Consultation Satisfaction Research Articles

Patient feedback in revalidation: an exploratory study using the consultation satisfaction questionnaire

Revalidation is the UK process for the review of doctors to ensure they are fit to practise. Revalidation will include patient feedback. To investigate the role of patient feedback on GPs' consultations in revalidation. Cross-sectional survey of patients consulting 171 GPs. A total of 6433 patients aged 16 years or over completed the consultation satisfaction questionnaire (CSQ). Generalisability analysis was undertaken, scale scores calculated, and outliers identified using two and three standard deviations from the mean as control limits. Comments made by patients were categorised into positive, neutral, or negative. After averaging each scale for each doctor, mean scores (standard deviation), out of a possible score of 100, were: general satisfaction 78.1 (7.2); professional care 82.1 (6.1); relationship 71.2 (7.1); perceived time 65.7 (7.6). A D-study (which enables estimation of the reliability from 0-1 of the CSQ scores for different numbers of responders for each doctor), indicated that ratings by 19 patients would achieve a generalisability coefficient of 0.80 for the combined score. Fifteen GPs had one or more scale scores below two standard deviations of the mean. Comments were more often negative for GPs with scores below two standard deviations of the mean. Most patients of most GPs are satisfied with their experience of consultations, and ways to make patient feedback formative for these doctors is required. For a few GPs, most patients report some dissatisfaction. Patient feedback may identify doctors who need educational support and possibly remediation, but agreed questionnaire score thresholds are required, and agreement is needed on the weight to be attached to patient experience in comparison with other aspects of performance.

Supporting Treatment Decision Making in Advanced Cancer: A Randomized Trial of a Decision Aid for Patients With Advanced Colorectal Cancer Considering Chemotherapy

Decision making in advanced cancer is increasingly complex. We developed a decision aid (DA) for patients with advanced colorectal cancer who are considering first-line chemotherapy and reviewing treatment options, prognostic information, and toxicities. We examined its impact on patient understanding, treatment decisions, decisional conflict, decision making, consultation satisfaction, anxiety, and quality of life by using a randomized trial design. In all, 207 patients with colorectal cancer who were considering first-line chemotherapy for metastatic disease were randomly assigned to receive a standard medical oncology consultation or a consultation in which the DA (take-home booklet with audio recording, reviewed by an oncologist) was used. Participants completed questionnaires postconsultation, postdecision, and 1 month later. In this study, 100 patients were randomly assigned to the control arm, and 107 received the DA. Median age of the sample was 62 years, 58% were male, 89% had a performance status of 0 or 1, and 36% had received prior adjuvant chemotherapy. Patients receiving the DA demonstrated a greater increase in understanding of prognosis, options, and benefits, with higher overall understanding (P < .001). Decisional conflict, treatment decisions, and achievement of involvement preferences were similar between the groups. Anxiety was similar across groups and decreased over time. Most patients were confident in a decision during the first consultation; 74% chose chemotherapy, 7% supportive care alone, and 10% observation. This randomized trial of a decision aid in advanced cancer showed that its use in advanced colorectal cancer improved patient understanding of prognosis, treatment options, risks, and benefits without increasing anxiety. DAs can improve informed consent and can be tested through randomized trials even in the advanced cancer setting.

Patients’ level of satisfaction and self-reports of intention to comply following consultation with nurses and midwives with prescriptive authority: A cross-sectional survey

Background Prescriptive authority for nurses and midwives was introduced in Ireland in 2007. This allows nurses and midwives who have completed a prescribing preparation programme to independently prescribe a wide-range of medications. To date little is known of patient outcomes such as satisfaction with the consultation process and intention to comply as a consequence of the introduction of nurse and midwife prescribing. Objectives There are four principal objectives within this study: (1) to measure the level of patients’ satisfaction with education and advice received from a nurse or midwife with a prescribing remit; (2) to measure patients’ satisfaction with the consultation process; (3) to measure patients’ self-reports of their intention to comply with the prescriber's prescription and advice; and (4) to identify the variables that predict patients’ intention to comply with the prescription and advice provided by a nurse or midwife with prescriptive authority. Design Cross-sectional descriptive survey. Participants and setting A total of one hundred and forty respondents completed the survey. Respondents consisted of adult patients who had received a prescription from a nurse prescriber in a general hospital, women who had received a prescription from a midwife in a maternity hospital and parents whose child received a prescription from a nurse in a children's hospital. Methods Instruments used to measure patient outcomes included the Consultation Satisfaction Questionnaire (CSQ) and the compliance intent subscale of the Medical Interview Satisfaction Scale (MISS). A linear multiple regression model was performed to identify the variables that predicted patients’ intent to comply. Results Patients and parents surveyed were highly satisfied with the care they received from nurses and midwives with prescriptive authority. Respondents also reported that they received comprehensive education and advice. Predictors of compliance intent included patient satisfaction with the time spent with the nurse or midwife during the prescribing consultation, overall satisfaction with the consultation process and patients’ health status. Conclusions Extending a prescribing remit to nurses and midwives has been an effective addition to the provision of health care. Providing patients with time to address their questions and concerns during the consultation process impacts positively on patient outcomes and develops a philosophy of concordance between the patient and nurse/midwife prescriber.

Survey of Patient and Physician Satisfaction Regarding Patient-Centered Outpatient Consultations in Japan

The purpose of this study was to show the difference in consultation satisfaction between patient and physician in rural settings, and identify the variables affecting their satisfaction regarding these encounters. We collected data by administering questionnaires that included questions regarding satisfaction for a patient-centered approach to patients and physicians, transcribing data from medical records, and observing consultations in person. We then modeled cumulative logits of patient and physician satisfaction scores by performing ordered logistic regression using the proportional odds model. Seven physicians and 122 patients participated in the study. Both patients and physicians expressed high satisfaction with their consultation sessions. Patient satisfaction tended to be higher than physician satisfaction. Physicians were satisfied with longer consultations but patients were not. Moreover, the long waiting times dissatisfied patients. In cases of multiple healthcare episodes (courses of treatment for a different condition) during a single visit, patient satisfaction decreased, while physician satisfaction increased. Physician satisfaction for interactions in general was less when they checked the same patient who had previously visited them. Our findings suggest that if physicians feel satisfied with their consultation, patients also feel satisfied regardless of the physician's opinion. The variables that affect patient and physician satisfaction include prior visits with the same physician, consultation length, longer waiting times, and number of episodes. These findings from Japanese clinics are consistent with those previously reported for other countries.

Gender differences in self‐reported late effects, quality of life and satisfaction with clinic in survivors of lymphoma

Gender differences in perceived vulnerability to late effects and views about follow-up among cancer survivors have received little attention. As lymphoma affects both genders similarly, we compared the consequences of cancer (late effects, perceived vulnerability and quality of life (health-related quality of life (HRQoL)), and satisfaction with clinic visits between genders. A cohort of 115 younger adults (18-45 years, >5 years disease-free survival), who had been treated for lymphoma participated. Questionnaires (n = 91) were completed before and after (n = 62) routine consultant-led appointments. Survivors (n = 24) without appointments were recruited by post. Questionnaires included HRQoL, late effects, perceived vulnerability, issues survivors wanted to discuss and reported discussing in clinic, time waiting in clinic and consultation satisfaction. There were no gender differences in number of self-reported late effects or perceived vulnerability. Men with more late effects reported worse psychological HRQoL (r = 0.50, p<0.001). While men wanted to discuss more topics than they did, women were able to discuss the topics they wanted (ANOVA, p = 0.01). Multiple regression analyses showed a shorter wait in clinic (r = -0.46, p = 0.009) and discussing more topics (r = 0.34, p = 0.06) explained 30.6% of the variance in consultation satisfaction for men. Issues surrounding follow-up provision are increasingly important given the length of survival in young adults following treatment for lymphoma. Men may experience poor psychological well-being due to distress about unanswered concerns. Consideration of their concerns should be prioritised, given that satisfaction and ultimately continued attendance at clinic and HRQoL may be dependent on the extent to which follow-up meets survivors' expectations.

Comment

Derek Wells is a housing association tenant and board member (though quite rightly he refuses to be defined purely by these terms alone) and therefore has much experience of being at the receiving end of consultation exercises and satisfaction surveys. In this frank piece, Derek comments on the validity of the ‘tick‐box’ approach to consultation and calls on service providers to see beyond the ‘tenant’ label and to start appreciating and utilising the life experiences of their older customers.

Emergency nurse practitioners and doctors consulting with patients in an emergency department: a comparison of communication skills and satisfaction

Background:Emergency nurse practitioners (ENPs) play an increasingly important role in UK emergency departments (EDs), but there is limited evidence about how this affects patient care and outcome. A study was...

Is satisfaction with doctors’ care related to health‐related quality of life, anxiety and depression among patients with carcinoid tumours? A longitudinal report

The aim of this study was to investigate (i) whether specific aspects of the initial consultation (IC) and/or patients' satisfaction with doctors' care are related to health-related quality of life (HRQoL), anxiety and depression among patients with carcinoid tumours and (ii) whether patients' satisfaction with doctors' care changes over time. The study has a longitudinal design. The HRQoL and psychosocial function among patients who met the doctors showing good ability to identify patients' worry and wish for information were compared with those patients who met doctors showing less good ability. Patients' HRQoL, anxiety, depression and satisfaction with doctors' care were assessed longitudinally, shortly after each of the first four admissions to specialist care. Patients who met doctors showing good ability to identify their wish for information at the IC reported higher levels of cognitive function. Higher satisfaction with doctors' care was related to higher emotional and cognitive function, to higher global QoL, and to lower levels of problems with diarrhoea, financial difficulties, constipation, anxiety and depression shortly after each of the first three admissions, although not after the fourth admission to the specialist care. Although most patients with carcinoid tumours report high satisfaction with care, it is important to be aware of the fact that some patients may be less satisfied. Doctors should provide patients with information which matches the individual patients' needs and preferences as patients' satisfaction with doctors' provision of information is related to patients' HRQoL, anxiety and depression.

Social adjustment among Chinese women following breast cancer surgery

How breast cancer surgery affects social adjustment among Chinese women is unknown, as are factors predicting such adjustment. 405 Chinese women receiving surgery for localized breast cancer completed Social Adjustment Scales (Ch-SAS) at 1-, 4- and 8-months post-operatively. Subscale scores were regressed on baseline (days 3-12 post-operatively) measures of treatment decision-making difficulty (TDMD), self-efficacy (GSeS), consultation satisfaction (C-MISS-R), psychological (CHQ-12) and physical distress (PD), and 1-month follow-up optimism (C-LOT-R), and disappointment (E-OI), fully adjusted for demographic and clinical factors. All Ch-SAS subscales except appearance & sexuality changed significantly over 8-months follow-up: Enjoyment of social activities (F=27.38, df 2, p<0.001) and self-image (F=3.63, df 2, p=0.027) improved slightly. Family interaction (F=26.63, df 2, p<0.001) and interaction with friends (F=3.37, df 2, p=0.035) declined slightly. Family and friends interaction subscales were predominantly predicted by high self-efficacy and optimism, whereas self-image and appearance & sexuality subscales were predominantly predicted by low treatment outcome disappointment, TDM difficulties, baseline psychological morbidity and high self-efficacy. Enjoyment of social activities was predicted by low baseline psychological distress and concurrent physical symptom distress. High self-efficacy and optimism predicted women who have better social relationships with friends and family. Higher self-efficacy, low TDM difficulties, less disappointment with treatment outcome and low psychological and physical distress predicted better adjustment to self-image and body image.

Acupuncture practitioner&amp;ndash;patient communication in Japan

We evaluated acupuncture practitioner-patient communication using pairs of practitioners and patients. Our primary objective was to evaluate the concordance of practitioner and patient perceptions in terms of explanations regarding consultation, therapy, and patient satisfaction. The subjects were 250 practitioners and their 1250 patients in Fukuoka, Japan. Answers were obtained from 91 acupuncture practitioners (36.40%) and 407 patients (32.56%). Of these, responses from 125 pairs without missing values were used for the analysis. When practitioner-patient communication, as evaluated by the difference between the patients' and the practitioners' perceptions with respect to the level of practitioner explanation, was good, patient outcome (ie, satisfaction with therapy, improvement in health) was also good. Factors related to poor practitioner-patient communication included age of the practitioner, the number of practitioners at a clinic, the experience of the practitioner, and the age of the patient. These findings may be useful in improving practitioner-patient communication.

Exploring patients’ perspectives of pharmacist supplementary prescribing in Scotland

The aim of this study was to explore patients' perspectives and experiences of pharmacist supplementary prescribing (SP) in Scotland. A survey in primary and secondary care in Scotland. Pharmacist supplementary prescribers (n = 10) were purposively selected across Scotland. All pharmacists distributed questionnaires to 20 consecutive patients as they attended appointments during October to December 2006. Reminders were mailed to all 20 patients by each pharmacist 2 weeks after initial distribution. The questionnaire contained items on: attitudes towards pharmacist SP derived from earlier qualitative research; consultation satisfaction derived from a validated scale developed initially for general practitioners, with the term 'doctor' being replaced by 'pharmacist prescriber'; and demographics. Closed and Likert scales were used as response options. One pharmacist withdrew. The patient response rate was 57.2% (103/180). The median age was 67 years (interquartile range 56.5-73 years), with 53.4% being female. Most (76, 73.8%) consulted with the pharmacist in a general practice setting. Patients reported positive consultation experiences with 89.3% agreeing/strongly agreeing that they were satisfied with the consultation, 78.7% thought the pharmacist told them everything about their treatment and 72.9% felt the pharmacist was interested in them as a person. Most patients were positive in their attitudes, agreeing that they would recommend a pharmacist prescriber to others and that they had trust in the pharmacist. However, 65% would prefer to consult a doctor. Most patient respondents were satisfied with, and had a positive attitude towards, pharmacist prescribing consultations. However, most patients would still elect to see a doctor given the choice.

The Relation between Good Communication Skills on the Part of the Physician and Patient Satisfaction in a Military Setting

The objective of this study was to assess the correlation between patients' view of the consultation and the assessment of an auditing physician on the same consultation. A prospective study in military clinics was conducted. A board-certified family physician made a real-time semistructured assessment of the medical consultation. At the end of it, the patient was asked to fill in the Consultation Satisfaction Questionnaire. The degree of correlation between patients' satisfaction from consultation and the scores given by the auditing physician was evaluated. Twelve primary care physicians were evaluated. A total of 117 (76.5%) of 153 patients returned their questionnaires. A positive correlation was found between physician's communication skills and general satisfaction (r = 0.614), professional care (r = 0.367), and depth of relationship (r = 0.275) calculated from the Consultation Satisfaction Questionnaire. No correlation was found between patient satisfaction and other consultation skills. Good communication skills may enhance patient satisfaction. It may be advisable to investigate whether a training program to enhance the physician's communication skills can improve patient satisfaction.

Predictors and Non-Predictors of Symptom Relief in Dyspepsia Consultations in Primary Care

Objective: We aimed to evaluate if the course of dyspepsia is influenced by medical consultation in primary care. Design, Setting and Patients: Australian general practitioners (n = 27) recruited 157 dyspeptic patients, of whom 94 were eligible for follow-up. Dyspepsia, comorbidity, quality of life, emotional status, locus of control and consultation satisfaction were measured at baseline and follow-up (mean 3 months). Main Outcome Measure: Response was defined as improvement of dyspepsia over time on the Nepean Dyspepsia Index score. Results: Dyspepsia improved in 82% (n = 77). There was no significant change in non-gastrointestinal symptoms. Half were worried or stressed by their symptoms, and 85% wanted reassurance, a need that (univariately) differentiated responders from non-responders (p = 0.02). Most patients seen in primary care with dyspepsia improved. If the doctor believed it was likely that the patient would follow their recommendations, the patient was nearly five times as likely to be a responder (OR 4.9, 95% CI 1.2–19.0). The only other significant predictor was acid suppression therapy (OR 3.5, 95% CI 1.1–10.9). Conclusion: Most primary care visits for dyspepsia are followed by improvement, which may be predicted in part by indicators of patient compliance. Prescription of acid suppression therapy may also improve outcome in dyspepsia.

Pilot Trial of Telemedicine as a Decision Aid for Patients with Chronic Wounds

The study goal was to evaluate the impact of the telemedicine consult on patients with chronic wounds. Thirty patients from long-term care skilled nursing facilities, referred to the ambulatory wound care program for wound assessment and preparation of management plans, were the subject of this prospective, randomized trial. To facilitate communication with a surgical wound care specialist, telemedicine feedback was provided prior to face-to-face consultation to 15 patients. The telemedicine consult included (1) wound assessment, (2) rationale for the suggested wound management with emphasis on wound risk projections, and (3) prevention and benefits of surgical intervention. This was communicated to the patient by the field wound care nurse. The telemedicine impact was measured by assessing the duration of the subsequent face-to-face consultation and patient satisfaction with further care decisions as well as by validation of a decisional conflict scale. The average duration of the face-to-face consultation was 50 +/- 12 minutes versus 35 +/- 6 (p < 0.01) minutes for patients subjected to the telemedicine feedback preceding the direct contact with the specialist. The telemedicine consult was found to be a useful aid in increasing the satisfaction rate from care decisions ultimately made during the direct consult (acceptance rate 93% vs. 47% in those subjected to treatment without the intermediate telemedicine consult, p < 0.01). The decisional conflict as a state of uncertainty about the course of action to take was reduced in patients subjected to telemedicine decision aid. The average Decisional Conflict Scale score was 14 +/- 1.73 in patients subjected to telemedicine feedback as opposed to 35 +/- 4.26 (p < 0.001) in no-telemedicine contact. The telemedicine consult preceding face-to-face evaluation improved patient satisfaction and understanding of their care as well as increased the perception of shared decision making regarding the wound care.

Consultation frequency and perceived consultation time in a Japanese psychiatric clinic: Their relationship with patient consultation satisfaction and depression and anxiety

To examine the relationship of the consultation frequency and the perceived consultation time of psychiatric clinic attenders with their satisfaction towards the consultation and depression and anxiety (measured by the Hospital Anxiety and Depression Scale). Questionnaires were distributed to 186 outpatients attending a psychiatric clinic. In a path analytic model, a longer session with shorter interval ('dense' session) predicted lowered depression and anxiety level of the patientsthrough the perceived satisfaction of the patients, and it was also predicted by the higher anxiety level. The dense session was also influenced by shorter duration of clinic attendance. Dense psychiatric sessions in busy Japanese outpatient clinics may benefit patients.

Wie gut schätzen Hausarzt-Patienten den Zeitbedarf einer Konsultation ein?

This study explored the association between the anticipated and the actual amount of time spent in consultation in a general medical practice and the possible consequences for patient satisfaction. A total of 95 patients (mean age: 42.4; 55.8 % females) from one general practice were asked before their consultation how much time they anticipated spending with the (53-year-old) doctor. Answers were categorized as "overestimate", "accurate" or "underestimate". At the end of the consultation, patient satisfaction was documented by the patient filling in a standardized questionnaire. Associations between the actual duration of the consultation and the accuracy of the patients' estimate of the time of consultation, patient satisfaction and recorded possible explanatory variables (e.g., sex, age, psychosomatic problems) were analysed by multiple logistic regression. Half of the patients (48/95) estimated that the consultation would last longer than it actually did. In contrast, significantly more patients with psychosomatic problems underestimated consultation length (38% vs. 10%; adjusted odds ratio = 6.9; 95% confidence interval = 1.9 to 24.3). The actual length of the consultation and patient satisfaction moderately correlated (Spearmans's rho correlation = 0.24 [p = 0.02]). If the length of consultation was shorter than expected, patients were somewhat more dissatisfied. Only about one-third of patients could accurately gauge ahead of time how long the consultation was going to take. Patients with psychosomatic or severe psychosocial problems took up the largest proportion of the doctor's time, but they significantly underestimated the time the doctor would actually spend with them. Both the predicted estimates of the duration and the actual time spent in consultation seem to influence to some extent patient satisfaction regarding the time spent with the doctor.

An internet method to assess cancer patient information needs and enhance doctor-patient communication: A pilot study

We previously reported that doctor-patient communication in the cancer context may be suboptimal. We therefore developed measures to assess patient communication preferences and established feasibility of an Internet-based intervention to improve communication. Cancer patients completed an Internet-based survey about communication preferences, with a summary provided to the physician before the consultation. Patients completed a follow-up survey to assess consultation content and satisfaction. Study procedures were feasible, measures exhibited strong internal consistency, and patients expressed satisfaction with the intervention. The Internet offers an opportunity to assess patient preferences and prompt physicians about individual patient informational needs prior to the clinical encounter.

Capturing users’ experience of UK out-of-hours primary medical care: piloting and psychometric properties of the Out-of-hours Patient Questionnaire

Background and objective:Provision of out-of-hours care in the UK National Health Service (NHS) has changed in recent years with new models of provision and the introduction of national quality requirements....

When the goal is not cure: A randomized trial of a patient decision aid in advanced colorectal cancer

6509 Background: With improvements in treatment and supportive care, decisions in advanced cancer are increasingly complex. To facilitate decision-making, we developed a decision aid (DA) for patients considering first-line chemotherapy for incurable colorectal cancer, reviewing treatment options, prognostic information and toxicities. We examined its impact on patient understanding, consultation and decision- making satisfaction, anxiety, decisional conflict, quality of life, information preferences, and treatment decisions made. Methods: 207 newly diagnosed advanced colorectal cancer patients at 5 cancer centers in Australia and Canada were randomized to receive either a standard medical oncology consultation, or the same plus the DA, (take-home booklet with audio-recording, selected review by oncologist). Results: 100 were randomized to the control arm, 107 to receive the DA. Sample characteristics: median age 62 years, 58% male, 89% PS 0/1, 36% prior adjuvant chemotherapy. Patients in the DA arm demonstrated a greater increase in understanding of prognosis, options, benefits and toxicities (+19% vs +5.6%, p 0.001), with higher overall understanding (72% vs 60%, p&lt;0.0001). Decision and consultation satisfaction, decisional conflict and quality of life were similar between groups. Anxiety, measured serially over 4–6 weeks, was similar and decreased over time. Most arrived at a decision during the first consultation; 80% chose chemotherapy, 7.5% supportive care alone, 10.5% a wait and watch strategy, with no differences between arms. 87% wanted as much information as possible, 82% wished to share decision-making with the physician, and only 15% felt the doctor alone should make the decision. More patients who received the decision aid felt they received all possible details about therapy, (72% vs 63%). 90% felt the decision was shared in part between physician and patient. Conclusion: This first randomized trial of a decision aid in advanced cancer patients shows that its use in advanced colorectal cancer improved patient understanding of prognosis, treatment options, risks and benefits without increasing anxiety. Decision aids can improve informed consent and decision-making, and can be tested through randomized trials even in the setting of advanced cancer. No significant financial relationships to disclose.

Patient satisfaction with nurse-led telephone consultation for the follow-up of patients with prostate cancer

Prostate cancer is being diagnosed earlier and in higher numbers than ever before. The nature of the disease means many patients have to be monitored regularly and for a prolonged period leading to increased pressure on urology outpatient resources and inconvenience for the patient. Here we investigate patient satisfaction with a nurse-led telephone-based follow-up clinic and compare it to satisfaction with traditional outpatient consultations. A Consultation Satisfaction Questionnaire (CSQ) evaluating four domains, namely General Satisfaction (GS), Professional Care (PC), Depth of Relationship (DR) and Perceived Time (PT) was used to assess satisfaction in three groups. Group 1 consisted of 299 patients attending the outpatient department before commencing telephone consultations; Group 2 consisted of 163 men attending outpatients after commencement of the telephone consultations; and Group 3 was the telephone group (234 men). We demonstrated no significant difference in GS or PC between Group 1 and Group 3 or Group 2 and Group 3, although DR and PT was significantly lower in the telephone group compared with Group 1. We also found that waiting times were significantly shorter in the telephone group. In conclusion, telephone follow-up appears to be an acceptable alternative to outpatient follow-up in terms of GS and PC and appears to be more convenient for the patient, although these benefits come at the expense of loss of DR and PT with the clinician.