Understanding Patient Expectations Research Articles

A Service Evaluation of What Satisfies Our Patients in Magnetic Resonance Imaging

IntroductionPatient experience is an essential component of high-quality care often measured through the satisfaction of patients. This service evaluation draws on a model from customer service to help better understand patient expectations and what matters to them most when attending for an MRI. MethodsAn online survey based on Kano's model of customer satisfaction was administered online. Participants assessed 28 attributes as part of undergoing an MRI scan, rating how important these were to their satisfaction and thereby their experience. ResultsSix hundred and fifteen patients responded, with the majority aged 55–74 years and having had an MRI before. Classification of the attributes shows how those deemed ‘functional’ in nature have more potential to dissatisfy if not present, whereas those considered ‘relational’ are thought to have more of an influence over enhancing satisfaction. ConclusionThe importance of relational aspects focused on communication and ensuring that patients are fully informed were highlighted as drivers for improving satisfaction within MRI.

Health service needs in patients receiving hemodialysis therapy: qualitative study

Quality health services are health services that are provided based on patient needs, not based on what is owned by the service-providing institution. Patients with chronic diseases such as kidney failure undergoing hemodialysis need more supportive nursing care, such as physical and psychological support and information about their condition. This study aims to explore and identify health service needs in patients receiving hemodialysis therapy. This research is qualitative research on phenomenology. Data was collected using semi-structured and in-depth interviews with 17 participants of end-stage renal failure who underwent hemodialysis therapy, selected by purposive sampling. Thematic analysis is used for data analysis. The study found three main themes: services to meet basic needs when hemodialysis therapy was carried out, support received while undergoing hemodialysis therapy, and Various health services that have yet to be received while undergoing hemodialysis therapy. It can be concluded that identifying service needs positively impacts service quality as healthcare workers will better understand patient expectations. Hemodialysis patients have basic physical, psychological, and support needs. Unmet needs include inadequate drug therapy, health workers, and unmet information needs. Healthcare providers should develop strategies to manage these needs, including physical and psychological modification, improvement of facilities, infrastructure, human resources, and interdisciplinary approaches.

Would you do it again? Discrepancies between patient and surgeon perceptions following adult spine deformity surgery

BACKGROUNDAdult spinal deformity (ASD) surgery can improve patient pain and physical function but is associated with high complication rates and long postoperative recovery. Accordingly, if given a choice, patients may indicate they would not undergo ASD surgery again. PURPOSEEvaluate surgically treated ASD patients to assess if given the option (1) would surgically treated ASD patients choose to undergo the same ASD surgery again, (2) would the treating surgeon perform the same ASD surgery again and if not why, (3) evaluate for consensus and/or discrepancies between patient and surgeon opinions for willingness to perform/receive the same surgery, and (4) evaluate for associations with willingness to undergo or not undergo the same surgery again and patient demographics, patient reported outcomes, and postoperative complications. STUDY DESIGNRetrospective review of a prospective ASD study. PATIENT SAMPLESurgically treated ASD patients enrolled into a multicenter prospective study. OUTCOME MEASURESScoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36) physical component summary (PCS) and mental component summary (MCS), Oswestry Disability Index (ODI), numeric pain rating for back pain (NRS back) and leg pain (NRS leg), minimal clinically important difference (MCID) for SRS-22r domains and ODI, intraoperative and postoperative complications, surgeon and patient satisfaction with surgery. METHODSSurgically treated ASD patients prospectively enrolled into a multicenter study were asked at minimum 2-year postoperative, if, based upon their hospital and surgical experiences and surgical recovery experiences, would the patient undergo the same surgery again. Treating surgeons were then matched to their corresponding patients, blinded to the patients’ preoperative and postoperative patient reported outcome measures, and interviewed and asked if (1) the surgeon believed that the corresponding patient would undergo the surgery again, (2) if the surgeon believed the corresponding patient was improved by the surgery and (3) if the surgeon would perform the same surgery on the corresponding patient again, and if not why. ASD patients were divided into those indicating they would (YES), would not (NO) or were unsure (UNSURE) if they would have same surgery again. Agreement between patient and surgeon willingness to receive/perform the same surgery was assessed and correlations between patient willingness for same surgery, postoperative complications, spine deformity correction, patient reported outcomes (PROs). RESULTSA total of 580 of 961 ASD patients eligible for study were evaluated. YES (n=472) had similar surgical procedures performed, similar duration of hospital and ICU stay, similar spine deformity correction and similar postoperative spinal alignment as NO (n=29; p>.05). UNSURE (n=79) had greater preoperative depression and opioid use rates, UNSURE and NO had more postoperative complications requiring surgery, and UNSURE and NO had fewer percentages of patients reaching postoperative MCID for SRS-22r domains and MCID for ODI than YES (p<.05). Comparison of patient willingness to receive the same surgery versus surgeon perceptions on patient's willingness to receive the same surgery demonstrated surgeons accurately identified YES (91.1%) but poorly identified NO (13.8%; p<.05). CONCLUSIONSIf given a choice, 18.6% of surgically treated ASD patients indicated they were unsure or would not undergo the surgery again. ASD patients indicating they were unsure or would not undergo ASD surgery again had greater preoperative depression, greater preoperative opioid use, worse postoperative PROs, fewer patients reaching MCID, more complications requiring surgery, and greater postoperative opioid use. Additionally, patients that indicated they would not have the same surgery again were poorly identified by their treating surgeons compared to patients indicating they would be willing to receive the same surgery again. More research is needed to understand patient expectations and improve patient experiences following ASD surgery.

Development and Validation of a Survey to Measure Patients' Expectations of Wrist Arthritis Surgery.

Background The purpose of this study was to develop and test a patient-derived expectations survey for wrist arthritis surgery. We hypothesized that preoperative patient expectations are higher in people with greater functional impairment and that postoperative fulfilment of patient expectations correlates with functional improvement. Methods The study was conducted in four phases. Development (n = 22) Preoperatively, patients were asked open-ended questions regarding expectations of surgery. A draft survey was then assembled. Reliability (n = 35) The survey was administered twice preoperatively. Concordance was measured with weighted kappa values and intraclass correlations (ICC). Validity (n = 58) Validity was assessed by comparing responses from the Expectations Survey to the patient-rated wrist evaluation (PRWE). Responsiveness (n = 18) Responsiveness was calculated by comparing the proportion of expectations fulfilled to PRWE scores 1-year postoperatively. Results Development Twenty-two distinct items representing the most frequent responses were utilized from the draft survey items of 1,244 expectations volunteered. Reliability Patients had high preoperative expectations of surgery (mean = 76.8); 30% had scores ≥90. Test-retest reliability was high (Cronbach α coefficients = 0.91, 0.93, ICC = 0.86). Endorsement of items = 66 to 100%; and weighted kappa values = 0.39 to 0.96. Validity Patients with greater preoperative expectations (≥63) had more pain, worse function, and worse PRWE scores than those with lower expectations. Responsiveness The proportion of fulfilled expectations was high (mean 0.80, median 0.79), and greater fulfillment (proportion > 0.80, n = 8) was associated with better postoperative PRWE scores. Conclusion The patient-derived expectations survey is reliable, valid, responsive, and addresses a spectrum of expectations for patients undergoing surgery for wrist arthritis. Clinical relevance Understanding patient expectations can contribute to customized care given the range of surgical choices for the arthritic wrist.

Violation of expectations is correlated with satisfaction following hip arthroscopy.

The mechanism by which preoperative expectations may be associated with patient satisfaction and procedural outcomes following hip preservation surgery (HPS) is far from simple or linear. The purpose of this study is to better understand patient expectations regarding HPS and their relationship with patient-reported outcomes (PROs) and satisfaction using machine learning (ML) algorithms. Patients scheduled for hip arthroscopy completed the Hip Preservation Surgery Expectations Survey (HPSES) and the pre- and a minimum 2year postoperative International Hip Outcome Tool (iHOT-33). Patient demographics, including age, gender, occupation, and body mass index (BMI), were also collected. At the latest follow-up, patients were evaluated for subjective satisfaction and postoperative complications. ML algorithms and standard statistics were used. A total of 69 patients were included in this study (mean age 33.7 ± 13.1years, 62.3% males). The mean follow-up period was 27months. The mean HPSES score, patient satisfaction, preoperative, and postoperative iHOT-33 were 83.8 ± 16.5, 75.9 ± 26.9, 31.6 ± 15.8, and 73 ± 25.9, respectively. Fifty-nine patients (86%) reported that they would undergo the surgery again, with no significant difference with regards to expectations. A significant difference was found with regards to expectation violation (p < 0.001). Expectation violation scores were also found to be significantly correlated with satisfaction. ML algorithms utilized in this study demonstrate that violation of expectations plays an important predictive role in postoperative outcomes and patient satisfaction and is associated with patients' willingness to undergo surgery again. IV.

Association between perceived and objective hand-wrist function in distal radius fracture

The relationship between patient-reported outcome measures and objective measures is important for understanding patient expectations. The aim of this study was to investigate the relationship of each section of the Michigan Hand Outcomes Questionnaire (MHQ) to objective measurements in patients with distal radius fracture (DRF). Eighty-four patients who were treated operatively or non-operatively for DRF were included. Injury severity was assessed by the Modified Hand Injury Severity Score. Joint motion was assessed at 6 and 12 weeks and grip strength at 12 weeks after non-operative treatment or surgery. The MHQ was used to assess hand functionality. The relationships between measurements were analyzed by Spearman correlation analysis. Statistical significance was set at p < 0.05. Fifty-one patients (60.7%) were women and 33 (39.3%) men. Mean age was 48.17 ± 12.26 (range, 20–64) years. Fifty-two (61.9%) patients were treated surgically and 32 (38.1%) non-operatively. Forearm pronation-supination and wrist flexion and ulnar deviation at week 6 and forearm pronation-supination, wrist extension and radial deviation at week 12 correlated with MHQ scores, unlike wrist extension and radial deviation at week 6 and flexion and ulnar deviation at week 12. Gross and fine grip strength at week 12 correlated with MHQ, except for the overall hand function, work performance and pain subsections. The MHQ subsections correlated with joint motion and grip strength in the early period after DRF. These findings clarified patient expectations in the early period.

Which Factors Are Important to Women When Choosing a Breast Reconstruction Surgeon?

Women undergoing breast reconstruction often research their health care provider options. The authors studied which factors may influence how a woman selects a plastic surgeon for breast reconstruction surgery. An online survey was distributed by means of Amazon Mechanical Turk (MTurk; Amazon Web Services, Inc., Seattle, Wash.) to 1025 adult women. Participants were asked to imagine a scenario in which they had breast cancer, needed to undergo mastectomy, and were choosing a reconstructive surgeon. They were then asked to rank factors influencing this decision on a 1 to 7 Likert scale. Two-sample t tests were used to compare Likert scores between dichotomized categories based on participant characteristics. Women assigned the highest scores [mean (standard deviation)] to online reviews on Vitals or WebMD [6.1 (1.2)], years of experience [5.7 (1.4)], recommendations from another surgeon [5.7 (1.3)] or family/friend [4.9 (1.7)], and attending a top medical school [4.7 (1.7)]. Lowest ranked factors were online advertising and surgeon demographics, including having a sex concordant (female) surgeon. After amalgamation into attribute subsections, mean (standard deviation) rated relative importance of surgeon reputation [0.72 (0.13)] was higher than that of appearance [0.46 (0.19)] and demographics [0.31 (0.13)]. Patient demographics influenced relative importance of certain attributes; older, educated, and higher-income patients placed higher value on surgeon appearance (all p < 0.05). When selecting a breast reconstruction surgeon, women place the highest value on surgeons' online, educational, and personal reputations. Though most show no strong preferences for surgeon demographics or physical attributes, specific features may be important for some patients. Cognizance of these preferences may enable providers to more effectively understand patient expectations.

Understanding Patient Expectations and Determinants of Satisfaction in an Outpatient Urology Clinic at an Academic Medical Center

To examine and better understand expectations and facilitators of satisfaction amongst patients presenting to an ambulatory urology clinic at an academic medical center. Patients completed an anonymous survey regarding expectations for their clinic visit. Patients were included in the investigation if they were aged 18-89 years and had the ability to complete informed consent. Chi-square analysis was then used to analyze the collected data. A total of five hundred patients were enrolled in the study. Patients were predominantly white males and were older than 60 years of age. Most patients had at least a college education and drew an annual household income between $40,000-$99,999. Most enrollees were return patients (74.8%). Most expected to be seen within 3-7 days of referral and expected 16-30 minutes with their provider. Patients noted they would not be equally satisfied seeing a physician vs advanced practice provider on their initial visit but would on a return visit. About half (52%) of the cohort stated they would be dissatisfied with their clinic experience if their expectations were not met. Significance was found between variables including age, race, gender and type of visit and their survey responses. Patient satisfaction remains an important measure for the quality and safety of patient care. This investigation highlighted patient prioritization of time to be seen after referral and the provider that cares for them at both initial and follow-up visits. Future research is needed to enhance stakeholder understanding of precisely how expectations impact overall satisfaction.

Who uses probiotics and why? A survey study conducted among general gastroenterology patients

BackgroundThe rapid growth of the probiotic industry suggests patients will continue to seek advice from gastroenterologists about probiotics. To best address patient questions and concerns, we must first understand who...

Scar tissue I wish you saw: Patient expectations regarding scar treatment.

Although many invasive and noninvasive approaches exist, management of keloids and hypertrophic scars remains challenging. By better understanding patient expectations regarding scar treatments, dermatologists can provide higher quality and more satisfying care. Survey patients age 18 to 80years with a history of hypertrophic, keloid, or disfiguring scars. Overall, 187 participants completed the 25-question survey. Expectations and willingness were measured on a 1-5 Likert scale. Results were analyzed overall and by patient demographics. Older respondents more often expected scar reduction, while younger patients expected scar removal. Compared with Caucasians, Asian respondents were more symptomatic, more likely to have seen a physician, and more willing to undergo invasive therapies. Respondent willingness for treatment and their perceived efficacy significantly differed across gender, age, and race. This study explores a gap in the literature of what role patient expectations play in electing specific treatments. Although patient expectations are complex and context dependent, gaining more understanding of what therapies patients are willing to attempt, and their expectations from those therapies could help guide counseling with the goal setting realistic expectations to improve patient compliance and satisfaction.

Examining Preoperative Expectations and Postoperative Satisfaction in Rhinoplasty Patients: A Single-Center Study.

Background: In Rhinoplasty, understanding patient expectations are pivotal in achieving an optimal surgical outcome. Objective: To understand preoperative expectations and postoperative satisfaction in patients undergoing rhinoplasty for functional, aesthetic, or both. Method: Adult patients undergoing functional, aesthetic, or combined rhinoplasty from March 2017 to June 2019 were prospectively enrolled. Only patients with complete preoperative functional and cosmetic expectation visual analog scales (VAS) and at least one postoperative functional and cosmetic satisfaction VAS were included. Nasal Obstruction and Symptom Evaluation Scale score and Standardized Cosmesis and Health Nasal Outcomes Survey score were also collected. Results: In the functional subgroup (mean preoperative functional expectation VAS score [17.98 (22.49)] higher mean (standard deviation) postoperative functional satisfaction VAS score were observed at postoperative time interval <2 months [29.59 (27.08), p = 0.008] and 8-12 months [31.43 (28.25), p = 0.035]. In the aesthetic subgroup mean preoperative cosmetic expectation VAS score [89.69 (17.74)], lower mean postoperative aesthetic satisfaction VAS scores were observed at <2 months [79.09 (20.01), p = 0.0001], 2-5 months [79.79 (20.79), p = 0.032], 5-8 months [72 (18.27), p < 0.0001], 8-12 months [78.15 (24.50), p = 0.021], and >12 months [75 (20.64), p = 0.00020]. In the combined subgroup (mean preoperative aesthetic expectation VAS score [85.85 (18.19)]), lower mean postoperative aesthetic satisfaction VAS scores were observed at 2-5 months [78.94 (20.88), p = 0.01] and at >12 months [75.86 (25.57), p = 0.01]. Conclusion: Although rhinoplasty patients tend to be less satisfied with aesthetic than the functional outcome of surgery, preoperative aesthetic expectations are higher in cosmetic rhinoplasty and functional and cosmetic rhinoplasty patients.

A Qualitative Exploration of Maternal Patient and Family Perspectives of Patient Safety

Maternal deaths in the United States are 26.6% higher than other developed countries. Sixty percent of these deaths are preventable by adopting a culture that promotes patient safety. In a recently developed Safer Culture framework, patients and families are integral members of the organizational safety culture. It is imperative to understand how patients and families perceive safety issues and how they want to engage to promote safety. The purpose of this study was to determine how patients and their families conceptualize patient safety and their role in promoting safe care. Using an ethnographic qualitative approach, we conducted semistructured interviews with a purposive sample of 23 ethnically diverse obstetric patients and their partners from a large academic Level 4 facility. We reviewed transcribed interviews and coded for meaning in a group of four researchers. After redundancy was reached, we conducted a thematic content through group consensus of the relevant themes expressed from exemplars in the data set. Participants perceived patient safety as a partnership with clinicians. A perception of safe caring was based on having their collective physical, emotional, and relational needs and those of their family members met. Central to perceived safe care was trust in their health care providers. Four influences to perceived safe care emerged from the data: (1) patient and family expectations of their outcomes, (2) methods of personalized communication and information exchange, (3) actions of relationship building with the health care team, and (4) positive clinician behaviors in providing care. Patient and family perceptions of safe caring were affected by their previous experiences, especially pregnancy losses and/or perceived harms, ability to prepare for the unexpected, their sense of control in decision making, and speaking up with their concerns. Inherent in promoting a safety culture is promoting a partnership of trust between clinicians and patients based on knowing what patients expect and need, listening and responding to their concerns about past experiences, and collaborating with them and their families. Nurses add to the patient’s perception of safe care by understanding patient expectations, promoting patients’ voice in communication, building a positive relationship, and providing emotional care.

Factors influencing patient perceptions of nutritionists’ epistemic authority and tendency to comply with treatment recommendations

Maintaining a healthy nutrition lifestyle is a challenge associated with a high risk of quitting. However, it has been shown that healthcare providers who are perceived as having a high degree of epistemic authority (EA) can influence compliance. The aim of this study was to examine the individual level of compliance required to maintain the healthy lifestyle recommended by nutritionists with different levels of expertise. Specifically, the aim was to examine whether the degree of EA affects patients’ compliance and whether active or passive dietary recommendations can affect the patient’s perception of the nutritionist as someone who possesses credible knowledge in this particular area. The present study included 187 participants who completed scenario based questionnaires concerning the nutritionist’s approach to treatment (from passive to very active treatment) and level of expertise, followed by questions examining compliance and ranking the EA accorded to the nutritionist. Data were collected using a self-report questionnaire. The results indicated that the formal level of expertise had no influence on compliance. In contrast, the type of recommendation given had an effect on participants’ intentions to comply, and this effect was mediated by the level of the nutritionists’ EA. Surprisingly, more active recommendations, although more behaviorally challenging, resulted in a higher intention to comply. Patients may possess prior expectations regarding prescribed treatment and these may bias their perception of the nutritionist’s EA and consequently, their intention to comply. It is important that nutritionists understand patient expectations in order to tailor a strategy for treatment that will optimize the compliance with treatment recommendations. Academic programs in nutrition and dietetics should incorporate an appreciation of the importance of EA.

Understanding Patient Expectations of Health Care: A Qualitative Study.

Understanding and measuring patient expectations of health care is central to improving patient satisfaction and delivering patient-centered care. However, most empiric research in this field has focused on measuring patient expectations for specific diseases only. Patient expectations common to a variety of settings and clinical contexts need to be better understood to design measures with wider utility. We aimed to understand how patients express and conceptualize their expectations of health care across a range of clinical contexts and conditions. Semi-structured interviews were conducted with patients presenting to a major metropolitan hospital, informed by interpretive phenomenological analysis. Sampling continued until thematic saturation. Interview topics explored the illness experience, interactions with clinicians, how patients communicated and conceptualized their expectations of health care, and the nature of these expectations. The 26 participants conceptualized and described their expectations in 3 distinct domains: (1) health outcomes, (2) individual clinicians, and (3) the health-care system. Importantly, these domains were consistent across a variety of clinical contexts, participant demographics, and medical conditions. Despite variation in expectations due to individual patient circumstances, we identified 3 conceptual domains within which expectations consistently lie. When designing measurement tools for patient expectations, we suggest incorporating questions specifically addressing the 3 domains we have identified. With such measures, clinicians and health-care providers can be empowered to provide and monitor patient-centered care with outcomes tailored to what patients desire.

PNS16 IMPROVING ACCESS TIME IN NUCLEAR CARDIOLOGY TOWARDS QUALITY DELIVERY OF HEALTHCARE SERVICES

This research aims to explore the timeliness of access to outpatient myocardial perfusion imaging (MPI) in a nuclear cardiology facility which caters for cardiac and non-cardiac scans. Access is a key health system performance indicator to measure quality delivery of healthcare services at an institutional level. The final (impact) outcome is to increase the proportion of patients undergoing MPI within an access time (AT) of <14 calendar days(gold standard) from 2% to 50% or higher over 6 months. AT is defined as the interval difference between the MPI request and scheduled appointment in days. Interventions are directed at best practices to address gaps and deficiencies within the system. First, the backlog reduction plan was aimed at elimination of backlog by recalibration of the scheduling system. Secondly, the surge contingency plan enables the utilization of available non-cardiac appointment slots to perform outpatient MPI. Thirdly, the adaptive workforce plan utilizes staggered working hours to accommodate for increase in number of appointment slots. A theory of change was developed to outline a road map of the sequence of events connecting the resources to the activities, and how it can lead to the desired short-, intermediate-, and long-term outcomes and impact. A comparative interrupted time series design is used. AT to outpatient cardiac computed tomography will serve as the comparison group to account for any time-varying fixed effect. Data are collected at various points over time before and after an intervention to determine whether the intervention had an effect significantly greater than the underlying trend to demonstrate causal-and-effect provided the parallel trend assumption is met. A qualitative survey will be performed to understand patient expectations on AT. Findings are aimed to guide evidence-based policy making in nuclear cardiology prior to wider implementation across other modalities in cardiac imaging for quality improvement and system management.

&lt;p&gt;Comparison Of Expectations For Health Services Between Inpatients From Mental Health Department And Endocrinology Department In China&lt;/p&gt;

BackgroundPatient expectations for health services refer to the anticipation or the belief about what should be encountered in the healthcare system. Understanding patient expectations can improve patient satisfaction and healthcare compliance. It is particularly important for patients with mental disorders, as greater healthcare compliance is required for them due to the chronic and relapsing nature of their diseases. However, little is known about expectations among Chinese patients with mental disorders.ObjectiveTo examine expectations for healthcare among patients with mental disorders and to compare them with those of patients with chronic physical diseases.Patients and methodsA cross-sectional survey was conducted among two inpatient groups, consecutively recruited from the Mental Health Department (MHD) and Endocrinology Department (ED) in one tertiary general hospital in Changsha, China. Patient expectations were measured by eight translated and modified vignettes of health system responsiveness. Group differences were compared using Chi-square tests for socio-demographic and clinical characteristics and Z-test for expectation rating. Logistic regression was performed to test whether group differences of expectations remained statistically significant after controlling for socio-demographic and clinical variables.ResultsMost patients from MHD rated scenarios in vignettes on communication, choice of provider, autonomy, and social support as “meeting expectations”, and rated scenarios in vignettes on prompt attention, dignity, confidentiality, and quality of basic amenities as “below expectations”. In comparison, patients from MHD had similar expectations with their counterparts from ED, for prompt attention, dignity, confidentiality, communication, choice of provider, and social support; however, patients from MHD had significantly lower expectations in quality of basic amenities and higher expectations in autonomy, after adjusting for socio-demographic and clinical factors.ConclusionLike their counterparts with physical diseases, patients with mental disorders also expect prompt attention, dignity, confidentiality, communication, choice of provider, and social support in their interaction with the healthcare system. Moreover, extra attention to autonomy is needed for patients with mental disorders to meet their expectations and improve patient satisfaction.

Community nursing and antibiotic stewardship: the importance of communication and training.

Antimicrobial stewardship (using antimicrobials responsibly) can reduce the risk of antimicrobial resistance (AMR). Many health professionals identify themselves as 'antibiotic guardians', but patient expectations, time constraints, and a lack of confidence or underdeveloped communication skills can influence decisions to prescribe. Nurse prescribers have an important role to play in antibiotic stewardship, and their numbers continue to grow. While nurse prescribers welcome this extension to their traditional role, they are often faced with barriers to antibiotic stewardship activities. These barriers may relate to their Capability (knowledge/skill), Opportunity (norms of practice, influence of patients, environmental factors), and Motivation (attitudes and beliefs, concern over outcome, emotion and habit) [COM-B]. Education, training and enablement can help to overcome these barriers, and the development of knowledge, confidence and effective communication skills should be of priority. Further, communication skills can help nurse prescribers understand patient expectations, with the use of open-ended questions, active listening and creation of a patient-centred consultation that leads to a mutually agreed end goal and way forward.

Informed consent in plastic surgery, evaluation of its effectiveness for mutual satisfaction of patient and doctor: Comparison of methods

The acquisition of signed informed consent is not always enough to ensure adequate medical protection. Particularly, in plastic surgery, improving the doctor-patient relationship by understanding the patient's emotions and expectations becomes a determining factor when choosing the best therapeutic strategy for the subject in question, which may also include nonsurgical eligibility. Ninety patients with various plastic surgery disabilities were recruited and randomly divided into three groups: Patients in the first group underwent the ``traditional'' clinical interview, those in the second underwent the clinical approach called Shared Decision Making (SDM), and those in the third group received both the SDM and a questionnaire evaluating patient expectations (Expectation Questionnaire-Pgm). At the end of each interview, a specialist physician in Plastic, Reconstructive and Aesthetic Surgery was asked to fill in a questionnaire regarding his/her satisfaction with the method used. Likewise, the patient filled in a questionnaire on his/her satisfaction with the interview. For the doctors, the third method was superior in investigating patient expectations, emotions, and personal preferences. For the patients, the third method scored significantly higher than the first one for overall satisfaction and ability to evaluate personal preferences and needs and higher than the first and second methods in assessing expectations. For doctors, the SDM coupled with the Expectation Questionnaire-Pgm proved to be the most useful tool to understand patient expectations and emotions and thus improve the medical-patient relationship through shared decision-making. The third method therefore aims for better patient coverage and improved informed consent, thereby reducing the likelihood of litigation and better assessing nonfitness for operation.

A Systematic Review of Patient-Reported Outcomes for Cosmetic Indications of Botulinum Toxin Treatment.

Botulinum toxin (BTX) injection is the most popular cosmetic procedure in the United States. Although facial rejuvenation is considered cosmetic, physical appearance has meaningful impact on quality of life (QOL), best measured by patient-reported outcomes (PROs). Patient-reported outcomes are now often required for Food and Drug Administration approval of new pharmaceuticals. This review summarizes the PRO instruments and outcomes in evaluating patient QOL after aesthetic BTX administration. PubMed, MEDLINE, Embase, Cochrane Library, CINAHL Plus, and PsycINFO databases were searched for prospective studies using PRO instruments to directly evaluate the success of cosmetic BTX intervention. Five psychometrically validated, facial rhytid-specific PRO tools are currently used in clinical research. Most studies addressing PROs after cosmetic BTX treatment use 1-item Likert scales evaluating overall satisfaction. BTX treatment generally resulted in improved satisfaction and QOL metrics, such as perception of youthfulness, attractiveness, restedness, affect, mood, and self-confidence. Combination treatments, whether of multiple facial areas or with multiple treatment modalities, may improve PROs even further. Validated, specific PRO instruments can be used to better understand patient expectations in regards to cosmetic treatment, thus helping aesthetic dermatologists maximize patient satisfaction and retention.

Developing a surgeon-patient communication checklist for total knee arthroplasty.

Total knee arthroplasty (TKA) is a well-established surgical procedure with high rates of clinical success, yet up to 20% of patients are dissatisfied with their outcomes. Surgeon-patient communication is an important contributor to patient satisfaction, particularly in the area of setting or resetting postoperative expectations that are reasonable and achievable for individual patients. The goal of the present research was to develop a communication checklist for surgeons to use with their patients, to enhance communication in order better to manage postoperative expectations and increase patient satisfaction with TKA. Content analysis was used to identify a preliminary list of checklist items from audio-recorded interviews of eight patients who were between 6weeks and 6months of their recovery from TKA. Patients identified eight issues for which more information was desired. The proportion of mentions for each topic was calculated, and chi-square tests assessed the distribution and pattern of the categories mentioned across groups of patients. Certain topics were used significantly more often than others. Age and employment status, but not gender, affected which topics were mentioned more often. The final categories for the checklist included pain management, physiotherapy, medication and general outcome information. An in-depth analysis of patient experiences of recovering from TKA was the foundation of this research. The result was a checklist that creates a potential new avenue for increasing patient satisfaction by improving surgeon-patient communication. The research described here could extend to any other type of intervention in which understanding patient expectations and increasing patient satisfaction is the goal.