen

doi:10.1186/1471-2296-14-116

Abstract

BackgroundThe widely used patient enablement instrument (PEI) is sometimes contrasted against measures of patient satisfaction as being a more objective measure of consultation quality, in that it is less likely to be positively influenced by fulfilling pre-existing expectations for specific consultation outcomes (such as prescriptions or referrals). However the relationship between expectation and enablement is underexplored, as is the relationship between ‘expectation’ understood as a patient preference for outcome, and patient prediction of outcome. The aims of the study are to 1) assess the feasibility of measuring the relationship between expectation fulfilment and patient enablement, and 2) measure the difference (if any) between expectation understood as preference, and expectation understood as prediction.MethodsA questionnaire study was carried out on 67 patients attending three General Practices in the Australian Capital Territory. Patient preferences and predictions for a range of possible outcomes were recorded prior to the consultation. PEI and the actual outcomes of the consultation were recorded at the conclusion of the consultation. Data analysis compared expectation fulfilment as concordance between the preferred, predicted, and actual outcomes, with the PEI as a dependant variable.ResultsNo statistically significant relationship was found between either preference-outcome concordance and PEI, or prediction-outcome concordance. Statistically insignificant trends in both cases ran counter to expectations; i.e. with PEI (weakly) positively correlated with greater discordance. The degree of concordance between preferred outcomes and predicted outcomes was less than the concordance between either preferred outcomes and actual outcomes, or predicted outcomes and actual outcomes.ConclusionsThe relationship between expectation fulfilment and enablement remains uncertain, whether expectation is measured as stated preferences for specific outcomes, or the predictions made regarding receiving such outcomes. However the lack of agreement between these two senses of ‘patient expectation’ suggests that explicitly demarcating these concepts during study design is strongly advisable.

Highlights

The widely used patient enablement instrument (PEI) is sometimes contrasted against measures of patient satisfaction as being a more objective measure of consultation quality, in that it is less likely to be positively influenced by fulfilling pre-existing expectations for specific consultation outcomes
Given the narrow scope of this study we developed a list of possible consultation outcomes, using medical and nursing clinicians to identify and classify common outcome types
Sixty eight participants agreed to participate in this preliminary study out of seventy four approached, and for sixty two participants all required information was gathered on preferred, predicted and actual outcomes, and a valid Patient Enablement Instrument (PEI) score obtained

Summary

Introduction

The widely used patient enablement instrument (PEI) is sometimes contrasted against measures of patient satisfaction as being a more objective measure of consultation quality, in that it is less likely to be positively influenced by fulfilling pre-existing expectations for specific consultation outcomes (such as prescriptions or referrals). A literature review by Rao et al in 2000 concluded that, while fulfilment of expectations for a diagnosis or good doctor-patient communication were more significant, there is a modest relationship between the fulfilment of service outcome-expectations and satisfaction [3]. This suggests that specific pre-consultation outcome-expectations (as opposed to more abstract expectations for diagnosis, empowerment, or clinician communication/empathy) can influence a patient’s self-reported satisfaction with a consultation

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