Laferton Johannes A C, Kube Tobias, Salzmann Stefan, Auer Charlotte J, Shedden-Mora Meike C
Department of Psychology, Clinical Psychology and Psychotherapy, Psychologische Hochschule BerlinBerlin, Germany; Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of MarburgMarburg, Germany.
Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg Marburg, Germany.
Front Psychol. 2017 Feb 21;8:233. doi: 10.3389/fpsyg.2017.00233. eCollection 2017.
Patients' expectations in the context of medical treatment represent a growing area of research, with accumulating evidence suggesting their influence on health outcomes across a variety of medical conditions. However, the aggregation of evidence is complicated due to an inconsistent and disintegrated application of expectation constructs and the heterogeneity of assessment strategies. Therefore, based on current expectation concepts, this critical review provides an integrated model of patients' expectations in medical treatment. Moreover, we review existing assessment tools in the context of the integrative model of expectations and provide recommendations for improving future assessment. The integrative model includes expectations regarding treatment and patients' treatment-related behavior. Treatment and behavior outcome expectations can relate to aspects regarding benefits and side effects and can refer to internal (e.g., symptoms) and external outcomes (e.g., reactions of others). Furthermore, timeline, structural and process expectations are important aspects with respect to medical treatment. Additionally, generalized expectations such as generalized self-efficacy or optimism have to be considered. Several instruments assessing different aspects of expectations in medical treatment can be found in the literature. However, many were developed without conceptual standardization and psychometric evaluation. Moreover, they merely assess single aspects of expectations, thus impeding the integration of evidence regarding the differential aspects of expectations. As many instruments assess treatment-specific expectations, they are not comparable between different conditions. To generate a more comprehensive understanding of expectation effects in medical treatments, we recommend that future research should apply standardized, psychometrically evaluated measures, assessing multidimensional aspects of patients' expectations that are applicable across various medical treatments. In the future, more research is needed on the interrelation of different expectation concepts as well as on factors influencing patients' expectations of illness and treatment. Considering the importance of patients' expectations for health outcomes across many medical conditions, an integrated understanding and assessment of such expectations might facilitate interventions aiming to optimize patients' expectations in order to improve health outcomes.
患者在医疗背景下的期望是一个不断发展的研究领域，越来越多的证据表明其对各种医疗状况下的健康结果有影响。然而，由于期望结构的应用不一致且分散，以及评估策略的异质性，证据的汇总变得复杂。因此，基于当前的期望概念，本批判性综述提供了一个患者医疗期望的综合模型。此外，我们在期望综合模型的背景下回顾现有的评估工具，并为改进未来评估提供建议。综合模型包括对治疗的期望以及患者与治疗相关的行为。治疗和行为结果期望可能涉及益处和副作用方面，并且可以指内部（例如症状）和外部结果（例如他人的反应）。此外，时间线、结构和过程期望是医疗治疗的重要方面。另外，还必须考虑诸如一般自我效能或乐观等广义期望。文献中可以找到几种评估医疗期望不同方面的工具。然而，许多工具的开发没有概念标准化和心理测量学评估。此外，它们仅评估期望的单个方面，从而阻碍了关于期望不同方面的证据整合。由于许多工具评估特定治疗的期望，它们在不同状况之间不可比。为了更全面地理解医疗治疗中期望的影响，我们建议未来的研究应应用经过标准化、心理测量学评估的措施，评估适用于各种医疗治疗的患者期望的多维方面。未来，需要更多关于不同期望概念之间的相互关系以及影响患者对疾病和治疗期望的因素的研究。考虑到患者期望对许多医疗状况下健康结果的重要性性，对期望的这种综合理解和评估可能有助于旨在优化患者期望以改善健康结果的干预措施。
