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Lewis A, Douka D, Koukoura A, Valla V, Smirthwaite A, Faarbaek SH, Vassiliadis E. Preference Testing in Medical Devices: Current Framework and Regulatory Gaps. MEDICAL DEVICES (AUCKLAND, N.Z.) 2022; 15:199-213. [PMID: 35822064 PMCID: PMC9271283 DOI: 10.2147/mder.s368420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022]
Abstract
Preference testing is a valuable source of information that can be provided by both healthcare professionals (HCPs) and patients (users). It can be used to improve the design and development of medical devices by feeding into device usability and, ultimately, risk management. Furthermore, it can aid with selecting the most appropriate clinical endpoints to be used in the clinical evaluation of a device and increase patient engagement by incorporating patient-relevant outcomes. Preference testing is widely conducted in the food industry but is not widespread in the medical field due to limited guidelines and a lack of regulatory framework. As such, manufacturers may be unaware of the benefits of preference testing and fail to take full advantage of it, or conversely, may use inappropriate methodology and/or analyses and consequently fail to collect meaningful data. In this position paper, we aim to highlight the benefits and uses of preference testing, along with potential methods that could be used for preference testing of medical devices. A key step towards the wider implementation of preference testing in medical devices is for the publication of international standards and guidelines for the collection, assessment, and implementation of preference data into the life cycle of a medical device.
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Wieske L, Richard E, Wijers D, Stam J, Smets EMA, Vergouwen MDI. Long-term satisfaction after neurological second opinions and tertiary referrals. Eur J Neurol 2011; 18:1310-6. [DOI: 10.1111/j.1468-1331.2011.03394.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sibbitt RR, Palmer DJ, Sibbitt WL, Bankhurst AD. Image-directed fine-needle aspiration biopsy of the thyroid with safety-engineered devices. Cardiovasc Intervent Radiol 2010; 34:1006-13. [PMID: 21057794 DOI: 10.1007/s00270-010-0013-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 09/20/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the present study was to integrate safety-engineered devices into outpatient fine-needle aspiration (FNA) biopsy of the thyroid in an interventional radiology practice. MATERIALS AND METHODS The practice center is a tertiary referral center for image-directed FNA thyroid biopsies in difficult patients referred by the primary care physician, endocrinologist, or otolaryngologist. As a departmental quality of care and safety improvement program, we instituted integration of safety devices into our thyroid biopsy procedures and determined the effect on outcome (procedural pain, diagnostic biopsies, inadequate samples, complications, needlesticks to operator, and physician satisfaction) before institution of safety devices (54 patients) and after institution of safety device implementation (56 patients). Safety devices included a patient safety technology-the mechanical aspirating syringe (reciprocating procedure device), and a health care worker safety technology (antineedlestick safety needle). RESULTS FNA of thyroid could be readily performed with the safety devices. Safety-engineered devices resulted in a 49% reduction in procedural pain scores (P < 0.0001), a 56% reduction in significant pain (P < 0.002), a 21% increase in operator satisfaction (P < 0.0001), and a 5% increase in diagnostic specimens (P = 0.5). No needlesticks to health care workers or patient injuries occurred during the study. CONCLUSIONS Safety-engineered devices to improve both patient and health care worker safety can be successfully integrated into diagnostic FNA of the thyroid while maintaining outcomes and improving safety.
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Affiliation(s)
- Randy R Sibbitt
- Montana Interventional and Diagnostic Radiology, 2969 Airport Road, Suite 1C, Helena, MT 59601, USA.
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Patient satisfaction in neurological second opinions and tertiary referrals. J Neurol 2010; 257:1869-74. [PMID: 20552363 PMCID: PMC2977057 DOI: 10.1007/s00415-010-5625-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 06/02/2010] [Indexed: 12/02/2022]
Abstract
Although the number of neurological second opinions (SOs) and tertiary referrals (TRs) is increasing, only little is known about expectations and patient satisfaction in this group of patients. Therefore, the purpose of this study was to explore expectations of patients who get a neurological SO or TR and to assess patient satisfaction in these groups of patients. All new patients attending an academic neurological day-care clinic in a 6-month period were investigated. Demographic characteristics, duration of symptoms, expectations and motivation, new diagnoses and treatment consequences were studied, and patient satisfaction with the previous physician and the day-care clinic physician was assessed. Three hundred consecutive patients (183 SOs and 117 TRs) were evaluated. SO patients were younger (47 years vs. 51 years), and their duration of symptoms was longer (24 vs. 13 months) than TR patients. Most patients expected a new diagnosis or treatment (60%). SO patients were equally as satisfied with the day-care clinic consultation as TR patients (overall satisfaction using a VAS-score ranging 0–10: 7.4 vs. 7.5; p = 0.81), and significantly less satisfied with the referring physician (overall satisfaction: 5.6 vs. 7.0; p < 0.001). SO patients, in particular, were more satisfied with the degree of information and emotional support provided by the consulting neurologist as compared to the referring physician. Receiving a new diagnosis and/or treatment advice did not influence satisfaction. A day-care admission for neurological SO and TR leads to an increase of patient satisfaction, irrespective of making a new diagnosis or initiation of a new treatment.
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Chow A, Mayer EK, Darzi AW, Athanasiou T. Patient-reported outcome measures: The importance of patient satisfaction in surgery. Surgery 2009; 146:435-43. [DOI: 10.1016/j.surg.2009.03.019] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Accepted: 03/18/2009] [Indexed: 11/16/2022]
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Service Recovery and Pre-Emptive Strategies for Service Failure: Both Lead to Customer Satisfaction and Loyalty, But for Different Reasons. ACTA ACUST UNITED AC 2008. [DOI: 10.1300/j150v13n03_09] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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A Randomized, Controlled Trial of the Reciprocating Procedure Device for Local Anesthesia. J Emerg Med 2008; 35:119-25. [PMID: 18281176 DOI: 10.1016/j.jemermed.2007.08.060] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 03/13/2007] [Accepted: 08/01/2007] [Indexed: 11/24/2022]
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Moorjani GR, Bedrick EJ, Michael AA, Peisajovich A, Sibbitt WL, Bankhurst AD. Integration of safety technologies into rheumatology and orthopedics practices: A randomized, controlled trial. ACTA ACUST UNITED AC 2008; 58:1907-14. [DOI: 10.1002/art.23499] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Dy SM. Instruments for evaluating shared medical decision making: a structured literature review. Med Care Res Rev 2007; 64:623-49. [PMID: 17804824 DOI: 10.1177/1077558707305941] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The author conducted a structured literature review of instruments for evaluating shared medical decision making. She included relevant instruments that were generalizable beyond specific situations and had been formally evaluated and organized them by domains of values or preferences, information and communication in decision making, and other aspects of decision making. For values or preferences, the author identified 11 instruments, mostly on preferences for roles and information. For information and communication, she found a systematic review of instruments for observational assessment of decision making, 3 additional observational instruments, and 3 questionnaires. For other aspects of decision making, the author identified 3 instruments in domains such as decision self-efficacy and 4 multidimensional instruments. Although instrument development tended to cluster in several areas and there were clear gaps in the literature, the diversity of instruments demonstrates the broad range of constructs involved in assessing shared decision making.
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Affiliation(s)
- Sydney Morss Dy
- Johns Hopkins Bloomberg School of Public Health and School of Medicine, MD, USA
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Kettwich SC, Sibbitt WL, Brandt JR, Johnson CR, Wong CS, Bankhurst AD. Needle phobia and stress-reducing medical devices in pediatric and adult chemotherapy patients. J Pediatr Oncol Nurs 2007; 24:20-8. [PMID: 17185398 DOI: 10.1177/1043454206296023] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Needle phobia--fear of medical devices--is a significant problem in pediatric and adult chemotherapy patients. Stress-reducing medical devices is a new, effective cognitive therapy for needle phobia. Twenty-five pediatric and 25 adult chemotherapy patients were randomly exposed to conventional or stress-reducing decorated butterfly needles and syringes. Emotional stress responses were determined with the Visual Aversion Scale, Visual Analogue Fear Scale, Visual Analogue Anxiety Scale, and Visual Overall Stress Score for each needle and syringe design. Sixty-eight percent of the pediatric and 52% of the adult patients were overtly needle phobic, but children demonstrated significantly more aversion and stress (P < .001). Stress-reducing medical devices effectively and significantly reduced aversion, anxiety, fear, and overall stress, and were 76% effective in preventing overt needle phobia in children and 92% effective in adults (P < .001). One hundred percent of children and adults felt that stress-reducing medical devices should be available in chemotherapy clinics. Needle phobia and stress in pediatric and adult chemotherapy patients are significantly reduced by the use of stress-reducing medical devices.
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Affiliation(s)
- Sharon C Kettwich
- Department of Internal Medicine, 5th FLACC, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
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Nunez SE, Draeger HT, Rivero DP, Kettwich LG, Sibbitt WL, Bankhurst AD. Reduced Pain of Intraarticular Hyaluronate Injection With the Reciprocating Procedure Device. J Clin Rheumatol 2007; 13:16-9. [PMID: 17278943 DOI: 10.1097/01.rhu.0000256280.85507.bd] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Greater than 50% of patients report significant pain with intraarticular injection of hyaluronate. The reciprocating procedure device (RPD), also known the reciprocating syringe, has 2 plungers that reciprocate with each other, permitting one-handed operation. The RPD increases physician control of the needle and is proposed to reduce patient pain during syringe procedures. OBJECTIVES To determine in a randomized controlled trial whether the RPD induces less pain than the traditional syringe during intraarticular hyaluronate therapy for the knee. METHODS Eighty intraarticular injection procedures of the knee were randomized to either the conventional syringe or the RPD using hyaluronate sodium derivative (Hylan G-F-20). Outcome measures included physician's estimate of pain, patient pain (Visual Analogue Pain Scale [VAPS]), procedure duration, operator satisfaction, complications, and response to the injected medication. RESULTS Patients reported 85% more pain than physicians estimated. Fifty-one percent (19/37) of subjects experienced moderate to severe pain with the conventional syringe, while only 14% (6/43) experienced pain with the RPD. The RPD reduced pain scores (RPD VAPS score: 2.12 +/- 2.15; conventional syringe VAPS score: 4.22 +/- 3.25; P < 0.001), reduced procedure time (RPD: 1.34 +/- 1.09, conventional syringe: 1.90 +/- 1.35 minutes, P < 0.001), and improved physician satisfaction (RPD VASS Score: 9.02 +/- 0.80, conventional syringe 5.69 +/- 1.33, P < 0.001). CONCLUSIONS Patients have considerably more pain with intraarticular needle introduction and injectable hyaluronate therapy than physicians estimate. The RPD reduces patient pain, reduces procedure time, and improves needle introduction compared with the conventional syringe for hyaluronate injection therapy for the knee.
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Affiliation(s)
- Sharon E Nunez
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA
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Draeger HT, Twining JM, Johnson CR, Kettwich SC, Kettwich LG, Bankhurst AD. A randomised controlled trial of the reciprocating syringe in arthrocentesis. Ann Rheum Dis 2005; 65:1084-7. [PMID: 16339287 PMCID: PMC1798237 DOI: 10.1136/ard.2005.045781] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the outcomes of arthrocentesis with the new highly controllable, one handed reciprocating procedure syringe compared with a conventional syringe. METHODS 100 arthrocentesis procedures were randomised between the reciprocating syringe and the conventional syringe. Outcome measures included patient pain, procedure duration, operator satisfaction, synovial fluid volume, cell counts, and complications. RESULTS 50 arthrocentesis procedures with the conventional syringe resulted in a mean (SD) procedure time of 3.39 (1.88) minutes, a mean VAPS (patient pain) score of 5.35 (3.15), and a mean VASS (operator satisfaction) score of 4.88 (1.92); 30 of the 50 subjects experienced moderate to severe pain (VAPS score 5 or greater) during arthrocentesis. In contrast, the reciprocating syringe resulted in a reduced procedure time of 1.94 (1.14) minutes (p<0.001), a reduced VAPS (patient pain) score of 2.54 (1.60) (p<0.001), and an increased VASS (operator satisfaction) score of 8.91 (0.79) (p<0.001). Only five of the 50 of subjects experienced moderate to severe pain with the reciprocating syringe. Synovial cell counts were similar between the two syringes (p>0.05), but there was a trend toward greater volume (greater synovial fluid yield) and fewer red blood cells with the reciprocating syringe. CONCLUSIONS Arthrocentesis with a conventional syringe results in moderate to severe pain in 60% of subjects. The reciprocating syringe prevents significant pain, reduces procedure time, and improves physician performance of arthrocentesis. The reciprocating syringe is superior to the conventional syringe in arthrocentesis.
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Affiliation(s)
- H T Draeger
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.
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Miguel FS, Ryan M, Amaya-Amaya M. 'Irrational' stated preferences: a quantitative and qualitative investigation. HEALTH ECONOMICS 2005; 14:307-22. [PMID: 15386664 DOI: 10.1002/hec.912] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Individuals' rationality has been a key issue long debated in Economics. While normative theories establish the way 'rational' consumers should behave, many empirical studies have documented numerous systematic violations of normative principles. This has led some to question the validity of classic economic models as an adequate approximation of individuals' real decision-making. This paper aims to shed more light on this debate. A stated preference choice experiment was set up to test rational choice properties. Attention was given to the extent to which satisfaction of such tests is related to both the complexity of the design, and subject characteristics. Quantitative and qualitative methods are applied. The majority of respondents passed the rationality tests. Satisfaction of the tests was sensitive to normatively irrelevant factors such as the complexity of the task and demographic characteristics. A significant proportion of those individuals who 'failed' seem to have reformulated the experiment in some way in their mental process. Implications for the design and analyses of future DCEs are discussed.
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The Repeatability of Three Methods for Measuring Prospective Patients' Values in the Context of Treatment Choice for End-Stage Renal Disease. J Clin Epidemiol 1999. [DOI: 10.1016/s0895-4356(99)00072-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sole TJ, Lipsky PE. Satisfaction of patients attending an arthritis clinic in a county teaching hospital. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1997; 10:169-76. [PMID: 9335628 DOI: 10.1002/art.1790100304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To gather information about the satisfaction of medically indigent arthritis patients with their health care. METHODS Patients attending a university-affiliated county hospital arthritis clinic were surveyed using a questionnaire about their satisfaction with various aspects of the clinic. RESULTS Two hundred thirty-two out of 283 questionnaires were completed. Patients were most satisfied with the care given by doctors, and least satisfied with the waiting times; accessibility, environment, and information received intermediate responses. Although most patients said that they were satisfied with their overall care, only 53% would continue to attend the clinic if they had full insurance. CONCLUSION A number of aspects of health care delivery were sources of dissatisfaction for medically indigent arthritis patients. Attention to these concerns could increase overall satisfaction and perhaps improve compliance in this group of patients.
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Affiliation(s)
- T J Sole
- Rheumatic Diseases Division, University of Texas Southwestern Medical Center, Dallas 75235-8884, USA
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Abstract
The aim of the study was to discover the views of parents about the 1991 Leicestershire child health surveillance programme, its organisation, and content. The study design was a postal questionnaire survey to parents of a sample of children eligible for the new surveillance programme. One thousand parents received questionnaires, of which 66% (660) were returned. Poor access for prams and wheelchairs (595 responses) and inadequate general cleanliness (249 responses) caused most criticism of clinic premises. The experiences of parents from ethnic minorities were significantly worse for some professional consultation factors, but they received significantly more health advice than other parents. Parents lacked sufficient information about the surveillance programme and their most frequent reasons for non-attendance were time related factors. Minimum standards for child health surveillance premises are required. At present, many fail to reach adequate standards of privacy and accessibility. Schemes to ensure an equal partnership in child health surveillance between parents and professionals are essential.
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Affiliation(s)
- J C Sutton
- Department of Public Health Medicine, Leicestershire Health
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Schmitz JM, Rhoades H, Grabowski J. A menu of potential reinforcers in a methadone maintenance program. J Subst Abuse Treat 1994; 11:425-31. [PMID: 7869463 DOI: 10.1016/0740-5472(94)90095-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study demonstrates the use of paired comparisons and interval scaling techniques for measuring the relative priority of program privileges available at a methadone maintenance clinic. Fifteen methadone program privileges were combined in all possible pairs (N = 105) on a reinforcer menu and administered to a group of 12 methadone patients and a second group of counselors (N = 4). Data were converted to interval scales using the law of comparative judgment to form a quantitative continuum from least to most preferable. Free methadone, free dental service, and more take-homes were ranked highest in both groups; however, patients showed less differentiation in their preference for these privileges. Dose decreases were least preferred. Results are discussed in terms of their clinical applicability in identifying privileges for potential use in modifying the behavior of drug abusers. The method of paired comparisons has excellent psychometric properties and may offer some advantages over other response scale formats.
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Affiliation(s)
- J M Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston
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Abstract
Single-item indicators that ask respondents for their global rating of a specific concept are congruent with nursing's emphasis on wholism and individualism. They allow the subject to take personally salient features of the situation into account when providing a response. The psychometric performance of single-item indicators in published research and in a sample data set using measures of the mother's choice and satisfaction with her employment decision support the validity and reliability of the measures, suggesting that these indicators deserve more attention in nursing research. Recommendations for the use of single-item indicators are provided.
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Affiliation(s)
- J M Youngblut
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106-4904
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Rouse RA, Hamilton MA. Dentists evaluate their patients: an empirical investigation of preferences. J Behav Med 1991; 14:637-48. [PMID: 1791626 DOI: 10.1007/bf00867176] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dental treatment is a dyadic encounter. Yet research on the dentist-patient dyad has tended to focus on patient perceptions of dentist, to the neglect of dentist perceptions of patient. Previous theoretic and qualitative work on caregiver perceptions of patients suggested three dimensions of evaluation. Dentists (N = 618) rated their patients on items taken from two prior studies. Dentists' responses were subjected to confirmatory factor analysis. The analysis substantiated the existence of three evaluative dimensions: compliance, tractability, and likability. Further analysis showed that the three dimensions formed a Guttman simplex, revealing a second-order factor of selectivity and allowing a classification of dentists on the basis of patient selectivity.
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Affiliation(s)
- R A Rouse
- Department of Communication Sciences, University of Connecticut, Storrs 06269
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