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Fabian A, Rühle A, Domschikowski J, Trommer M, Wegen S, Becker JN, Wurschi G, Boeke S, Sonnhoff M, Fink CA, Käsmann L, Schneider M, Bockelmann E, Treppner M, Mehnert-Theuerkauf A, Nicolay NH, Krug D. Satisfaction with radiotherapy care among cancer patients treated in Germany-secondary analysis of a large multicenter study. Strahlenther Onkol 2024; 200:487-496. [PMID: 37975882 PMCID: PMC11111518 DOI: 10.1007/s00066-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Patient satisfaction with healthcare has been linked to clinical outcomes and regulatory agencies demand its regular assessment. Therefore, we aimed to investigate patient satisfaction with radiotherapy care and its determinants. METHODS This is a secondary analysis of a multicenter prospective cross-sectional study. Eligible cancer patients anonymously completed questionnaires at the end of a course of radiotherapy. The outcome variable was overall patient satisfaction with radiotherapy care measured with a 10-point Likert scaled single-item. Given patient satisfaction was defined for patients scoring ≥ 8 points. Determinants of given patient satisfaction were assessed by univariable and multivariable analyses. A p-value < 0.05 was considered statistically significant. RESULTS Out of 2341 eligible patients, 1075 participated (participation rate 46%). Data on patient satisfaction was provided by 1054 patients. There was a right-skewed distribution towards more patient satisfaction (mean = 8.8; SD = 1.68). Given patient satisfaction was reported by 85% (899/1054) of the patients. Univariable analyses revealed significant associations of lower patient satisfaction with tumor entity (rectal cancer), concomitant chemotherapy, inpatient care, treating center, lower income, higher costs, and lower quality of life. Rectal cancer as tumor entity, treating center, and higher quality of life remained significant determinants of patient satisfaction in a multivariable logistic regression. CONCLUSION Overall patient satisfaction with radiotherapy care was high across 11 centers in Germany. Determinants of patient satisfaction were tumor entity, treating center, and quality of life. Although these data are exploratory, they may inform other centers and future efforts to maintain high levels of patient satisfaction with radiotherapy care.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Alexander Rühle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Maike Trommer
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, 50931, Cologne, Germany
| | - Simone Wegen
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, 50937, Cologne, Germany
| | - Jan-Niklas Becker
- Department of Radiotherapy and Special Oncology, Medical School Hannover, 30625, Hannover, Germany
| | - Georg Wurschi
- Department of Radiotherapy and Radiation Oncology, Jena University Hospital, 07747, Jena, Germany
| | - Simon Boeke
- Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Mathias Sonnhoff
- Center for Radiotherapy and Radiation Oncology, 28239, Bremen, Germany
| | - Christoph A Fink
- Department of Radiation Oncology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
- Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), 81377, Munich, Germany
- Partner Site Munich, German Cancer Consortium (DKTK), 81377, Munich, Germany
| | - Melanie Schneider
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Elodie Bockelmann
- Department of Radiotherapy and Radiation Oncology, University Hospital Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Martin Treppner
- Institute of Medical Biometry and Statistics, University Hospital Freiburg, 79106, Freiburg, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, 04103, Leipzig, Germany
| | - Nils H Nicolay
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, 04103, Leipzig, Germany
- Partner Site Leipzig, Cancer Center Central Germany, 04103, Leipzig, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Altıngöz EN, Yenisoy Y, Kapusuz A, Abacar K, Şişman-Kitapçı N, Yay M, Karacaylı U, Alibaz-Öner F, İnanç N, Ergun T, Fortune F, Direskeneli H, Mumcu G. The mediator role of treatment response on oral health related quality of life in Behçet's syndrome. Med Oral Patol Oral Cir Bucal 2023; 29:26319. [PMID: 38150605 PMCID: PMC11175573 DOI: 10.4317/medoral.26319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The aim of the study was to analyse the effects of Treatment Response with oral ulcers on oral health related quality of life in Behçet's syndrome (BS). MATERIAL AND METHODS In the cross-sectional study, 339 BS patients (F/M: 179/160, mean age: 36,13±9,81 years) were included. Data were collected by clinical examinations and patient reported outcome measures (PROMs) regarding Oral Health Impact Profile-14 (OHIP-14) questionnaire and self-reported Treatment Responses coded by a 5-point Likert-type scale (1: symptoms were cured- 5: symptoms were worsened). Moderated Mediation analysis (MA) was used to understand how oral ulcer activity (independent variable; X) influenced OHIP-14 score (outcome variables, Y) through self-reported Treatment Response (M1) and age (M2) as possible mediator variables (M) and disease course (mucocutaneous and musculuskeletal involvement vs. major organ involvement) as a possible moderator variable (W) on these relationships. RESULTS In Moderated MA, OHIP-14 score (Y) was mediated by the presence of oral ulcer (X) (p=0.0000), the negative Treatment Response (M1) (p=0.0001) and being young (M2) (p=0.0053) with mucocutaneous involvement (W)(p=0.0039). CONCLUSIONS Self-reported Treatment Response as an underestimated issue has a Mediator role in relation to oral ulceration on oral health related quality of life in the framework of patient empowerment strategies. Therefore, study results give clues to assist physicians and dentists for better understanding of patients' perspective.
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Affiliation(s)
- E-N Altıngöz
- Faculty of Health Sciences Marmara University, Istanbul, Turkey
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Cook CE, Pergolotti M, Garcia AN, Hopwood D. Creation and Validation of the Select Medical Patient Reported Experience Measure for Physical and Occupational Therapy Outpatient Clinics. Arch Phys Med Rehabil 2023; 104:1767-1774. [PMID: 37150428 DOI: 10.1016/j.apmr.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE This study describes the creation and examination of the internal consistency, content validity, construct/structural validity, and criterion/concurrent validity of the Select Medical Patient Reported Experience Measure (SM-PREM). DESIGN Observational study design. SETTING 1054 Outpatient physical and occupational therapy locations in North America. PARTICIPANTS The study included 89,205 patients with various musculoskeletal disorders (N=89,205). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Content validity was described, and internal consistency, construct/structural validity (factor analysis), and criterion/concurrent validity were analyzed, with concurrent validity compared against patient reported outcomes (PROM), the Net Promoter Scale, and the Orebro Musculoskeletal Screening Questionnaire-12. RESULTS Exploratory and confirmatory factor analysis of the SM-PREM yielded 3 dimensions, each with a very strong internal consistency (>.850). The SM-PREM yielded statistically significant results in all areas, with values that reflected minimal to fair association with PROMs. CONCLUSION The SM-PREM appears to capture a unique construct compared to PROMs. The 11-item tool has 3 definitive dimensions and exhibits strong internal consistency. The tool may be useful in examining patient experience in patients with musculoskeletal injuries seen by physical and occupational therapists.
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Affiliation(s)
- Chad E Cook
- Department of Orthopedic Surgery, Duke University, Durham, NC; Department of Population Health Sciences, Duke University, Durham, NC; Duke Clinical Research Institute, Duke University, Durham, NC
| | - Mackenzi Pergolotti
- Select Medical, ReVital Cancer Rehabilitation, Mechanicsburg, PA; Department of Health Sciences, University of North Carolina, Chapel Hill, NC
| | | | - David Hopwood
- Select Medical Outpatient, Select Medical, Mechanicsburg, PA
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Pierson SR, Lam R, Ngoue M, Rajagopalan D, Ring D, Ramtin S. Clinician Interruptions and Patient-Rated Clinician Empathy in Specialty Visits. J Am Acad Orthop Surg 2023; 31:1129-1135. [PMID: 37467397 DOI: 10.5435/jaaos-d-23-00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Clinicians tend to interrupt patients when they are describing their problem, which may contribute to feeling unheard or misunderstood. Using transcripts of audio and video recordings from musculoskeletal (MSK) specialty visits, we asked what factors are associated with (1) Perceived clinician empathy, including the time a patient spends describing the problem and time to the first interruption, (2) duration of patient symptom description, and (3) duration between the end of greeting and first nonactive listening interruption. METHODS We analyzed transcripts of 194 adult patients seeking MSK specialty care with a median age (Interquartile range [IQR]) of 47 (33 to 59) years. Participants completed postvisit measures of perceived clinician empathy, symptoms of depression, accommodation of pain, and health anxiety. A nonactive listening interruption was defined as the clinician unilaterally redirecting the topic of conversation. Factors associated with patient-rated clinician empathy, patient problem description duration, and time until the first nonactive listening interruption were sought in bivariate and multivariable analyses. RESULTS The patient's narrative was interrupted at least one time in 144 visits (74%). The duration of each visit was a median of 12 minutes (IQR 9 to 16 minutes). The median time patients spent describing their symptoms was 139 seconds before the first interruption (IQR 84 to 225 seconds). The median duration between the end of the initial greeting and the first interruption was 60 seconds (IQR 30 to 103 seconds). Clinician interruption was associated with shorter duration of symptom description. Greater perceived clinician empathy was associated with greater accommodation of pain (regression coefficient [95% confidence interval] = 0.015 [0.0005-0.30]; P = 0.04). DISCUSSION Clinician interruption was associated with shorter symptom presentation, but not with diminished perception of clinician empathy. Although active listening and avoidance of interruption are important communication tactics, other aspects of the patient-clinician relationship may have more effect on patient experience.
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Affiliation(s)
- S Ryan Pierson
- From the Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX
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Pierson SR, Ngoue M, Lam R, Rajagopalan D, Ring D, Ramtin S. When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy? Clin Orthop Relat Res 2023; 481:1771-1780. [PMID: 36853843 PMCID: PMC10427050 DOI: 10.1097/corr.0000000000002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/05/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Patient use of verbal and nonverbal communication to signal what is most important to them can be considered empathetic opportunities. Orthopaedic surgeons may have mixed feelings toward empathetic opportunities, on one hand wanting the patient to know that they care, and on the other hand fearing offense, prolonged visit duration, or discussions for which they feel ill prepared. Evidence that action about empathetic opportunities does not harm the patient's experience or appreciably prolong the visit could increase the use of these communication tactics with potential for improved experience and outcomes of care. QUESTIONS/PURPOSES Using transcripts from musculoskeletal specialty care visits in prior studies, we asked: (1) Are there factors, including clinician attentiveness to empathetic opportunities, associated with patient perception of clinician empathy? (2) Are there factors associated with the number of patient-initiated empathetic opportunities? (3) Are there factors associated with clinician acknowledgment of empathetic opportunities? (4) Are there factors associated with the frequency with which clinicians elicited empathetic opportunities? METHODS This study was a retrospective, secondary analysis of transcripts from prior studies of audio and video recordings of patient visits with musculoskeletal specialists. Three trained observers identified empathetic opportunities in 80% (209 of 261) of transcripts of adult patient musculoskeletal specialty care visits, with any uncertainties or disagreements resolved by discussion and a final decision by the senior author. Patient statements considered consistent with empathetic opportunities included relation of emotion, expression of worries or concerns, description of loss of valued activities or loss of important roles or identities, relation of a troubling psychologic or social event, and elaboration on daily life. Clinician-initiated empathetic opportunities were considered clinician inquiries about these factors. Clinician acknowledgment of empathetic opportunities included encouragement, affirmation or reassurance, or supportive statements. Participants completed post-visit surveys of perceived clinician empathy, symptoms of depression, and health anxiety. Factors associated with perceived clinician empathy, number of empathetic opportunities, clinician responses to these opportunities, and the frequency with which clinicians elicited empathetic opportunities were sought in bivariate and multivariable analyses. RESULTS After controlling for potentially confounding variables such as working status and pain self-efficacy scores in the multivariable analysis, no factors were associated with patient perception of clinician empathy, including attentiveness to empathetic opportunities. Patient-initiated empathetic opportunities were modestly associated with longer visit duration (correlation coefficient 0.037 [95% confidence interval 0.023 to 0.050]; p < 0.001). Clinician acknowledgment of empathetic opportunities was modestly associated with longer visit duration (correlation coefficient 0.06 [95% CI 0.03 to 0.09]; p < 0.001). Clinician-initiated empathetic opportunities were modestly associated with younger patient age (correlation coefficient -0.025 [95% CI -0.037 to -0.014]; p < 0.001) and strongly associated with one specific interviewing clinician as well as other clinicians (correlation coefficient -1.3 [95% CI -2.2 to -0.42]; p = 0.004 and -0.53 [95% CI -0.95 to -0.12]; p = 0.01). CONCLUSION Musculoskeletal specialists can respond to empathic opportunities without harming efficiency, throughput, or patient experience. CLINICAL RELEVANCE Given the evidence that patients prioritize feeling heard and understood, and evidence that a trusting patient-clinician relationship is protective and healthful, the results of this study can motivate specialists to train and practice effective communication tactics.
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Affiliation(s)
- S. Ryan Pierson
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Marielle Ngoue
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ryan Lam
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Dayal Rajagopalan
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - David Ring
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Sina Ramtin
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
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Blount E, Davey MG, Joyce WP. Patient reported satisfaction levels with the use of telemedicine for general surgery-A systematic review of randomized control trials. SURGERY IN PRACTICE AND SCIENCE 2023; 12:100152. [PMID: 36570642 PMCID: PMC9769022 DOI: 10.1016/j.sipas.2022.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background As healthcare continues to evolve in the wake of COVID-19 pandemic, surgeons are presented with the opportunity to integrate telemedicine into healthcare in tandem with in-person consultations. We aimed to perform a systematic review of randomized controlled trials to assess patient satisfaction with telemedicine interventions in general surgery. Methods A systematic review was performed in accordance to the PRISMA guidelines. Randomized control trials (RCTs) were included. The risk of bias 2.0 assessment was used to determine potential bias. Results In total, 11 prospective, randomized trials involving 1,598 patients (mean age: 49.1 years) were included. Overall 45.5% (5/11) of the trials compared videoconferencing or telephone follow up to traditional in person follow up. Three studies used smart technologies which include activity tracking devices in combination with a website and mobile application (27.3%). The other 3 interventions involved accelerated discharge on post operative day (POD) 1 with tele videoconferencing on POD 2, Post-operative daily text messages with education videos and video calling capability, and supportive text messages post-operatively. Telemedicine was shown to provide similar levels of patient satisfaction compared to controls in all 11 included RCTs. Conclusion Patient reported satisfaction with the use of telemedicine is similar to standard of care models in general surgery. With several shortcomings confounding the results in support of telemedicine, further experimentation with telemedicine interventions will likely improve patient reported satisfaction with using telemedicine for peroperative surgical care.
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Affiliation(s)
- Eoghan Blount
- Department of Surgery, Galway Clinic, Co. Galway H91 HHT0, Ireland
| | - Matthew G Davey
- Department of Surgery, Galway Clinic, Co. Galway H91 HHT0, Ireland
- Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin 2, D02 YN77, Ireland
| | - William P Joyce
- Department of Surgery, Galway Clinic, Co. Galway H91 HHT0, Ireland
- Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin 2, D02 YN77, Ireland
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Ryan C, Miner H, Ramachandran S, Ring D, Fatehi A. General Anxiety Is Associated with Problematic Initial Recovery After Carpal Tunnel Release. Clin Orthop Relat Res 2022; 480:1576-1581. [PMID: 35023866 PMCID: PMC9278949 DOI: 10.1097/corr.0000000000002115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/22/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Carpal tunnel release can stop the progression of idiopathic median neuropathy at the wrist (carpal tunnel syndrome). Intermittent symptoms tend to resolve after surgery, but loss of sensibility can be permanent. Both pathophysiology (severe neuropathy) and mental health (symptoms of despair or worry) contribute to problematic recovery after carpal tunnel release, but their relative associations are unclear. QUESTION/PURPOSE Is problematic initial recovery after carpal tunnel release associated with psychologic distress rather than with disease severity? METHODS We retrospectively studied 156 patients who underwent in-office carpal tunnel release between November 2017 and February 2020, and we recorded their symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD]) and depression (Patient Health Questionnaire), signs of severe median neuropathy (loss of sensibility, thenar muscle atrophy, and palmar abduction weakness), and problematic recovery. The initial recovery (first 2 weeks) was categorized as problematic if the patient was upset about persistent numbness, experienced unsettling postoperative pain, developed hand stiffness, or experienced wound issues-all of which are routinely recorded in the medical record by the treating surgeon along with signs of severe median neuropathy. Twenty-four percent (38 of 156) of patients had a problematic initial recovery characterized by distress regarding persistent numbness (16% [25 of 156]), unsettling pain (8% [12 of 156]), hand stiffness (5% [8 of 156]), or wound issues (1% [2 of 156]); 6% (9 of 156) of patients had more than one issue. Associations between problematic initial recovery and age, gender, symptoms of anxiety and depression, disease severity, specific exam findings, and insurance were evaluated using t-tests, Mann-Whitney tests, and chi-square tests, with the plan to perform logistic regression if at least two variables had an association with p < 0.10. RESULTS The only factor associated with problematic initial recovery was greater symptoms of anxiety (median GAD score 1.5 [interquartile range 0 to 7.8] for problematic initial recovery compared with a median score of 0 [IQR 0 to 2] for nonproblematic recovery; p = 0.04), so we did not perform a logistic regression. Physical examination findings consistent with severe median neuropathy were not associated with problematic initial recovery. CONCLUSION The finding that problematic initial recovery after carpal tunnel release was related to symptoms of anxiety and not to the severity of median neuropathy highlights the need to study the ability of efforts to ameliorate anxiety symptoms before carpal tunnel release as an effective intervention to reduce unplanned visits and additional tests, therapy, and repeat surgery, while improving patient-reported outcomes and experience. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Claire Ryan
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Harrison Miner
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Shyam Ramachandran
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Ring DC. CORR Insights®: Which Factors Are Associated With Satisfaction With Treatment Results in Patients With Hand and Wrist Conditions? A Large Cohort Analysis. Clin Orthop Relat Res 2022; 480:1302-1304. [PMID: 35020684 PMCID: PMC9191383 DOI: 10.1097/corr.0000000000002113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 01/31/2023]
Affiliation(s)
- David C Ring
- Associate Dean for Comprehensive Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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Arslan T, Çandereli ZÖ, Kitapçi OC, Kitapçi NŞ, Kiliç Aksu P, Köksal L, Özdamar EÖ, Yay M, Ecevit Alpar Ş, Mumcu G. Do Patient Experiences Have Mediating Roles on Patient Loyalty? J Patient Exp 2022; 9:23743735221103027. [PMID: 35651482 PMCID: PMC9149619 DOI: 10.1177/23743735221103027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The study aimed to evaluate the mediating roles of patient experiences on patient
loyalty. The data were collected through an electronic questionnaire regarding
feedback from 5732 patients received outpatient clinics. Patient loyalty was
evaluated using the Net Promoter Score (NPS11) that patients were
asked whether they would like to recommend the hospital to their relatives or
friends. Patient experiences with physicians, nurses, and waiting times were
also asked in the questionnaire. After preliminary analysis, mediation analyses
were performed to evaluate direct and indirect causal effects among variables
for NPS11. While patient experiences are used as possible mediators,
Branch Groups in the first and Admission Time in the second model are
independent variables. In the analyses, Surgical Medical
Science (p = 0.019) and Day Shift
(p = 0.000) have a direct mediating effect on
NPS11. Nursing care experiences were found to be
a mediator variable for NPS11 in both models
(p = 0.000 for both). Patient loyalty was associated with
Surgical Medical Science and Day Shift primarily whereas
Nursing care experience had a mediating role.
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Affiliation(s)
- Tuncay Arslan
- Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Z. Özge Çandereli
- Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Okan Cem Kitapçi
- Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Nur Şişman Kitapçi
- Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Pınar Kiliç Aksu
- Department of Health Management, Faculty of Health Sciences, Altınbaş University, Istanbul, Turkey
| | - Leyla Köksal
- Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Elif Özge Özdamar
- Department of Statistics, Faculty of Science and Literature, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Meral Yay
- Department of Statistics, Faculty of Science and Literature, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Şule Ecevit Alpar
- Department of Nursing, Faculty of Health Science, Marmara University, Istanbul, Turkey
| | - Gonca Mumcu
- Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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Badejo MA, Ramtin S, Rossano A, Ring D, Koenig K, Crijns TJ. Does Adjusting for Social Desirability Reduce Ceiling Effects and Increase Variation of Patient-Reported Experience Measures? J Patient Exp 2022; 9:23743735221079144. [PMID: 35155757 PMCID: PMC8829720 DOI: 10.1177/23743735221079144] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Social desirability bias (a tendency to underreport undesirable attitudes and behaviors) may account, in part, for the notable ceiling effects and limited variability of patient-reported experience measures (PREMs) such as satisfaction, communication effectiveness, and perceived empathy. Given that there is always room for improvement for both clinicians and the care environment, ceiling effects can hinder improvement efforts. This study tested whether weighting of satisfaction scales according to the extent of social desirability can create a more normal distribution of scores and less ceiling effect. In a cross-sectional study 118 English-speaking adults seeking musculoskeletal specialty care completed 2 measures of satisfaction with care (one iterative scale and one 11-point ordinal scale), a measure of social desirability, and basic demographics. Normality of satisfaction scores was assessed using Shapiro-Wilk tests. After weighting for social desirability, scores on the iterative satisfaction scale had a more normal distribution while scores on the 11-point ordinal satisfaction scale did not. The ceiling effects in satisfaction decreased from 47% (n = 56) to 2.5% (n = 3) for the iterative scale, and from 81% (n = 95) to 2.5% (n = 3) for the ordinal scale. There were no differences in mean satisfaction when the social desirability was measured prior to completion of the satisfaction surveys compared to after. The observation that adjustment for levels of social desirability bias can reduce ceiling effects suggests that accounting for personal factors could help us develop PREMs with greater variability in scores, which may prove useful for quality improvement efforts.
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Affiliation(s)
- Megan A. Badejo
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Ayane Rossano
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Karl Koenig
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Tom J Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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