Strooker Joost A, Nota Sjoerd P F T, Hageman Michiel G J S, Ring David C
Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA.
Clin Orthop Relat Res. 2015 Apr;473(4):1478-83. doi: 10.1007/s11999-014-3971-5. Epub 2014 Oct 4.
A clash between a patient's assumptions and a doctor's advice can feel adversarial which might influence satisfaction ratings and compliance with treatment recommendations. A better understanding of sources of patients' bewilderment might lead to improved strategies for conveying counterintuitive information that improve patient comfort and wellbeing.
QUESTIONS/PURPOSES: This study addressed the following questions: (1) Are magnitude of disability, pain intensity, symptoms of depression, or health anxiety associated with a higher level of surprise when a patient is presented with diagnostic information and/or therapeutic recommendations? (2) Does the surgeon accurately perceive the patient's bewilderment? (3) Does the surgeon's perception of patient bewilderment correlate with diagnosis or a patient's magnitude of disability, pain intensity, symptoms of depression, or health anxiety?
In this prospective cohort study, we invited new patients who met prespecified criteria during a 3-month period in one hand-surgery practice to enroll; of 93 patients invited, 84 (90%) agreed to participate. Patients reported demographics and completed the short versions of the DASH questionnaire (QuickDASH), the Patient Health Questionnaire, the Pain Self-Efficacy Questionnaire, and the Short Health Anxiety Inventory; rated their pain intensity; and rated the degree to which the information given by the surgeon was unexpected or surprising on an 11-point ordinal scale. The surgeon also rated his impression of the patient's surprise on an 11-point ordinal scale.
Only greater symptom intensity and magnitude of disability (QuickDASH) correlated with greater unexpected information when rated by the patient (ß = 0.058; p < 0.001). There was a correlation between patient surprise and the surgeon's perception of the patient's surprise (r = 0.58; p < 0.001). Greater surgeon-perceived patient surprise correlated with nonspecific illness (p = 0.007; ß = 3.0).
Patients with greater symptom intensity and magnitude of disability, and perhaps also patients with nonspecific diagnoses, are more likely to be surprised by a hand surgeon's advice. Future research might address the ability of previsit preparation (using decision aids or other alternative means of education) to ameliorate the discordance between patient assumptions and hand surgeon advice.
患者的设想与医生的建议之间的冲突可能会让人感觉充满对抗性，这可能会影响满意度评分以及对治疗建议的依从性。更好地理解患者困惑的根源可能会带来更好的策略，用于传达与直觉相悖的信息，从而提高患者的舒适度和幸福感。
问题/目的：本研究探讨了以下问题：（1）当患者收到诊断信息和/或治疗建议时，残疾程度、疼痛强度、抑郁症状或健康焦虑程度是否与更高程度的惊讶感相关？（2）外科医生是否能准确感知患者的困惑？（3）外科医生对患者困惑的感知是否与诊断或患者的残疾程度、疼痛强度、抑郁症状或健康焦虑程度相关？
在这项前瞻性队列研究中，我们邀请了在一家手外科诊所3个月期间符合预先设定标准的新患者入组；在邀请的93名患者中，84名（90%）同意参与。患者报告了人口统计学信息，并完成了DASH问卷（QuickDASH）、患者健康问卷、疼痛自我效能量表和简短健康焦虑量表的简版；对他们的疼痛强度进行评分；并在一个11点的序数量表上对外科医生提供的信息的意外程度或惊讶程度进行评分。外科医生也在一个11点的序数量表上对他对患者惊讶程度的印象进行评分。
当由患者评分时，只有更高的症状强度和残疾程度（QuickDASH）与更多的意外信息相关（β = 0.058；p < 0.001）。患者的惊讶程度与外科医生对患者惊讶程度的感知之间存在相关性（r = 0.58；p < 0.001）。外科医生感知到的患者更高的惊讶程度与非特异性疾病相关（p = 0.007；β = 3.0）。
症状强度和残疾程度更高的患者，以及可能还有诊断不明确的患者，更有可能对手外科医生的建议感到惊讶。未来的研究可能会探讨就诊前准备（使用决策辅助工具或其他替代教育方式）改善患者设想与手外科医生建议之间不一致的能力。
