Department of Communication, University of Illinois Urbana-Champaign, Urbana, IL, USA; Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, USA.
Department of Communication Studies, California State University, Long Beach, CA, USA.
Patient Educ Couns. 2024 Dec;129:108403. doi: 10.1016/j.pec.2024.108403. Epub 2024 Aug 16.
This study tests two hypotheses about spine pain patients' expectations for consultations and their negative evaluations. High expectations may be impractical or unachievable and can set patients up for disappointment. Unmet expectations are the absolute difference between expectations before the visit and perceptions of expectations actually enacted.
We conducted a single-site prospective study using pre- and post-consultation surveys. Patients (N = 200) were English-speaking individuals aged 18-75 presenting for an initial consultation for musculoskeletal pain. Analyses were conducted in SPSS v. 28.0 using mixed modeling to account for interdependence among cases.
Contrary to initial predictions, higher pre-consultation expectations for shared decision-making were positively linked to post-consultation satisfaction, trust, and agreement. Exceeding expectations in shared decision-making, history-taking, examination, and interpersonal skills significantly enhanced post-consultation outcomes.
Results support the unmet expectations hypothesis over the high expectations hypothesis. Increased expectations and exceeding these expectations in key areas of patient-physician interaction were positively associated with improved consultation outcomes.
Findings highlight the importance of exceeding multifaceted patient expectations in physician evaluations. Yet, physicians must first understand the nature and source of each patient's expectations pre-consultation, which vary across individuals in aspirational and realistic dimensions.
本研究检验了两个关于脊柱疼痛患者对咨询的期望及其负面评价的假设。高期望可能不切实际或无法实现，并可能使患者感到失望。未满足的期望是就诊前的期望与实际实现的期望之间的绝对差异。
我们进行了一项单站点前瞻性研究，使用了就诊前和就诊后的问卷调查。患者（N=200）为 18-75 岁的英语使用者，因肌肉骨骼疼痛初次就诊。使用 SPSS v. 28.0 进行分析，采用混合模型来考虑病例之间的相互依存关系。
与最初的预测相反，对共同决策的较高就诊前期望与就诊后满意度、信任和一致性呈正相关。在共同决策、病史采集、检查和人际交往技能方面超出期望，显著提高了就诊后的结果。
结果支持未满足的期望假设，而不是高期望假设。在医患互动的关键领域增加期望并超出这些期望与改善咨询结果呈正相关。
研究结果强调了在医生评估中超出患者多方面期望的重要性。然而，医生首先必须在就诊前了解每个患者期望的性质和来源，这些期望在理想和现实维度上因人而异。
