Align Patient Expectations Research Articles

Expectations concerning cancer treatment: perspectives of medical oncologists and patients on advanced, unresectable lung carcinoma.

This study seeks to compare expectations regarding systemic cancer treatment for advanced lung cancer from the perspectives of both patient and medical oncologist. A cross-sectional study involving 17 medical oncologists from 13 Spanish hospitals between 2021 and 2022. Patients with advanced, unresectable lung cancer were recruited prior to initiating systemic cancer treatment. Both patients and oncologists completed the NEOetic-EIT and the STAR. Seventeen medical oncologists specializing in lung cancer participated, with a mean age of 36.2 years (range 28-56); 65% were female. The study included 298 patients with advanced, unresectable lung cancer, predominantly non-small cell type (72%), and most at stage IV (77%). Most patients were retired or unemployed (71%), and married or partnered (77%). Treatment approaches varied, with 44% based on biomarkers. Oncologists had greater expectations of positive outcomes for participants with better baseline prognosis, such as ECOG 0, newly diagnosed, locally advanced, unresectable non-small cell lung cancer, and those receiving biomarker-based treatments. In contrast, patients' treatment expectations did not vary based on sociodemographic or clinical factors. Generally, patients had high expectations of cure, in contrast to oncologists' lower expectations, though both anticipated similar quality-of-life improvements. Patients anticipated more side effects than oncologists. Among oncologists, expectations varied by gender and decreased with age and experience, with no differences detected among patients based on gender, age, or doctor-patient relationship. This study reveals the complex expectations of patients and oncologists in advanced lung cancer treatment. It underscores the need for effective communication in oncology to align patient expectations with clinical realities.

CINDERELLA clinical trial: Using artificial intelligence–driven healthcare to enhance breast cancer locoregional treatment decisions.

TPS621 Background: Breast cancer treatments often pose challenges in balancing efficacy with quality of life. The CINDERELLA Project pioneers an artificial intelligence (AI)-driven approach (CINDERELLA APP) for shared decision-making process, aiming to harmonise locoregional therapeutic interventions with breast cancer patients' expectations about aesthetic outcomes. The CINDERELLA clinical trial aims to establish a new standard in patient-centred care by bridging the gap between clinical treatment options and patient expectations through innovative technology. The trial focuses on evaluating the effectiveness of the CINDERELLA APP in improving patient satisfaction regarding locoregional treatment aesthetic outcomes, aligning patient expectations with real-world results, and assessing its impact on overall quality of life and psychological well-being. Methods: Trial design and statistical methods: This international multicentric interventional randomised controlled open-label clinical trial will recruit and randomise patients into two groups: one receiving standard treatment information and the other using the AI-powered CINDERELLA APP. The primary objective is to assess the levels of agreement among patients' expectations regarding the aesthetic outcome before and 12 months after locoregional treatment. The trial will also evaluate the aesthetic outcome level of agreement between the AI evaluation tool and self-evaluation. The impact of the intervention on aligning expectations with outcomes will be evaluated using the Wilcoxon signed-rank test. The improvement in classification of aesthetic results post-intervention will be measured by calculating the Weighted Cohen's kappa. Outcomes across different groups will be compared using statistical tests and bootstrap methods. CANKADO functions as the base system, allowing doctors to supervise APP content for patients and handle data gathering, while upholding principles of privacy, data security, and ethical AI practices. Intervention planned: Using the CINDERELLA APP, the patient will have access to supervised medical information approved by breast cancer experts, and the AI system will match patient's information to pictures showing the potential aesthetic outcome (spectrum of good-poor) according to different locoregional approach. Major eligibility criteria: Non-metastatic breast cancer patients eligible for either breast-conserving surgery or mastectomy with immediate reconstruction. Current enrollment: Recruitment is currently open at six study sites. The recruitment started on 8 August 2023, aiming to enroll at least 515 patients/arm. As of January 26, 2024, clinical study sites have successfully randomised 177 patients. Clinical trial information: NCT05196269 .

Accuracy of machine learning to predict the outcomes of shoulder arthroplasty: a systematic review

BackgroundArtificial intelligence (AI) uses computer systems to simulate cognitive capacities to accomplish goals like problem-solving and decision-making. Machine learning (ML), a branch of AI, makes algorithms find connections between preset variables, thereby producing prediction models. ML can aid shoulder surgeons in determining which patients may be susceptible to worse outcomes and complications following shoulder arthroplasty (SA) and align patient expectations following SA. However, limited literature is available on ML utilization in total shoulder arthroplasty (TSA) and reverse TSA.MethodsA systematic literature review in accordance with PRISMA guidelines was performed to identify primary research articles evaluating ML’s ability to predict SA outcomes. With duplicates removed, the initial query yielded 327 articles, and after applying inclusion and exclusion criteria, 12 articles that had at least 1 month follow-up time were included.ResultsML can predict 30-day postoperative complications with a 90% accuracy, postoperative range of motion with a higher-than-85% accuracy, and clinical improvement in patient-reported outcome measures above minimal clinically important differences with a 93%–99% accuracy. ML can predict length of stay, operative time, discharge disposition, and hospitalization costs.ConclusionML can accurately predict outcomes and complications following SA and healthcare utilization. Outcomes are highly dependent on the type of algorithms used, data input, and features selected for the model.Level of EvidenceIII

Public Perceptions of Rotator Cuff Tears.

(1) Background: Full-thickness rotator cuff tears (RCTs) impact 25% of those over 60 and 50% over 80; however, minimal data exists on public understanding; (2) Methods: The primary outcome was to determine the public's baseline understanding of RCTs utilizing a 36-question survey regarding anatomy and function, risk factors, diagnosis and treatment options, and expectations. Secondarily, we evaluated the effect of an educational video and informational handout created by the authors to improve understanding. Participants ≥ 18 years were recruited from the senior author's clinic and online discussion platforms over a 5-month period; (3) Results: Baseline surveys were completed by 382 individuals: 56% men, 64% Caucasian, 27% with at least a master's degree, and 56% with very little or no RCT knowledge. Mean correct answer scores improved from 47% to 68% posteducational intervention (p < 0.001). Males, higher education level, healthcare experience, and a higher self-rated understanding of RCTs were significantly correlated with higher survey performance (p < 0.001); (4) Conclusions: The public's knowledge of RCTs at baseline was poor, with demographic factors correlating with survey performance. The educational intervention effectively enhanced participants' understanding. By focusing on common misconceptions, this data can help clinicians align patient expectations and enhance patient outcomes.

Diversity in online resources for breast reconstruction: What do patients see?

Online resources are commonly used by patients to obtain information on breast reconstruction. Despite the key role of these resources in patient decision-making, their visual content has not yet been evaluated. This study sought to 1) characterize the presence and content of visual aids in online patient education breast reconstruction resources and 2) determine if the women represented in these visual aids reflect the breast reconstruction patient population in the United States. The top 10 Google websites and the first 400 Google Images containing photographs/graphics depicting human skin for the search phrase "breast reconstruction" were analyzed. Images were categorized by content as "Before/After," "Surgical/Anatomical," "Step-by-Step," or "Breast-Centric Stock Images." Image subjects were classified by skin tone into "White" or "Non-White" using the Fitzpatrick scale and by body type into "Lean" or "Full-Figured." In total, 471 images were analyzed. These were predominantly "Before/After" images (43.9%), followed by "Breast-Centric Stock Images" (27.4%), "Surgical/Anatomical" (24.2%), and "Step-by-Step" (4.5%). The majority of all images depicted "White" skin types (90.7%) and "Lean" body types (73.0%). "Before/After" images were more likely to show "Full-Figured" women than the other content categories (p<0.0001) and had the highest percentage of "Non-White" skin types (35.3%). Our findings demonstrate that breast reconstruction online resources are not reflective of the patient population seeking reconstruction. Improving the diversity of online image resources can both better represent our diverse patient population as well as better align patient expectations with postoperative outcomes, likely improving patient satisfaction.

Public Interest in Shoulder Platelet-Rich Plasma Injections Is Increasing: A 10-Year Google Trends Analysis

To quantify and analyze public interest trends in platelet-rich plasma (PRP) therapy for shoulder pathology between 2011 and 2020 using Google Trends data. Google Trends data were queried for online search data ranging from January 2011 to December 2020. Various combinations of terms related to PRP and shoulder pathology were queried. Terms related to corticosteroid therapy in association with shoulder pathology were also generated for comparative analysis. Analyses were performed regarding trends in online search volumes. Linear models were generated to evaluated trends in the volume of online searches for PRP and corticosteroid therapy for shoulder pathology. For both the PRP and steroid groups, linear models showed a statistically significant increase in search volume for the period studied (P < .001). The PRP group showed a significantly greater growth rate than the steroid group (P < .001). There were no statistically significant differences in online search volume when compared between different geographic and socioeconomic locations. This study indicates consistently increasing public interest in PRP injections in the shoulder. The rate of online search volume growth of PRP is significantly greater than that of corticosteroid injections for the period studied. Awareness of patient perceptions has value in informing shared decision making, aligning patient expectations, and guiding areas of future research. Each of these has an impact on patient care. Being aware of patient interest and expectations is particularly important in areas with controversial or emerging research.

847-P: SGLT2 Inhibitors and GLP-1s Are Falling Short of Expectations among Patients with Type 2 Diabetes Newly Initiating Therapy

SGLT-2s and GLP-1s have demonstrated significant glucose lowering, cardiorenal, and weight loss benefits. However, the exisiting research on patients’ perception of these benefits is limited. Thus, the present study aims to identify and compare new users' expectations of SGLT-2s and GLP-1s and the degree to which their expectations have been met. In September 2022, 3,785 adults living with T2D took an online survey in which they indicated their SGLT-2 and GLP-1 usage and start date. Those who initiated SGLT-2 (n=108) or GLP-1 (n=128) use in the past year reported their expected changes upon starting the therapy. Participants were then asked the degree to which their expectations were met for each expectation held. Met expectations were calculated based on the percent of people selecting a 9 or 10 on a 10-point Likert scale. New SGLT-2 users expected lower A1c, increased protection against kidney disease, and weight loss (76%, 43%, and 40%, respectively), although less than a third of SGLT-2 new users expecting a lower A1c and weight loss felt that their expectations were met (29% and 28%, respectively). GLP-1 new users expected lower A1c, weight loss, and fewer instances of hyperglycemia (80%, 74%, and 48%, respectively). Only a third of new users felt their expectations of lower A1c and weight loss were met (34% and 33%, respectively). Expectations of A1c lowering were similar between GLP-1s and SGLT-2s (80% vs. 76%); however, weight loss expectations were significantly higher among GLP-1 users compared to those on SGLT-2s (74% vs. 43%, p&amp;lt;.01). Among patients initiating SGLT-2 or GLP-1 therapy, A1c lowering and weight loss expectations were not met for the majority of participants. These findings emphasize the need for improved expectation management and realistic goal setting. Future research is needed to understand how failed expectations translate into clinical outcomes and medication adherence, and to identify steps to better align patient expectations and outcomes. Disclosure C.Holleman: Employee; Close Concerns, Other Relationship; Abbott Diabetes, Eli Lilly and Company, LifeScan Diabetes Institute, Tandem Diabetes Care, Inc., Medtronic, Ascensia Diabetes Care, MannKind Corporation, dQ&amp;A. E.Xu: Employee; dQ&amp;A. E.Cox: Employee; dQ&amp;A. T.L.Bristow: Employee; dQ&amp;A.

79. The Sensory Assessment After FTM Gender Affirming Mastectomy (SAFTY) Study

Purpose: The double-incision gender-affirming mastectomy with free-nipple graft (DM-FNG) is increasing in demand. One concern is sensation loss to the chest and nipple areolar complex (NAC); however, the extent of sensation loss is poorly understood. Therefore, this study aims to quantify the degree and timing of sensation return to the chest and NAC to improve counseling and expectations for patients. Methods: Participants are enrolled at consultations and post-DM-FNG follow-ups. Semmes-Weinstein Monofilaments, ranging from 1.65-6.50 mm, assessed light touch and pressure at standardized locations. Sizes up to 2.83, 3.61, and 4.31 represent normal sensation, diminished light touch, and diminished protective sensation, respectively. Test tubes filled with warm and cool water assessed temperature sensibility. Results: Sensory tests were performed on 16 preoperative and 29 postoperative patients. There were no significant differences in demographics and clinical characteristics. 100% and 89.7% of preoperative and postoperative patients correctly identified warm and cool stimuli, respectively (p=0.18).At different postoperative times, there is normal sensation in the upper chest (F1, G-H1, G-H2), but decreased sensation closer to the NAC (G3, H3, p=0.023-0.037). Patients less than a year postoperatively have significantly decreased sensation along the inframammary scar (A-C) (p=0.0006-0.003), mid-axillary line (D-D2) (p=0.014-0.048), and nipple (p=0.00037-0.002).For breasts that had more than 500 g resected, there were significant sensation decreases along the inframammary scar (B, C) (p=0.004-0.031), mid-axillary line (D-D3) (p=0.00016-0.015), and below the inframammary scar (A1-C1) (p=0.014-0.04), whereas breasts with less than 500 g resected had normal sensation at those locations.48.3% had absent nipple sensation postoperatively. Compared to preoperative breasts, postoperative breasts had significantly reduced nipple sensation at all times (p=0.00000037-0.018). For those who were able to sense any stimuli on their nipples, a thicker monofilament size was required (4.45-4.46, p=0.00037-0.002). Conclusion: Postoperative sensation is normal except on the nipple, inframammary scar, and mid-axillary line. The inframammary scar is located along the dermatome of the 4th intercostal nerve that is routinely resected in DM-FNGs. Patients with large breasts have gravitational traction injury of their intercostal nerves with concomitant binding due to gender dysphoria have decreased sensation at baseline, which may explain why those with larger resected weights have less sensation postoperatively. Those who retained nipple sensibility had diminished protective sensation, increasing their risk for pressure injury. Protection against temperature injury was preserved. Understanding how sensation returns will better align patient expectations with outcomes.

Measuring Stakeholder Assessments of Postsurgical Facial Scars: A Retrospective Cohort Inter-rater Analysis of Patients, Physicians, and Medical Student Observers.

The relationship of postoperative facial scar assessments among patients, physicians, and societal onlookers is not clearly defined. To identify differences in perceived scar outcomes by different stakeholders. Retrospective cohort study at a single Mohs micrographic surgery (MMS) center during which scars were assessed by: patients, physicians, and medical student observers not involved in patients' care using the Patient and Observer Scar Assessment Scale (v.2). Eighty-one patients graded their scars at 2 visits: 1 to 2 weeks post-MMS and 3 months post-MMS. Deidentified patient photographs were taken at each visit and graded by 4 physicians and 12 observers. At week 1, there was a significant difference in overall opinion of scar appearance between patient and physicians (p = .001) and medical student observers and physicians (p < .001). Physicians graded scars more favorably. At 3 months, there remained a difference in scar evaluations between patient and physicians (p = .005), whereas medical student observers rated scars more similarly to physicians (p = .404). Postoperative scar perceptions differ among stakeholders. Physicians must be mindful of this disparity when counseling patients in the perioperative setting to align patient expectations with realistic scar outcomes.

DEVELOPMENT OF SHARED DECISION MAKING TRAINING MODULE FOR PATIENTS FACING PREFERENCE-SENSITIVE DECISIONS REGARDING MAJOR SURGICAL PROCEDURES

DEVELOPMENT OF SHARED DECISION MAKING TRAINING MODULE FOR PATIENTS FACING PREFERENCE-SENSITIVE DECISIONS REGARDING MAJOR SURGICAL PROCEDURES

Soft toric contact lenses: Aligning patient expectations and eye care professional attitudes

In this article Krupa Patel and Karen Walsh examine the expectations around soft toric lenses from both the practitioner and patient's point of view. It serves as a timely review of current toric fitting practices and how they relate to the prevalence of astigmatism, highlighting a number of opportunities for enhancing patient satisfaction and increasing practice revenue.

Patient expectations of manual and non-manual therapy within an osteopathic consultation: A cross sectional study

IntroductionPatient expectations of an osteopathic consultation can influence their evaluation of the effectiveness of osteopathic management. Throughout an osteopathic consultation practitioners' may use manual therapy (MT) and/or non-manual therapy (NMT). Currently, little is known regarding patient's expectations and preferences of osteopathic management. The aim of this study was to identify patients' expectations of their management within an osteopathic consultation, specifically in terms of the ratio of MT and NMT. MethodsNew patients to the Victoria University student osteopathic clinic were invited to complete a 5 question likert survey about their previous osteopathic experience; body region to be treated, and the expected ratio of MT to NMT during the consultation. ResultsOverall, Of the 161 participants, 85.7% expected a ratio of 75:25 or 50:50 MT to NMT (Q3), while 49% of participants were ‘extremely likely’ to ‘likely’ to attend a solely NMT consultation, if it were best practice for their condition (Q4). No significant difference was identified between responses to Q3 or Q4 when grouped according to the number of previous osteopathic consults, or gender. There was a positive, weak correlation between Q3 and Q4. ConclusionThe majority of participants expected their osteopathic consultation to consist mostly of MT. This study enhances osteopaths’ understanding of patient expectations, which can contribute to the formulation of improved education and management plans. Future research should focus on strategies on how to best align patient expectations of management with the broader evidence base.

Matching Patient Expectations after Ankle Fusion Based on Patient Reported Outcome Measures

Category:Ankle ArthritisIntroduction/Purpose:Much research on outcomes after ankle fusion focuses on gait changes, progression of adjacent joint arthritis, and other clinical measures, but little has been reported on the patient’s perspective. The purpose of this study was to determine the change in physical function and pain after undergoing ankle arthrodesis as determined by patient reported outcomes (PROs).Methods:This was a retrospective review of prospectively collected patient reported outcomes data in 88 consecutive ankle arthrodesis procedures performed from May 2015 to March 2018. Patient reported physical function (PF) and pain interference (PI) were measured as part of the routine care via the PROMIS computerized adaptive test at 6 months and 1 year post- operatively. Descriptive data and Spearman correlations were determined for PF and pain at 6 months and 1 year.Results:The mean pre-operative PF T-score was 37, less than the pre-determined threshold value of 42, indicating that this cohort was impaired physically and would respond positively to surgical intervention. The mean pre-operative PI T-score was 63 indicating moderate to high baseline pain and greater than the threshold value of 60, indicating that this patient cohort would have decreased pain after surgical intervention. The meaningful clinically important difference (MCID) was achieved for PI at 6 months and 1 year post-operatively (T-score of 4 and 6, respectively). At 6 months and 1 year, there was a moderate inverse correlation between PF and PI (r=-0.49, r=-0.61 respectively) suggesting less pain and more function. Demographic data, mean follow-up time, and mean PROMIS T-scores are seen in Table 1.Conclusion:The results of this study indicate that patients can expect to have a clinically meaningful improvement in pain after undergoing ankle fusion. Although patients do improve marginally in physical function, it is most likely the improvement in pain that is the greatest benefit to these patients at one year after ankle arthrodesis. This information is important to share with patients to align patient expectations with surgical results.

Prevalence and Predictors of Symptom Resolution and Functional Restoration in the Index Knee After Knee Arthroplasty: A Longitudinal Study

ObjectivesTo determine the prevalence of a 1- to 2-year postsurgical pain-free state and pain plus symptom-free state as well as functional restoration after knee arthroplasty (KA) and to identify predictors of these outcomes. DesignCohort study. SettingCommunities of 4 sites. ParticipantsConsecutive participants (N=383) who underwent KA on at least 1 knee during the first 8 years of the study (mean age, 67.95±8.5y; 61.4% women; n=235). InterventionsNot applicable. Main Outcome MeasuresA composite pain score included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scale and 2 generic pain rating scales. Composite pain plus other symptoms scores included 3 pain scales, a stiffness scale, and, in addition, the Knee injury and Osteoarthritis Outcome Score Symptoms scale. The WOMAC Function scale was used to quantify functional status. Prevalence estimates and predictors of a pain-free state, symptom-free state, and a fully functioning state were determined. ResultsA sample of 383 participants with KA was studied, and of these, 34.1% (95% confidence interval [CI], 29.3%–39.2%; n=131) had a composite score of 0 for pain. A total of 14.1% (95% CI, 10.8%–18.1%; n=54) had a composite score of 0, indicating a symptom-free state, whereas 29.0% (95% CI, 24.4%–34.0%; n=111) achieved a score of 0 on the WOMAC Function scale. ConclusionsThe prevalence of complete pain relief was 34%, the prevalence of complete pain and symptom relief was 14%, and the prevalence of complete functional restoration was 29% after KA. Participants who are older and with lower (better) WOMAC Pain scores were more likely to be pain-free after surgery. These data collected from a community-based sample have the potential to inform clinicians screening patients for KA consultation in a shared decision-making discussion to better align patient expectations with the most likely outcome.

Trainee Involvement in Patient Care: A Necessity and Reality in Teaching Hospitals.

Trainee Involvement in Patient Care: A Necessity and Reality in Teaching Hospitals.

Patient-centered risk stratification of disposition outcomes following radical cystectomy

PurposePatient-centered care involves providing understandable information to facilitate individualized health decisions among patients. We sought to determine the effect of age and comorbidity status on clinically meaningful outcomes following radical cystectomy (RC), in an effort the help optimize patient selection and enhance discussions among those considering surgery. Materials and methodsIn a retrospective review, 6,460 patients were treated with RC for bladder cancer from the U.S. Premier Perspectives Database between 2007 and 2013. The influence of age and comorbidity count on the rates of inpatient mortality, prolonged length of stay (LOS), disposition to other than home and hospital readmission within the month of surgery or month after, were assessed. Comorbidity was calculated using the Elixhauser method. Prolonged LOS was defined as >10 days. Multivariable logistic regression models were used. ResultsFollowing RC, 16% of patients were discharged to somewhere other than home, 37% had a prolonged LOS and 2% died during the index admission. Among those discharged home after surgery, 27% of patients were readmitted. Prolonged LOS was associated with increasing comorbidities and age >70 years (P < 0.001). The adjusted likelihood of readmission increased with increasing burden of comorbid conditions (P < 0.001), however, not with age. The likelihood of being discharged to other than home increased with age and comorbidity count (P < 0.001). Mortality was associated with ≥3 comorbidities and age >70 years. ConclusionsIncreasing age and comorbidity are associated with poorer outcomes following RC, with comorbidity being the predominant factor. Our findings may improve surgical selection and better align patient expectations following surgery by providing estimated rates of postoperative events for patients considering RC.

Patient expectations for chronic pain management

In New Zealand, one in six people report chronic pain, but the literature indicates only a 30% pain reduction is typically achieved in about half of treated patients. Most patients expecting a cure of their pain, or even substantial pain reduction, are therefore likely to be disappointed. It is important to align patient expectations with this reality. This study analysed the responses of 250 patients referred to a Pain Management Centre to the free-text question: 'What are your main goals or reasons for attending the Pain Management Centre?' Free-text comments were analysed using ethnographic content analysis, an inductive approach in which the themes and subthemes are not predetermined, but emerge from the data during analysis, and thus reflect the issues of importance to patients themselves. Three themes emerged from the analysis: patients' desire to understand their pain, regain 'normality', and concerns about medication. Responses were divided into those with an expectation of cure, and those who seemed to be more accepting of their pain and who desired management. Patients hope to return to what they perceive as normal and to have clear, relevant information about their diagnosis, prognosis and medications. Those desiring cure, or significant pain reduction, present more of a challenge to their general practitioners and the Pain Management Centre. When referring a patient for chronic pain management, there is a need to align patient expectations at the point of referral with what can realistically be achieved.

Development of an outcome prediction tool for patients considering a total knee replacement--the Knee Outcome Prediction Study (KOPS).

BackgroundKnee osteoarthritis affects 10% of the UK population over 55 years, resulting in pain and decreased quality of life. Knee replacement surgery has a proven benefit, with over 85,000 performed each year in the UK; however, approximately 17% of people are dissatisfied after surgery. Consequently, some Primary Care Trusts have reduced the funding available for knee replacements.Most previous work has focused on the effect of different prostheses and treatment protocols on patient’s outcome. However, this has been unable to account for all the variability and there is growing evidence that patient factors may significantly affect outcome. How to identify these at risk patients has been identified as a research priority by the National Institute of Clinical Excellence, the British Orthopedic Association, and the National Joint Registry.The aim of this study is to develop a clinically appropriate outcome prediction tool based on measurable predictors affecting outcome.Methods/designWe propose a prospective cohort study, designed to develop and validate an outcome prediction tool based on patient factors.Six hundred patients who are scheduled for total knee replacement secondary to primary osteoarthritis will be recruited before surgery from all six hospitals (NHS and private) that provide total knee replacements to the population of Coventry and Warwickshire (UK). Patients will complete a baseline assessment of patient factors before their operation and will be followed up at 6 and 12 months post surgery.DiscussionA clinically appropriate outcome prediction tool will allow patients to make a more informed decision regarding surgery. Aligning patient expectations with a realistic prediction of outcome should improve satisfaction. Ultimately, this project is likely to inform national policy making and regional service provision.

Complementary and alternative medicine (CAM) providers’ views of chronic low back pain patients’ expectations of CAM therapies: a qualitative study

BackgroundSome researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. However, there is a paucity of research on CAM providers’ views of their patients’ expectations regarding CAM therapy and the role of these expectations in patient outcomes.MethodsTo better understand how CAM providers view and respond to their patients’ expectations of a particular therapy, we conducted 32 semi-structured, qualitative interviews with acupuncturists, chiropractors, massage therapists and yoga instructors identified through convenience sampling. Interviews were recorded, transcribed and analyzed thematically using Atlas ti version 6.1.ResultsCAM providers reported that they attempt to ensure that their patients’ expectations are realistic. Providers indicated they manage their patients’ expectations in a number of domains— roles and responsibilities of providers and patients, treatment outcomes, timeframe for improvement, and treatment experience. Providers reported that patients’ expectations change over time and that they need to continually manage these expectations to enhance patient engagement and satisfaction with treatment.ConclusionsProviders of four types of CAM therapies viewed patients’ expectations as an important component of their experiences with CAM therapy and indicated that they try to align patient expectations with reality. These findings suggest that CAM providers are similar in this respect to conventional medical providers.

Rectal Cancer Patients’ Quality of Life With a Temporary Stoma

Patients with rectal cancer who have a temporary ostomy report good quality of life despite identifying a number of stoma-related difficulties. This study aimed to qualitatively explore the experiences of patients with rectal cancer who have a temporary ileostomy to better understand the discordant findings of previous quantitative quality-of-life studies. We conducted in-depth qualitative interviews with patients with stage I to III rectal cancer who underwent sphincter-preserving surgery that resulted in a temporary ileostomy. Twenty-six patients (54% male, median age 54) participated. Sixty-five percent had stage III disease, and 88% received neoadjuvant therapy. Interviews examined preoperative expectations, overall experience, and stoma impact on quality of life. With the use of grounded theory, 2 investigators independently performed line-by-line content analysis to identify key themes. Analysis continued until data saturation. Two major themes were identified: stoma-related difficulties and perceived response shift. Patients reported difficulty in exercise, sleep, social activities, sexuality, and clothing. Patients' perception of quality of life with a temporary stoma appears to have undergone a response shift through recalibration of their standards for measuring quality of life (internal measurement scale altered by side effects of neoadjuvant/adjuvant treatment, temporary nature of stoma, and accommodation to stoma) and reconceptualization of what "good quality of life" is (stoma difficulties were felt to be less important in comparison with cancer-related mortality). Although qualitative research is, by design, not generalizable, these data support our previous quantitative work. This convergence of findings suggests that our data may be representative. A temporary ileostomy represents significant difficulties for patients with rectal cancer. However, because of response shift, these difficulties may not be perceived as important to overall quality of life when considered within the context of the cancer experience. Our results can inform preoperative consultations with patients who have rectal cancer to assist in aligning patient expectations of what life with a temporary ileostomy may be like.