Patient's satisfaction and distress compared with expectations of the medical staff

Patient satisfaction: Concept analysis in the healthcare context

OBJECTIVE

Patient satisfaction had been the focus of many scientific studies worldwide. However, very few studies published had addressed the definition of the concept of patient satisfaction. Therefore this present concept analysis is to explore the attributes of the concept in the broader healthcare context.

METHODS

The Rodgers method, an inductive method of concept analysis, was selected to guide this concept analysis.

RESULTS

The attributes of patient satisfaction in the healthcare context identified were provider attitude, technical competence, accessibility, and efficacy. Perception in relation to expectation, patient demographics and personality, and market competition were regarded as prerequisites of patient satisfaction. Consequences of patient satisfaction identified in this analysis were: patient compliance, clinical outcomes, loyalty and referrals.

CONCLUSION

As healthcare is becoming an increasingly competitive marketplace, studying patient experience could certainly help practitioners to better encompass patient perspectives in service delivery and improve patient satisfaction.

PRACTICE IMPLICATIONS

To ensure the validity of patient satisfaction measurement and subsequently improve healthcare quality, practitioners should involve patients in identifying important factors relevant to each attributes of patient satisfaction.

Association between emergency physician self-reported empathy and patient satisfaction

Background

Higher physician self-reported empathy has been associated with higher overall patient satisfaction. However, more evidence-based research is needed to determine such association in an emergent care setting.

Objective

To evaluate the association between physician self-reported empathy and after-care instant patient-to-provider satisfaction among Emergency Department (ED) healthcare providers with varying years of medical practice experience.

Research design

A prospective observational study conducted in a tertiary care hospital ED.

Methods

Forty-one providers interacted with 1,308 patients across 1,572 encounters from July 1 through October 31, 2016. The Jefferson Scale of Empathy (JSE) was used to assess provider empathy. An after-care instant patient satisfaction survey, with questionnaires regarding patient-to-provider satisfaction specifically, was conducted prior to the patient moving out of the ED. The relation between physician empathy and patient satisfaction was estimated using risk ratios (RR) and their corresponding 95% confidence limits (CL) from log-binomial regression models.

Results

Emergency Medicine (EM) residents had the lowest JSE scores (median 111; interquartile range [IQR]: 107–122) and senior physicians had the highest scores (median 119.5; IQR: 111–129). Similarly, EM residents had the lowest percentage of “very satisfied” responses (65%) and senior physicians had the highest reported percentage of “very satisfied” responses (69%). There was a modest positive association between JSE and satisfaction (RR = 1.04; 95% CL: 1.00, 1.07).

Conclusion

This study provides evidence of a positive association between ED provider self-reported empathy and after-care instant patient-to-provider satisfaction. Overall higher empathy scores were associated with higher patient satisfaction, though minor heterogeneity occurred between different provider characteristics.

Residents' satisfaction with primary medical and health services in Western China

BACKGROUND

Currently, China is in the process of medical and health care reform, and the establishment of primary medical and health services covering urban and rural residents is an important aspect of this process. Studying the satisfaction of residents of underdeveloped areas with their primary medical and health services and identifying the factors that can increase the satisfaction of different groups may improve patient compliance and ultimately improve health. Moreover, such research may provide a reference for the development of medical and health undertakings in similarly underdeveloped areas.

METHODS

A face-to-face survey was conducted on a stratified random sample of 2200 residents in Gansu by using structured questionnaires. Demographic characteristics were collated, and questionnaires were factor-analysed and weighted using SPSS software to obtain scores for each factor, as well as total satisfaction scores. The characteristics of poorly satisfied populations were determined by a multiple linear regression analysis using SAS software. A cluster analysis was performed using SAS software for classification and a separate discussion of populations.

RESULTS

The hypertension self-awareness rate (11.29%) of the sampled population was lower than the average hypertension prevalence (23.85%), as recorded in the 2014 Health Statistical Yearbook of the region. The disease knowledge awareness factor was the lowest factor (2.857), whereas the policy awareness factor was the highest factor (4.772). The overall satisfaction was moderate (3.898). The multivariate linear regression model was significant (p <0.05). The regression coefficients were -0.041 for minors; 0.065 for unemployed people; and 0.094 for people with an elementary school educational level, a value lower than that of other population groups. A cluster analysis was used to divide the respondents into five groups. The overall satisfaction was lowest in the second population group (rural, middle-aged)(Fz = 3.64) and was highest in the fourth population group(minors) (Fz = 4.13). Different population groups showed different satisfaction rates in F1 to F6.

CONCLUSION

Hypertensive patients had low self-awareness, and residents had a poor grasp of disease and limited health knowledge. Their overall satisfaction was moderate. Residents expressed comparatively high satisfaction with the current policy. Minors, adults with low level of education, unemployed people and other vulnerable groups expressed low overall satisfaction. The degree of satisfaction varied greatly among the different groups. Targeted medical and health practices should be implemented for different groups; additionally, the public health practice should be strengthened.

'Some patients are more equal than others': Patient-centred care differential in two-tier inpatient ward hospitals in Ghana

OBJECTIVE

To examine differences in patient-centred care among private and public inpatients in public hospitals and whether satisfaction with patient-centred care differ between the patient groups.

METHOD

Cross-sectional data collected from inpatients in private wards (n=300) and public wards (n=520) in Ghana, using a structured questionnaire modelled on four dimensions of patient-centred care: respect and dignity, emotional support, interpersonal relations and information sharing.

RESULTS

Patient-centred care differed significantly among private and public patients (p<0.001), with an effect size ranging from medium to large. Private patients rated patient-centred care higher than public patients in all the items of the four dimensions. Satisfaction with patient-centred care discriminated between the patient groups. Satisfaction was significantly high for private patients who are aged 50+ (p<0.001), had high education (p<0.05) and high income (p<0.001) compared to the same category of public patients.

CONCLUSION

Physicians behaviour is stereotyping and less favourable to public patients, suggesting inequitable access to patient-centred care for inpatients from high and low socioeconomic backgrounds.

PRACTICE IMPLICATIONS

Hospitals with private and public wards should be compelled to properly coordinate and regulate the activities of physicians to avoid fragmented care for inpatients.

An evaluation of support of patients with prostate cancer during and beyond radiotherapy treatment. A local perspective on future provision

Purpose

This study was designed to evaluate whether radiographer-led on-treatment review clinics are meeting the wider needs of prostate patients receiving radiotherapy.

Methods

Semi-structured interviews were used to elicit patient and staff perspectives. Interviews are used extensively in qualitative research to produce a breadth and depth of insight into participants’ experiences and opinions. Seven patients and two radiographers participated in individual audio-taped interviews. Thematic analysis of the data identified some key themes and their perceived importance within the review service for both patients and staff.

Results

Semi-structured interviews were used to elicit patient and staff views. Several themes emerged from patient and radiographer perspectives. Radiographers and patients both expressed overall satisfaction with the service. Strengths included staff communication, relaxed environment, individualised support, regular information spread throughout the review pathway and consistency in managing acute side effects. Weaknesses included information and communication gaps at the beginning and end of treatment, information inconsistency between staff groups, gaps in specialist knowledge and a possible gap in skills where staff could train as supplementary prescribers.

Conclusion

Interviews produced an in-depth view of patient and staff experiences. Staff and patients identified both strengths and areas for improvement within the local service. Study findings support review radiographers in sourcing additional specialist training and a closer collaboration with other staff groups, which will further develop the service. As a next step, triangulation of research methods with questionnaires could be used to evaluate whether this small sample of patients is characteristic of prostate patients in general.

Patients' perceptions of what makes a good doctor and nurse in an Israeli mental health hospital

The aim of this study was to identify inpatients' expectations of their doctors and nurses in a mental health hospital setting. Individual interviews were conducted with 72 inpatients of a large mental health hospital in northern Israel. Our study produced three major results. First, most patients, whatever their emotional status, share similar expectations of staff, of which the most conspicuous is that they be respected as whole persons and that staff not treat them merely as cases of illness. Second, they expect to be involved in making decisions about their treatment, including being informed of reports and records referring to them. Third, patients expect all hospital staff, particularly nurses, to provide them with emotional support. The findings of this study can be used to facilitate improved care of mental health inpatients by both doctors and nurses. Structured and methodical examinations of inpatients' expectations at the time they are hospitalized can help adjust not only the professional aspect of health care but also the therapeutic communication approach to patients' individual needs.

On residents' satisfaction with community health services after health care system reform in Shanghai, China, 2011

Background

Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents’ satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform.

Methods

Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents’ satisfaction.

Results

Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1) the health insurance system; 2) essential drugs; 3) basic clinical services; and 4) public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied) and the public health/preventive services (average score=3.62); but less satisfied with the provision of essential drugs (average score=3.20) and health insurance schemes (average score=3.23). The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes) had overall poorer satisfaction levels on these four aspects of health care (P<0.01). 25.39% of the respondents thought that their financial burden had increased and 38.49% thought that drugs had become more expensive.

Conclusion

The respondents showed more satisfaction with the clinical services (average score=3.79) and public health services/interventions (average score=3.79); and less satisfaction with the health insurance system (average score=3.23) and the essential drug system (average score=3.20). Disadvantaged groups showed lower satisfaction levels overall relative to non-disadvantaged groups.

Satisfaction with communication in ICU patients and relatives: comparisons with medical staffs' expectations and the relationship with psychological distress

OBJECTIVE

To study intensive care unit (ICU) patients' and relatives' satisfaction in regard to communication with medical staff (nurses and physicians), perceived support, environmental strain and their psychological distress. Further, to compare this with expectations of the medical staff.

METHODS

Cross-sectional study, 4-6 weeks post-ICU discharge. Respondents to the questionnaire were: 255 (63%) patients, 354 (82%) relatives and 145 (74%) medical staff. Degree of satisfaction and distress were measured on a five-point Likert-scale (0=low to 4=high).

RESULTS

The mean score for patient satisfaction with communication was 3.0 (95%CI 2.9-3.1) and for relatives 3.4 (3.3-3.5). This was significantly higher than expected by the staff for patients 2.5 (2.4-2.6) and relatives 2.8 (2.7-2.9), both p<0.001. Relatives' degree of psychological distress, 2.5 (2.4-2.6) was significantly higher than for patients', 1.6 (1.5-1.7), but was significantly lower than expected by the staff, 2.9 (2.8-3.0) and 2.7 (2.6-2.8) respectively, both p<0.001.

CONCLUSION

Patients and relatives were more satisfied with the communication than expected by the staff. The staff overestimated the patients' and relatives' psychological distress. Relatives report more psychological distress symptoms post-ICU discharge compared to the patients.

PRACTICE IMPLICATIONS

Medical staff is aware of psychological distress in ICU patients and relatives and effort to reduce this during ICU stay and afterwards should be implemented.

Patient satisfaction with care in the intensive care unit: can we rely on proxies?

BACKGROUND

To investigate whether next of kin can be addressed as proxy to assess patients' satisfaction with care in the intensive care unit (ICU).

METHODS

Prospective observational multicentre study. Two hundred and thirty-five patients with an ICU length of stay of ≥2 days and 266 of their adult next of kin participated. Patient satisfaction was assessed by a questionnaire, distributed upon discharge from an ICU and compared with next of kin's answers. The possible range of answers was 0-100, with higher numbers indicating higher satisfaction. The main outcome measure was the extent of agreement between patients' satisfaction with care and the ratings of their next of kin.

RESULTS

Patients were most satisfied concerning physicians' competence (86.7±16.3), while least satisfaction was observed for the management of agitation and restlessness (78.2±23.5). There was no significant difference between next of kin's and patients' ratings. Agreement between patients and proxies was the highest concerning overall satisfaction (Cohen's κ 0.40) and the lowest for coordination of care (0.24). Spouses/partners had a higher agreement with the patients' ratings than other proxies.

CONCLUSIONS

If the patient is unable to rate his satisfaction with care in the ICU, next of kin may be taken as an appropriate surrogate.

TRIAL REGISTRATION

The study has been registered at ClinicalTrials.gov, Reg No: NTC 00890513.

Patients' memory and psychological distress after ICU stay compared with expectations of the relatives

PURPOSE

To compare patients' psychological distress and memories from intensive care unit (ICU) treatment 4-6 weeks after ICU discharge with expectations of their relatives. Further, to explore the relationship between personality traits and ICU memories with psychological distress.

METHODS

A cross-sectional study of 255 patients and 298 relatives. The questionnaire included: hospital anxiety and depression scale (HADS), impact of event scale (IES), life orientation test, ICU memory tool and memory of ICU; technical procedures, pain, lack of control and inability to express needs. Relatives were assessed for their expectations of the patients' memories and psychological distress.

RESULTS

Twenty-five percent of the patients reported severe posttraumatic stress symptoms, IES-total >or= 35. The levels of anxiety and depression were significantly higher than in the general population, mean anxiety was 5.6 versus 4.2 (p < 0.001), and mean depression was 4.8 versus 3.5 (p < 0.001). Relatives expected more psychological distress and the relatives thought the patient was less able to express needs than the patients reported (p < 0.001). Higher age, unemployment, respirator treatment, pessimism, memory of pain, lack of control and inability to express needs were independent predictors of posttraumatic stress symptoms (p < 0.01).

CONCLUSIONS

Psychological distress symptoms were frequent among ICU survivors. Relatives expected the patients to be more distressed after ICU treatment than the patients reported. The strongest predictors of posttraumatic stress symptoms from the ICU were memoris about pain, lack of control and inability to express needs. Pessimism may be a reason for psychological distress and should be addressed during follow up, as pessimistic patients may need more motivation and support.