Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Health Expect. 2017 Dec;20(6):1201-1217. doi: 10.1111/hex.12527. Epub 2016 Dec 23.
Chronic pain is a major economic and social health problem. Up to 79% of chronic pain patients are unsatisfied with their pain management. Meeting patients' expectations is likely to produce greater satisfaction with care. The challenge is to explore patients' genuine expectations and needs. However, the term expectation encompasses several concepts and may concern different aspects of health-care provision.
This review aimed to systematically collect information on types and subject of patients' expectations for chronic pain management.
We searched for quantitative and qualitative studies. Because of the multidimensional character of the term "expectations," the search included subject headings and free text words related to the concept of expectations.
A framework for understanding patients' expectations was used to map types of expectations within structure, process or outcome of health care.
Twenty-three research papers met the inclusion criteria: 18 quantitative and five qualitative. This review found that assessment of patients' expectations for treatment is mostly limited to outcome expectations (all 18 quantitative papers and four qualitative papers). Patients generally have high expectations regarding pain reduction after treatment, but expectations were higher when expressed as an ideal expectation (81-93% relief) than as a predicted expectation (44-64%).
For health-care providers, for pain management and for pain research purposes, the awareness that patients express different types of expectations is important. For shared decision making in clinical practice, it is important that predicted expectations of the patient are known to the treating physician and discussed. Structure and process expectations are under-represented in our findings. However, exploring and meeting patients' expectations regarding structure, process and outcome aspects of pain management may increase patient satisfaction.
慢性疼痛是一个主要的经济和社会健康问题。高达 79%的慢性疼痛患者对他们的疼痛管理不满意。满足患者的期望可能会产生更高的护理满意度。挑战在于探索患者的真实期望和需求。然而，“期望”一词包含了几个概念，可能涉及医疗保健提供的不同方面。
本综述旨在系统地收集有关慢性疼痛管理患者期望的类型和主题的信息。
我们搜索了定量和定性研究。由于“期望”一词具有多维性，因此搜索包括与期望概念相关的主题词和自由文本词。
使用理解患者期望的框架来映射医疗保健结构、过程或结果中的期望类型。
符合纳入标准的研究论文有 23 篇：18 篇定量研究和 5 篇定性研究。本综述发现，对患者治疗期望的评估大多仅限于结果期望（所有 18 篇定量研究和 4 篇定性研究）。患者普遍对治疗后疼痛减轻抱有很高的期望，但当以理想期望（81-93%缓解）表示时，期望比预测期望（44-64%）更高。
对于医疗保健提供者、疼痛管理和疼痛研究目的，意识到患者表达不同类型的期望很重要。对于临床实践中的共同决策，了解患者对治疗的预测期望并进行讨论对治疗医生很重要。我们的研究结果中结构和过程期望的代表性不足。然而，探索和满足患者对疼痛管理的结构、过程和结果方面的期望可能会提高患者满意度。
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