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The literature lacked research examining the ethical attitudes of nursing students in nursing care and their ability to manage patient expectations. This study aimed to determine the relationship between nursing students' ethical attitudes in providing care and their ability to manage patient expectations. This descriptive-correlational study was carried out in the nursing school a university located in eastern region of Turkey. The population of the study consisted of 1254 students studying at nursing school. The sample consisted of 400 students. The data were collected using the Participant Information Form, Ethical Attitude Scale for Nursing Care and Ability of the Managing Patient Expectations Scale. Descriptive statistics, MANOVA, Correlation and the Cronbach's Alpha reliability analysis were used to evaluate the data. Within the scope of the study, students' ethical attitudes in nursing care and their ability of the managing patient expectations were found to be at high levels. On the other hand, it was found that the ethical attitude in nursing care had a significant and positive effect on the ability to manage patient expectations. The results of the study indicate that a nurse's ethical attitude is a significant factor that predicts their ability to manage patient expectations. [Med-Science 2022; 11(2.000): 452-6]

OBJECTIVE: To develop a conceptual framework and preliminary item bank for childbirth-specific patient-reported outcome (PRO) domains. DATA SOURCES: Women, who were U.S. residents, ≥18 years old, and ≥20 weeks pregnant, were surveyed regarding their childbirth values and preferences (V&P) using online panels. STUDY DESIGN: Using community-based research techniques and Patient-Reported Outcomes Management Information System (PROMIS® ) methodology, we conducted a comprehensive literature review to identify self-reported survey items regarding patient-reported V&P and childbirth experiences and outcomes (PROs). The V&P/PRO domains were validated by focus groups. We conducted a cross-sectional observational study and fitted a multivariable logistic regression model to each V&P item to describe who wanted each item. PRINCIPAL FINDINGS: We identified 5,880 V&P/PRO items that mapped to 19 domains and 58 subdomains. We present results for the 2,250 survey respondents who anticipated a vaginal delivery in a hospital. Wide variation existed regarding each V&P item, and personal characteristics, such as maternal confidence and ability to cope well with pain, were frequent predictors in the models. The resulting preliminary item bank consisted of 60 key personal characteristics and 63 V&P/PROs. CONCLUSIONS: The conceptual framework and preliminary (PROMIS® ) item bank presented here provide a foundation for the development of childbirth-specific V&P/PROs.

The objective of this study was to compare unannounced standardized patient (USP) and patient reports of care. Patient satisfaction surveys and USP checklist results collected at an urban, public hospital were compared to identify items included in both surveys. Qualitative commentary was reviewed to better understand USP and patient satisfaction survey data. Analyses included χ2 and Mann-Whitney U test. Patients provided significantly higher ratings on 10 of the 11 items when compared to USPs. USPs may provide a more objective perspective on a clinical encounter than a real patient, reinforcing the notion that real patients skew overly positive or negative. [ABSTRACT FROM AUTHOR]

Older adults and caregivers play an essential role in medication safety; however, self-perception of their and health professionals' roles in medication safety is not well-understood. The objective of our study was to identify the roles of patients, providers, and pharmacists in medication safety from the perspective of older adults. Semi-structured qualitative interviews were held with 28 community-dwelling older adults over 65 years who took five or more prescription medications daily. Results suggest that older adults' self-perceptions of their role in medication safety varied widely. Older adults perceived that self-learning about their medications and securing them are critical to avoiding medication-related harm. Primary care providers were perceived as coordinators between older adults and specialists. Older adults expected pharmacists to inform them of any changes in the characteristics of medications to ensure medications were taken correctly. Our findings provide an in-depth analysis of older adults' perceptions and expectations of their providers' specific roles in medication safety. Educating providers and pharmacists about the role expectations of this population with complex needs can ultimately improve medication safety. [ABSTRACT FROM AUTHOR]

Summary: Many people living with obesity may have unrealistic expectations prior to undergoing bariatric surgery. These expectations can lead to frustration, regret and even worse psychological outcomes after surgery. Prior to undergoing bariatric surgery, patients completed the BODY‐Q Expectations scale. This 15‐item scale asks patients to imagine what their life will be like when 2 years have passed since bariatric surgery. Scores for expectations range from 0 (low) to 100 (high). Linear regression models were used to assess which of the patient characteristics could predict patients' expectations. From 2019 to 2020, a total of 333 patients were recruited from three different countries. The mean score on the BODY‐Q Expectations scale was 73.1, ±20. Out of the 15 items on the Expectation scale, people living with obesity found it most likely that bariatric surgery would make them feel better and improve their energy, while it was reported least likely that they would look good without clothes on. Younger age (p = <.01) and race (non‐white) (p =.046) were found to be significant predictors for higher scores on the Expectations scale. Participants who identified as non‐white from the Netherlands and United States, and those aged under 40 years reported higher expectations compared with participants who identified as white race and were 40 years of age or older. Prior to bariatric surgery, patients aged under 40 years and those who identified as non‐white for race had higher expectations that their life would change after bariatric surgery. These relevant findings should be considered when giving pre‐operative counselling. [ABSTRACT FROM AUTHOR]

(1) Background: Colorectal cancer (CRC) is a serious health problem in Poland as well as many European Union countries. The study aimed to describe factors that, from the patient's perspective, could increase the attendance rate and regularity of participation in the colorectal cancer screening programme (SP); (2) Methods: The qualitative approach was applied. The study involved six focus interviews conducted with 24 respondents (12 women and 12 men) aged 40–49, who had at least one first-degree family member diagnosed with CRC and persons aged 50–65, living in five selected voivodships (provinces) of Poland. The collected data were thematically coded. Further, a comparative analysis was conducted, and aggregated statements were formulated; (3) Results: The inclusion of primary care clinics within the CRC SP organization was reported as a key factor in improving the attendance rate and regularity of patient participation in the programme. Particularly important factors included an invitation in the form of a personal letter or a phone call made by staff from primary care clinics; (4) Conclusions: Patients were confirmed to have clear expectations and preferences for the organizational conditions of the CRC SP. Preferences nature allows them to be treated as one of the potential criteria for selecting critical parameters of CRC SPs. [ABSTRACT FROM AUTHOR]

Patients with spinal metastases often receive palliative surgery or radiation therapy to maintain or improve health-related quality of life. Patients with unrealistic expectations regarding treatment outcomes have been shown to be less satisfied with their post-treatment health status. This study evaluated expectations of patients with spinal metastases scheduled for surgery and/or radiation therapy. Individual semistructured interviews were conducted with patients with symptomatic spinal metastases before and 6 weeks after surgery and/or radiation therapy. Expectations regarding treatment outcomes were discussed before treatment, and level of fulfillment of these pretreatment expectations was discussed after treatment. Interviews were recorded, transcribed and analyzed according to the thematic analysis method to identify themes. Before treatment, patients thought they were not, or minimally, informed about (expected) treatment outcomes, but they felt well informed about treatment procedures and possible complications. Although patients expected pain relief and improvement in daily functioning, they found it difficult to describe any recovery timeline or the impact of these expected improvements on their daily life. Patients generally understood that treatment was not curative, but lacked insight into the impact of treatment on life expectancy given that this was hardly discussed by their surgeon and/or radiation oncologist. Pretreatment expectations regarding pain and daily functioning were only partially met in most patients post-treatment. Patients thought they were not, or only minimally, informed about expected outcomes after surgery and/or radiation therapy for symptomatic spinal metastases. Improvements in patient-physician communication and counseling could help guide patients toward realistic pretreatment expectations. • Fulfillment of pretreatment expectations of patients with symptomatic spinal metastases about outcomes of palliative surgery and/or radiation therapy may play an important role in post-treatment health-related quality of life. Nevertheless, currently little is known about these pretreatment expectations. • This qualitative study explored patient expectations regarding treatment outcomes after surgery and/or radiation therapy for the treatment of spinal metastases. These insights can help physicians to guide toward realistic pretreatment expectations and hence improved health-related quality of life. • Patients thought they were not or minimally informed about (expected) treatment outcomes. They expected pain relief and improvement in daily functioning, but found it difficult to describe any recovery timeline or the impact of these expected improvements on their daily life. Expectations regarding pain and daily functioning were only partially met after treatment. [ABSTRACT FROM AUTHOR]

Background: This article is part two of a series presenting the findings of stakeholder surveys with ostomates and stoma care nurses (SCNs) for stoma services in England. Part one explored the experiences of ostomates. This article focuses on the views and experiences of 108 SCNs in England. Aim: To understand the experience of SCNs in England in relation to current services provided. This includes the scope of the SCN role, the service they provide, and SCN experience and views on areas for improvement. Method: SCNs were invited to share their experiences and views in a national online survey. Questions considered the experience of the nurse, where the care they provide is delivered, how their post is funded and their views on current issues such as responsibility for managing waste of stoma product. Two free-text questions asked what areas of stoma care services worked well and what areas could be improved, results of which were coded and thematically analysed. Findings: Themes included patient care, industry involvement and prescribing process. Conclusion: Overall, survey respondents felt that they provided a good standard of care. Nurses reported complex industry relationships. Awareness of the Nursing and Midwifery Council Code, Bribery Act 2010 and NHS England guidance on managing conflicts of interest is advocated, as is promoting transparency in funding arrangements. It was noted that there appears to be variation in the care provided to ostomates. [ABSTRACT FROM AUTHOR]

Background: Food allergies are increasingly common and so hospitals must promptly identify and manage these to maintain patient safety. The present study explored patient understanding and expectations of food allergy management in hospital food services., Methods: This exploratory descriptive study used mixed methods, including semi-structured interviews and surveys with hospital inpatients declaring food allergies, aiming to explore understanding, expectations and preferences for food allergy management in the hospital setting., Results: Twenty-four participants were interviewed, reporting between one and six food allergies across 25 different allergens. Three main themes were identified: "Shared responsibility for declaring and managing allergens in hospital", "Varied understanding and trust in hospital food service processes" and "Satisfactory hospital food service experience". In the latter, participants identified 13 key factors valued for hospital food, including appearance, food quality and flavour. Remarkably, being "free from" the food allergen was not amongst the most common factors. Generally, participants felt that declaring a food allergy had not negatively impacted their hospital admission, and overall satisfaction with food services did not differ between the food allergic study participants and the general hospital population., Conclusions: Overall, the declaration of a food allergy did not negatively impact on hospital experience. However, further investigations are required to identify the most valued factors for hospital meals, aiming to enable a more targeted approach to better meet patient expectations., (© 2024 The Author(s). Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Background: Robotic-assisted total joint arthroplasty (TJA) has gained popularity in recent years. Despite mixed patient and surgeon perceptions, conflicting evidence regarding efficacy and cost-effectiveness in comparison to manual TJA exists. Patients' beliefs surrounding robotic-assisted TJA remain unclear. This study aims to assess patients' expectations on robotic technology in TJA., Methods: A 9-question survey assessing patient understanding and expectations of the use of robotics in TJA was distributed to preoperative and postoperative hip and knee patients of five surgeons at a high-volume academic center. Responses were descriptively analyzed., Results: A total of 498 responses were collected. Of all respondents, 69.1% are aware of robotic usage in TJA, 68.5% are interested but unsure of the benefits, and only 19.5% feel it is superior to manual surgery. Most patients did not consider robotic TJA as minimally invasive surgery, with 61.7% stating they are not the same. In addition, 52.3% were not comfortable with extra or longer incisions for robotic procedures. Regarding surgeon choice, 94.9% did not consider if the surgeon is able to perform robotic TJA, 74.4% wanted their surgeon proficient in manual TJA, and 72.4% felt that surgeons who use robotic technology are not more capable than manual surgeons., Conclusions: Awareness and curiosity of robotic-assisted TJA exists; however, most patients did not appear to acknowledge superiority or benefits over manual surgery. Furthermore, patients appear to prefer surgeon proficiency in manual techniques, which may influence training programs in the future. Surgeons should weigh patient goals, expectations, outcomes, and costs when choosing to perform robotic TJA., (© 2024 The Authors.)

Rare disease patients constitute a significant part of the healthcare system of all countries. However, the information on the experiences during disease processes and daily life of rare disease patients is still limited. So far, there is a small number of studies conducted in Türkiye, and they mainly cover specific issues like education or anxiety. Here we present a comprehensive survey analysis conducted among the patients and their families within the scope of the Istanbul Solution Platform for Undiagnosed and Rare Diseases-ISTisNA project. A total of 498 individuals responded to the survey, and 58% of the participants answered all questions. The majority of the patients were in the age range of 1–10 years (44.7%), and 91% of all the patients had a precise diagnosis. The diagnosis rate in the first 6 months was 69%, and almost 10% of the patients remained undiagnosed. The mothers were the primary caregivers (72%). Nearly 30% of the caregivers had to quit their jobs and 25% of the patients (0–18 years) had to leave school. Accessing physicians with relevant specialization and reaching treatments/medications/supplements were the two main obstacles the participants mentioned, with a frequency of 81% and 73%, respectively. Around 50% of participants noted that they commonly faced difficulties at work/school and in their social lives. The highest expectation or priority was the establishment of rare disease-specific diagnosis and treatment centers, accurate and detailed information on diseases in the Turkish language, and easy access to physicians, treatments, and supportive therapies. To the best of our knowledge, this is the most comprehensive survey conducted on the rare disease community in Türkiye. These results show that regardless of the country, the individuals affected by rare diseases and their families have similar problems and expectations. On the other hand, regional and country-specific issues are still in the line to be solved. These studies can provide a deeper insight into rare diseases and guide the activities of Türkiye's national rare disease action plan.

Objectives: To validate the use of a patient experience survey composed of the Spanish version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and of questions locally created in our institution, a private hospital in Panama. To identify which domains of our patient experience survey have the strongest association with the overall inpatient hospital experience rating. Methods: A retrospective analysis of 1619 electronic survey results of adult inpatient experience data was performed using exploratory factor and Pearson correlation analyses. The data was collected between March 2018 and December 2019 from a web-survey application, accessible through a link sent by email after hospital discharge. Results: Results from analyses showed that questions grouping occurred under the same domains as the HCAHPS English version (factor loading 0.456 to 0.918) and that a new domain named administrative processes (0.818 to 0.846) arose for the newly created questions. Cronbach's alpha values ranged from 0.32 to 0.85, with an α of0.65 for the new local questions. Correlation analyses were higher for the domains of communication from nurses (0.670) and administrative processes (0.618). Conclusions: Our investigation validates the use of our patient experience survey, composed of questions from the Spanish version of the HCAHPS survey and locally created ones. In our institution, communication from nurses is most correlated with the inpatient hospital experience rating. Hospital administrative processes were also strongly associated with the overall inpatient hospital rating, and we argue that these later aspects should be addressed to improve the patient experience. [ABSTRACT FROM AUTHOR]

There is a large demand for online patient information for patients considering rhinoplasty. While there are many resources available, the quality and content of the information provided are unknown. This study aimed to assess the quality of the most popular information available online, using the "Ensuring Quality Information for Patients" (EQIP) tool to evaluate the content, structure, and readability of patient information on websites. Search terms including nose operation, nose job, nose reshaping, nose tip surgery, rhinoplasty, septorhinoplasty, were identified using Google AdWords and Trends. Unique links from the first 10 pages for each term were identified and evaluated with websites written in English and for general non-medical public use were included. 295 websites met the eligibility criteria with a median overall EQIP score of 17. Only 33% contained balanced information on the risks and benefits. Bleeding and infection risk was only mentioned in 29% and 27% of websites, respectively. Two percent described complication rates of the procedures and only 20% of articles explained further surgery may be required to achieve patient cosmetic or functional satisfaction. Information regarding rhinoplasty available online is currently of poor quality. The lack of effective risk counselling, possible outcome management, and complications may likely lead to unrealistic expectations of rhinoplasty. It is crucial the risks of surgery are communicated to the patient to ensure they can make an informed decision. Improved education through online resources would likely help to promote more realistic patient expectations. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to explore expectations of patients with bilateral vestibulopathy regarding vestibular implant treatment. This could advance the definition of recommendations for future core outcome sets of vestibular implantation and help to determine on which characteristics of bilateral vestibulopathy future vestibular implant research should focus. Methods: Semi-structured interviews were conducted with 50 patients diagnosed with bilateral vestibulopathy at Maastricht UMC +. Interviews followed a semi-structured interview guide and were recorded and transcribed. Transcripts were analyzed thematically by two independent researchers. A consensus meeting took place to produce a joint interpretation for greater dimensionality and to confirm key themes. Results: Overall, patient expectations centralized around three key themes: (physical) symptom reduction, functions and activities, and quality of life. These themes appeared to be interrelated. Patient expectations focused on the activity walking (in a straight line), reducing the symptom oscillopsia and being able to live the life they had before bilateral vestibulopathy developed. In general, patients indicated to be satisfied with small improvements. Conclusion: This study demonstrated that patient expectations regarding a vestibular implant focus on three key themes: symptom reduction, functions and activities, and quality of life. These themes closely match the functional improvements shown in recent vestibular implantation research. The results of this study provide a clear guideline from the patient perspective on which characteristics of bilateral vestibulopathy, future vestibular implant research should focus. Trial registration: NL52768.068.15/METC [ABSTRACT FROM AUTHOR]

Lung cancer screening (LCS) is a process involving multiple low-dose computed tomography (LDCT) scans over multiple years. While adherence to recommended follow-up is critical in reducing lung cancer mortality, little is known about factors influencing adherence following the initial LDCT scan. The purpose of this study was to examine patients' and providers' depictions of continued screening and their understandings of patients' decisions to return for follow-up. Qualitative methodology involves interviews with patients about their understanding of the screening process and perceptions of lung cancer risk, including motivations to adhere to follow-up screening and surveillance. Analysis of interview transcripts followed the general procedures of grounded theory methodology. Patient adherence to LCS was influenced by their understanding of the process of screening, and their expectations for the next steps. Perceptions of lung cancer risk and associated motivation were not static and changed throughout the screening process. Recognizing that patients' motivations may be dynamic over the course of screening and surveillance will assist providers in helping patients make decisions regarding continued engagement with LCS. [ABSTRACT FROM AUTHOR]

Abstract Background Realistic pre-treatment expectations are important and have been associated with post-treatment health related quality of life (HRQOL). Patient expectations are greatly influenced by physicians, as they are the primary resource for information. This study aimed to explore the communication practices of physicians regarding treatment outcomes for patients with spinal metastases, and physician experiences with patients’ pre-treatment expectations. Methods An international qualitative study using semi-structured interviews with physicians routinely involved in treating metastatic spine disease (spine surgeons, radiation and medical oncologists, and rehabilitation specialists) was conducted. Physicians were interviewed about the content and extent of information they provide to patients with spinal metastases regarding treatment options, risks and treatment outcomes. Interviews were transcribed verbatim and analyzed using a thematic coding network. Results After 22 interviews data saturation occurred. The majority of the physicians indicated that they currently do not establish patients’ pre-treatment expectations, despite acknowledging the importance of these expectations. Spine surgeons often believe that patient expectations are disproportionate. Physicians expressed they manage expectations by detailing the most common risks and providing a broad but nonspecific overview of treatment outcomes. While the palliative intent seems clear to the physicians, their perception is that the implications of a palliative treatment remains elusive to most patients. Conclusion This study highlights the current gap in patient-physician communication regarding expectations of treatment outcomes of patients with spinal metastases. These results warrant further research to improve communication practices and determine the effect of patient expectations on patient reported outcomes in this population.

Abstract Background Patients’ relationship with their GPs is linked to adherence, patient behaviour and satisfaction with healthcare. Several factors pertaining to this relationship have already been identified, however expectations and preferences vary depending on age and diagnosis. Chronically ill elderly patients constitute a group of patients with specific needs that are not yet understood. Methods For this observational study, 100 (44 female, mean age 72.72 + − 8.28 years) patients were interviewed. Multiple linear or binary logistic regression as well as analysis of variance was used to understand the link between factors pertaining to GP relationship and patient behaviour, and principal component analysis was performed to understand the underlying structure of patients’ needs. Results Patients attribute high importance to their GP’s opinion of them. On average, what the GP thinks about the patients is almost as important as what their partners think. Patients primarily want to be perceived as engaged, friendly and respected individuals, and it is important for patients to be liked by their GP. This importance is linked to active preparation; 65% of the patients prepared actively for GP consultations. Expectations regarding GP consultations can be split into two components: a medical aspect with a subfactor concerning emotional support, and a social component. Prominent factors influencing the relationship are the possibility to talk about emotions and mental well-being, trust, and GP competency. Satisfaction and trust were mainly linked to medical competency. Being able to show emotions or talk about mental well-being enhances perceived GP competence, satisfaction, and active patient preparation. However, a focus on the social component such as frequent talking about private topics reduces both perceived GP competency as well as active patient preparation. Conclusion Older patients take GP consultations seriously, and their expectations regarding GP consultations focus on medical competence and care as well as empathetic listening and understanding. Older persons seek a deeper connection to their GPs and are willing to be active and cooperative. As the patient–GP relationship influences health outcomes, treatment of older patients should be adjusted to enable this active participation.

The literature lacked research examining the ethical attitudes of nursing students in nursing care and their ability to manage patient expectations. This study aimed to determine the relationship between nursing students' ethical attitudes in providing care and their ability to manage patient expectations. This descriptive-correlational study was carried out in the nursing school a university located in eastern region of Turkey. The population of the study consisted of 1254 students studying at nursing school. The sample consisted of 400 students. The data were collected using the Participant Information Form, Ethical Attitude Scale for Nursing Care and Ability of the Managing Patient Expectations Scale. Descriptive statistics, MANOVA, Correlation and the Cronbach's Alpha reliability analysis were used to evaluate the data. Within the scope of the study, students' ethical attitudes in nursing care and their ability of the managing patient expectations were found to be at high levels. On the other hand, it was found that the ethical attitude in nursing care had a significant and positive effect on the ability to manage patient expectations. The results of the study indicate that a nurse's ethical attitude is a significant factor that predicts their ability to manage patient expectations. [ABSTRACT FROM AUTHOR]

The relationship between managing patient expectations and postoperative functional outcomes has been studied widely in other areas of orthopedics, but there is a paucity of information in the foot and ankle literature. The primary objective of the study was to identify the most common patient "expectations" from hallux valgus surgery and establish over what time period postsurgery they would meet those goals. A prospective study of 45 consecutive patients was performed at a single center. This included adult patients (>18 years old) that underwent a scarf osteotomy for primary hallux valgus correction. Patients were followed up for 6 months and completed pre- and postoperative Manchester-Oxford Foot Questionnaire and Visual Analogue Scale scores. A separate "expectations" questionnaire was designed and completed assessing the patient's preoperative rehabilitation expectations compared to the actual time taken to achieve those goals. These included 5 domains: pain improvement, return to walking unaided, return to normal foot sensation, return to normal footwear, and return to driving. The postoperative functional scores demonstrated statistically significant improvement postsurgery (p <.001). It also highlighted the overall time frame over which the above expectations were met. On average, patients achieved satisfactory pain improvements 1.4 weeks earlier than expected (p <.001) along with trends toward an earlier return to driving function of patient expectation (p <.05). Patients can thus be reliably informed that their pain symptoms are likely to settle within one month of surgery. This should allow patients to prepare for their rehabilitation more informed, thus facilitating earlier weightbearing and return to function. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to determine the association between baseline patient recovery expectations and outcomes following physical therapy care. Methods. PubMed, CINAHL Complete, PEDro, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO were searched from inception to February 2021. Concepts represented in the search included physical therapy, patient expectations, patient outcomes, and their relevant synonyms. Two reviewers independently screened studies of article abstracts and full texts. Eligibility criteria included English language studies that evaluated adults seeking physical therapist intervention for any health condition where both patient outcome (recovery) expectations and functional or other outcome measures were reported. Methodologic standards were assessed using the Critical Appraisal Skills Program criteria. Data were extracted using a custom template for this review with planned descriptive reporting of results. Vote counting was used to measure reported outcomes. Results. Twenty-one studies were included in this review, representing 4879 individuals. Studies were most commonly prospective cohort studies or secondary analyses of controlled trials. Varied expectation, outcome, and statistical measures that generally link patient recovery expectations with self-reported outcomes in musculoskeletal practice were used. Conclusion. Patient recovery expectations are commonly associated with patient outcomes in musculoskeletal physical therapy. Impact. Evidence supports measuring baseline patient expectations as part of a holistic examination process. [ABSTRACT FROM AUTHOR]

Decision making about breast reconstruction (BR) is complex. The Patients' Expectations and Goals: Assisting Shared Understanding of Surgery (PEGASUS) intervention aims to support shared decision making by helping women and clinicians clarify and discuss their expectations around reconstructive surgery. We conducted a multi-centred sequential trial comparing PEGASUS (n = 52) with usual care (UC) (n = 86) in women considering reconstruction, who completed outcome measures at baseline, and 3, 6 and 12 months post-surgery. The primary outcome was BR-specific quality of life (Breast-Q) 6 months post-intervention. Secondary outcomes were health-related quality of life (EQ-5D-5L), capabilities (ICECAP-A) and decisional regret, compared using t -tests and Cohen's d. Comparative analyses revealed no significant differences between groups in Breast-Q scores at any time point, except for a favourable effect for UC on psychological well-being at 3 months (t = -2.41, p =.019, d = -0.59). Intervention participants reported significantly higher, therefore improved, ICECAP-A (t = -2.13, p =.037, d = -0.45) and EQ VAS (t = -2.28, p =.026, d = -0.49) scores at 12 months compared to UC. Decisional regret was significantly lower in the PEGASUS group compared to the UC group at 6 months (t =2.06, p =. 044, d = -0.51), but this was not sustained at 12 months. In conclusion, the PEGASUS intervention offers some benefits to women considering BR. At times, women experienced less decisional regret, improved health-related quality of life and capability well-being. Findings are discussed in the light of fidelity testing and embedding PEGASUS into practice. [ABSTRACT FROM AUTHOR]

Objective: To explore clinicians' and women's views and experiences with managing polycystic ovary syndrome (PCOS).Methods: Semi-structured interviews with 36 clinicians and 26 women with PCOS. Clinicians were recruited through advertising via relevant professional organisations, snowballing and contacting clinics across Australia. Women with PCOS were recruited through social media advertising. Transcribed audio-recordings were analysed thematically using Framework analysis.Results: Findings across women with PCOS and clinician interviews were organised into three themes. Both women and clinicians experienced 1) challenges with managing PCOS, often stemming from the disparate and wide spectrum of presentations, issues with current treatment options (including limited evidence) and the long-term nature of management. Both spoke about 2) online information about PCOS and alternative treatments, including lack of relevant information and widespread misinformation. 3) Follow-up and continuity of care, where we found notable differences between women's and clinicians' expectations.Conclusions: This is the first study to explore both clinicians' and women's experiences with managing PCOS, illustrating several challenges in managing this heterogeneous condition.Practice Implications: Clarifying and addressing patient expectations, providing personalised counselling and information according to PCOS phenotype and a multidisciplinary approach may reduce uncertainty and improve patient-centred care. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic ductal adenocarcinoma cancer (PDAC) remains a challenging diagnosis. The likelihood of long-term survival is limited even for patients who undergo maximal medical therapy with systemic chemotherapy and surgical resection. Within this intensive process, there remains limited understanding of patients' pretreatment expectations of PDAC treatment experience and their decision-making process.Methods: PDAC patients who underwent chemotherapy and surgical resection were retrospectively identified. Semi-structured phone interviews were completed regarding patient experience with therapy. Qualitative descriptive analysis was performed, and categories, subcategories, and themes were determined.Results: Fifteen patients were interviewed regarding their experience with PDAC treatment. An overall personal disease trajectory experience was identified with two phases. The first phase encompassed the patients' treatment. In this phase, patients expressed a choice, non-choice regarding therapy decisions, viewing therapy as the only option. Misconceptions about the roles of therapies and expected experience of treatment were observed. The second phase focused on life after therapy. Patients reported persistent physical changes secondary to therapy. An overall realistic understanding of the patient's limited prognosis was observed, with patients expressing appreciation of the life time gained as a benefit of treatment.Conclusions: There remains critical areas for improvement in communication and care of patients with PDAC. Physicians should continue to ensure that patient's goals and wishes are respected when making treatment decisions and confirm that patients understand the roles and limitations of prescribed therapies. Additionally, patients continue to have significant physical changes post treatment which should be assessed for and managed as appropriate to maintain quality of life. [ABSTRACT FROM AUTHOR]

Abstract Background Little is known about treatment expectations of patients with spinal metastases undergoing radiotherapy and/or surgery. Assuming that patients with spinal metastases share characteristics with patients who had spinal surgery for non-cancer related conditions and with advanced cancer patients, we performed a systematic review to summarize the literature on patient expectations regarding treatment outcomes of spinal surgery and advanced cancer care. Methods A comprehensive search was performed in MEDLINE, EMBASE and PsycINFO for studies between 2000 and sep-2019. Studies including adult patients (> 18 years), undergoing spinal surgery or receiving advanced cancer care, investigating patients’ pre-treatment expectations regarding treatment outcomes were included. Two independent reviewers screened titles, abstracts and full-texts, extracted data and assessed methodological quality. Results The search identified 7343 articles, of which 92 were selected for full-text review. For this review, 31 articles were included. Patients undergoing spinal surgery had overly optimistic expectations regarding pain and symptom relief, they underestimated the probability of functional disability, and overestimated the probability of (complete) recovery and return to work. Studies highlighted that patients feel not adequately prepared for surgery in terms of post-treatment expectations. Similarly, advanced cancer patients receiving palliative treatment often had overly optimistic expectations regarding their survival probability and cure rates. Conclusions Patients tend to have overly optimistic expectations regarding pain and symptom relief, recovery and prognosis following spinal surgery or advanced cancer care. Pretreatment consultation about the expected pain and symptom relief, recovery and prognosis may improve understanding of prognosis, and promote and manage expectations, which, in turn, may lead to better perceived outcomes. Trial registration PROSPERO registration number: CRD42020145151 .

Abstract Background Low back pain is a common reason for patients to seek medical care. Physician non-adherence to clinical guidelines has been observed. We investigated the extent to which patient expectations correspond to recommendations of the German national guideline for management of low back pain (G-LBP) and whether patient characteristics, history of LBP and previous treatment experience are associated with expectations. Methods A cross-sectional study including patients from 13 general practices was conducted. Data were collected using a questionnaire. Inverse probability weights were used to address non-response bias. Descriptive analysis and multivariate logistic regression models were performed. Results A total of 977 patients were included in analyses (median age 57 years, 39% male). 75% of patients reported experiencing LBP currently or within the last year. More than 65% indicated they would agree to forgo further examinations if their LBP was judged by their physician to be of no serious concern. This was associated with the highest level of education and no prior imaging, and negatively associated with good-to-poor health status and moderate-to-severe pain intensity. 40% of participants expected imaging. The highest educational level, female gender and no prior imaging were associated with a decreased expectation of imaging. 70% expected prescriptions for massages. Females, participants with good-to-poor health status, current LBP or LBP in the last 12 months had an increased expectation for massages. Expectations for injection therapy (45%) were mainly associated with previous injections. Expectations for physiotherapy (64%) were associated with female gender, lower educational level, good-to-poor health status, current LBP or in the last 12 months. The perspective that daily activities should be continued (66%) was associated with female gender and higher educational level. Participants who agreed to the statement ‘There is no effective treatment for LBP’ (11%) had a poor health status, current LBP and a severe pain intensity. Conclusion Patient views regarding LBP management are partially concordant with guideline recommendations and are strongly influenced by previous treatment experiences and education level. Exploration of patient expectations and experiences in LBP treatment may help minimize dissatisfaction of patients expecting treatments not endorsed by guidelines and simultaneously increase physician guideline adherence.

Purpose: This study sought to identify patterns of self-reported regret after hysterectomy. Methods: Women undergoing hysterectomy for a benign indication were recruited in the 2 weeks prior to surgery. Women reported demographics and completed validated questionnaires (Decisional Regret Scale, Patient Health Questionnaire-9, Decisional Conflict Scale, and the Comprehensive Score for Financial Toxicity) up to 7 times over the first year postsurgery. Medical records were reviewed for clinical and operative details. Latent class growth mixture models were applied to the repeated regret scores to identify patterns after hysterectomy. Clinical and other participant characteristics were compared across the classes. Results: Three latent classes were identified among the 459 participants (422 of whom completed questionnaires at 12 months): “High Regret” (7.4%), women with a high regret score at baseline that did not improve over time; “Decreasing Regret” (13.3%), women with high baseline levels of regret but whose regret scores improved over time; and “Least Regret” (79.3%), women with the lowest baseline regret scores that remained low after surgery. These classes did not vary with respect to indication for surgery, clinical characteristics, age, or body mass index. Disproportionately more African American women (adjusted odds ratio: 1.99, 95% CI: 1.01–3.9) were in the “Decreasing Regret” versus “Least Regret” classes. Baseline satisfaction varied between the classes, with the “Least Regret” group having higher baseline satisfaction with their decision. Women with “Decreasing Regret” reported worse financial toxicity associated with surgery versus women in the “Least Regret” class (adjusted odds ratio: 0.95, 95% CI: 0.92–0.99). Conclusions: For some women, decisional regret may worsen after hysterectomy. More often, initial regret lessens over time. Future studies that identify factors strongly associated with self-reported regret could lead to improved counseling about postsurgical expectations.

One of the roles of a genetic counselor, when returning genetic test results for Parkinson's disease (PD), is to provide emotional support to the patient. However, whether or not these needs are being met in the genetic counseling setting is unknown. In this cross-sectional qualitative study, semi-structured interviews with 15 PD research participants were conducted to evaluate their emotional needs and expectations throughout the genetic counseling process. Interview questions assessed participants' background understanding of genetic counseling, informational and emotional expectations prior to the genetic counseling session, and experience with emotional support throughout the genetic counseling process. Through reflexive thematic analysis, we defined four major themes: (1) knowledge of genetic counselors' role in education but not in emotional support, (2) limited expectations for emotional support, (3) emotional support is not sought from genetic counselors, and (4) emotional support from genetic counselors was viewed ambivalently. One of the most important findings from this study was that regardless of whether participants had previously heard of genetic counseling, none of the participants knew that the provision of emotional support was an aspect of the genetic counselor's role. Although the majority of participants did not expect emotional support from their genetic counselor, over 60% of participants recognized that receiving emotional support is or could be important to them. Collectively, these findings highlight the necessity for enhanced patient education pertaining to the informational and emotional support that genetic counselors are trained to provide. We suggest that clarifying the role of emotional support with patients may increase comfort in disclosing their emotional needs with genetic counselors, improving patient-centered care overall., (© 2024 The Author(s). Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Background: An increasing number of lumbar spine conditions are treated surgically. Such intervention, however, is commonly thought to be more effective in addressing leg pain than low back pain. Patient expectations may also contribute to self-reported surgical outcomes. Questions/Purposes: We sought to compare the expectations of patients in 2 groups undergoing lumbar spine surgery: those with predominantly low back pain and those with predominantly leg pain. We also sought to evaluate how these expectations were fulfilled for each group. Methods: We carried out a retrospective analysis of prospectively collected data from a prior study in which patients scheduled for lumbar spine surgery at a single institution completed validated surveys preoperatively and at 2 years postoperatively, including a 20-item survey on expectations for lumbar spine surgery. The patients were enrolled in the study between February 2010 and August 2012, and were divided into 2 cohorts: a "Back > Leg" group that consisted of patients with back pain that was isolated or greater than leg pain, and a "Leg ≥ Back" group that consisted of patients with leg pain that equaled or exceeded back pain. The primary analysis compared composite expectation scores (range, 0–100) between groups. Results: A total of 366 patients were deemed eligible for the study; of these, 162 patients were allocated to the Back > Leg group and 204 patients were allocated to the Leg ≥ Back group. Patients in the Leg ≥ Back group had a greater mean preoperative expectation score compared with those in the Back > Leg group. Multivariate analysis demonstrated that higher preoperative expectations were associated with leg pain symptoms after controlling for disease diagnosis. Both groups reported similar proportions of fulfilled expectations. Conclusion: Patients with predominantly leg pain hold greater preoperative expectations for lumbar spine surgery than do patients with predominantly back pain. That these patient groups reported similar fulfillment of their expectations at 2 years postoperatively illustrates the greater clinical outcomes achieved among patients who presented with predominantly leg pain. [ABSTRACT FROM AUTHOR]

Migraine is a common condition that causes significant morbidity. It is often divided into acute and chronic, but there can be overlap between those who have variable frequency acute episodes and those who have chronic migraine with 15 headache-associated days per month. Botulinum toxin is a prophylactic treatment licensed for chronic migraine, where it has been shown to be an effective and safe treatment. It requires approximately 200 units per treatment session, usually at 3-month intervals. The protocols allowing NHS treatment strictly limit its use. Patients may seek this on a private basis, and suitably qualified aesthetic clinicians who are Care Quality Commission-registered could reasonably treat patients. [ABSTRACT FROM AUTHOR]

Background: Realistic pre-treatment expectations are important and have been associated with post-treatment health related quality of life (HRQOL). Patient expectations are greatly influenced by physicians, as they are the primary resource for information. This study aimed to explore the communication practices of physicians regarding treatment outcomes for patients with spinal metastases, and physician experiences with patients' pre-treatment expectations.Methods: An international qualitative study using semi-structured interviews with physicians routinely involved in treating metastatic spine disease (spine surgeons, radiation and medical oncologists, and rehabilitation specialists) was conducted. Physicians were interviewed about the content and extent of information they provide to patients with spinal metastases regarding treatment options, risks and treatment outcomes. Interviews were transcribed verbatim and analyzed using a thematic coding network.Results: After 22 interviews data saturation occurred. The majority of the physicians indicated that they currently do not establish patients' pre-treatment expectations, despite acknowledging the importance of these expectations. Spine surgeons often believe that patient expectations are disproportionate. Physicians expressed they manage expectations by detailing the most common risks and providing a broad but nonspecific overview of treatment outcomes. While the palliative intent seems clear to the physicians, their perception is that the implications of a palliative treatment remains elusive to most patients.Conclusion: This study highlights the current gap in patient-physician communication regarding expectations of treatment outcomes of patients with spinal metastases. These results warrant further research to improve communication practices and determine the effect of patient expectations on patient reported outcomes in this population. [ABSTRACT FROM AUTHOR]

Purpose: Medial pivot (MP) total knee arthroplasty (TKA) aims to restore native knee kinematics due to highly conforming medial tibio-femoral articulation with survival comparable to contemporary knee designs. Posterior stabilized (PS) TKAs use cam-post mechanism to restore native femoral rollback. However, there is conflicting evidence regarding the reported patient satisfaction with MP TKA designs when compared to PS TKAs. The primary aim of this study is to compare the patient satisfaction between MP and PS TKA and the secondary aim is to establish potential reasons behind any differences in the outcomes noted between these two design philosophies. Methods: In this IRB-approved single surgeon, single centre prospective RCT, 53 patients (mean age 62 years, 42 women) with comparable bilateral end-stage knee arthritis undergoing simultaneous bilateral TKA were randomized to receive MP TKA in one knee and PS TKA in the contralateral knee. At 4 years post-surgery, all patients were assessed using Knee Society Score (KSS)-Satisfaction and -Expectation scores, and Oxford Knee Score (OKS). In addition, all the patients underwent standardized radiological and in vivo kinematic assessment. Results: Patients were more satisfied with the MP TKA as compared to PS TKA: mean KSS-Satisfaction [34.5 ± 3.05 in MP and 31.7 ± 3.16 in PS TKAs (p < 0.0001)] and mean KSS-Expectation scores [12.5 ± 1.39 in MP TKAs and 11.2 ± 1.41 in PS TKAs (p < 0.0001)]. No significant difference was noted in any other clinical outcomes. The in vivo kinematics of MP TKAs was significantly better than those of PS TKAs. Conclusion: MP TKAs provide superior patient satisfaction and patient expectations as compared to PS TKA. This may be related to better replication of natural knee kinematics with MP TKA. Level of evidence: I. [ABSTRACT FROM AUTHOR]

Objective This study sought to evaluate if actively informing new chronic pain patients about treatment options and setting realistic expectations for care, through the use of a pre-visit informational handout prior to the first clinic visit, improved patient satisfaction with subsequently proposed treatment plans. Methods The study was divided into two 3-month periods. During the first 3 months, with our current pain clinic practices in place, new patients (n = 147) were given surveys to establish a baseline of patient satisfaction with treatment plans proposed on their first visit. During the second 3 months, a different group of new patients (n = 156) was given a detailed informational handout which described our clinic's multimodal approach to pain management and therapeutic expectations prior to their visit with a provider. Patient satisfaction with subsequently proposed treatment plans was then assessed and compared with the baseline group. Results The average patient satisfaction score for the group of patients given the informational handout was 4.21 (on a 5-point Likert scale), compared to an average score of 3.25 for the baseline group (P  < .0001, unpaired t -test). 77.6% of patients given the informational handout said their proposed treatment plan met their expectations compared to 46.3% of patients in the baseline group (χ2= 31.61, two-tailed P  < .0001). Conclusions Patient satisfaction with proposed chronic pain treatment plans was improved when clinic approaches to pain were explicitly outlined and therapeutic expectations were clearly established in the form of an informational handout at the outset of the first visit. [ABSTRACT FROM AUTHOR]

Background: Patients' relationship with their GPs is linked to adherence, patient behaviour and satisfaction with healthcare. Several factors pertaining to this relationship have already been identified, however expectations and preferences vary depending on age and diagnosis. Chronically ill elderly patients constitute a group of patients with specific needs that are not yet understood.Methods: For this observational study, 100 (44 female, mean age 72.72 + - 8.28 years) patients were interviewed. Multiple linear or binary logistic regression as well as analysis of variance was used to understand the link between factors pertaining to GP relationship and patient behaviour, and principal component analysis was performed to understand the underlying structure of patients' needs.Results: Patients attribute high importance to their GP's opinion of them. On average, what the GP thinks about the patients is almost as important as what their partners think. Patients primarily want to be perceived as engaged, friendly and respected individuals, and it is important for patients to be liked by their GP. This importance is linked to active preparation; 65% of the patients prepared actively for GP consultations. Expectations regarding GP consultations can be split into two components: a medical aspect with a subfactor concerning emotional support, and a social component. Prominent factors influencing the relationship are the possibility to talk about emotions and mental well-being, trust, and GP competency. Satisfaction and trust were mainly linked to medical competency. Being able to show emotions or talk about mental well-being enhances perceived GP competence, satisfaction, and active patient preparation. However, a focus on the social component such as frequent talking about private topics reduces both perceived GP competency as well as active patient preparation.Conclusion: Older patients take GP consultations seriously, and their expectations regarding GP consultations focus on medical competence and care as well as empathetic listening and understanding. Older persons seek a deeper connection to their GPs and are willing to be active and cooperative. As the patient-GP relationship influences health outcomes, treatment of older patients should be adjusted to enable this active participation. [ABSTRACT FROM AUTHOR]

Background/Aims: Atrial fibrillation is the most common heart rhythm disorder, which increases the risk for stroke and heart failure, and commonly impairs quality of life. Increasing evidence has shown the causative role of several risk factors and suggested that aggressive lifestyle interventions might reduce atrial fibrillation incidence and effects. The size of the problem and how to provide optimal multidisciplinary management is less well known. This study aimed screened patients with atrial fibrillation for potentially modifiable risk factors and describe patients' symptom burden, wellbeing and treatment expectations. Methods: The atrial fibrillation risk profile, symptom burden, wellbeing and expectations of future treatment were studied in 352 patients. Various questionnaires and instruments were used, in addition to medical history assessment. Results: In total, 69% of patients had 1–5 possibly modifiable risk factors for atrial fibrillation: 50% were overweight/obese, 39% had a blood pressure of >140/90 mmHg, 28% had symptoms of obstructive sleep apnoea and 25% reported no physical exercise. Most patients had high expectations for their upcoming atrial fibrillation treatment, but men expected full recovery more often than women. Worries about future health and reduced survival were present in approximately 28% of patients. Conclusions: Most patients with paroxysmal/persistent atrial fibrillation had potentially modifiable risk factors for atrial fibrillation and other cardiovascular events suitable for lifestyle interventions. Several patients experienced limitations in daily life, anxiety related to atrial fibrillation, and worry about their future health and survival. The results of this study might help identify relevant components for risk management and plan an individualised programme for atrial fibrillation patients. [ABSTRACT FROM AUTHOR]

Qian Liu,1 Wei Zhou,1,2 Lu Niu,3 Yu Yu,4 Lizhang Chen,1,2 Bihua Luo,5 Shuiyuan Xiao1,2 1Xiangya School of Public Health, Central South University, Changsha, Hunan, People’s Republic of China; 2Hospital Administration Institute, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 3Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, People’s Republic of China; 4Division of Prevention and Community Research and the Consultation Center, Yale School of Medicine, New Haven, CT, USA; 5Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Wei Zhou; Shuiyuan XiaoXiangya School of Public Health, Central South University, No. 87 Xiangya Street, Changsha, Hunan 410087, People’s Republic of ChinaTel/fax +86 731 8480 5459Email weizhou86@163.com; xiaosy@csu.edu.cnBackground: Patient expectations for health services refer to the anticipation or the belief about what should be encountered in the healthcare system. Understanding patient expectations can improve patient satisfaction and healthcare compliance. It is particularly important for patients with mental disorders, as greater healthcare compliance is required for them due to the chronic and relapsing nature of their diseases. However, little is known about expectations among Chinese patients with mental disorders.Objective: To examine expectations for healthcare among patients with mental disorders and to compare them with those of patients with chronic physical diseases.Patients and methods: A cross-sectional survey was conducted among two inpatient groups, consecutively recruited from the Mental Health Department (MHD) and Endocrinology Department (ED) in one tertiary general hospital in Changsha, China. Patient expectations were measured by eight translated and modified vignettes of health system responsiveness. Group differences were compared using Chi-square tests for socio-demographic and clinical characteristics and Z-test for expectation rating. Logistic regression was performed to test whether group differences of expectations remained statistically significant after controlling for socio-demographic and clinical variables.Results: Most patients from MHD rated scenarios in vignettes on communication, choice of provider, autonomy, and social support as “meeting expectations”, and rated scenarios in vignettes on prompt attention, dignity, confidentiality, and quality of basic amenities as “below expectations”. In comparison, patients from MHD had similar expectations with their counterparts from ED, for prompt attention, dignity, confidentiality, communication, choice of provider, and social support; however, patients from MHD had significantly lower expectations in quality of basic amenities and higher expectations in autonomy, after adjusting for socio-demographic and clinical factors.Conclusion: Like their counterparts with physical diseases, patients with mental disorders also expect prompt attention, dignity, confidentiality, communication, choice of provider, and social support in their interaction with the healthcare system. Moreover, extra attention to autonomy is needed for patients with mental disorders to meet their expectations and improve patient satisfaction.Keywords: patient expectations, responsiveness, mental health, China

Summary Objective Weight perception and degree of confidence in achieving healthy lifestyle can be determinants of engagement in obesity interventions. This study explored patients' perceived need for weight loss and the degree of self‐confidence in ability to lose weight and sought to identify factors associated with patients' self‐confidence in ability to lose weight. Methods The authors analysed data from a survey mailed to primary care patients within five sites of the Learning Health Systems Network that explored participants' prior experience with weight management. Results Among the 2,263 participants who completed the survey section on ‘Patients’ Experience with Weight Management’, perceived need to lose 51 lb or more was statistically significant among those with class III obesity compared with other body mass index (BMI) groups (p value 10 lb were each independently associated with less belief in being able to lose weight. Conclusions Patients had varying perceptions on weight loss; those with category III obesity had the highest desire to lose weight but had the least confidence in ability to lose weight. Higher BMI, female gender and need to lose >10 lb were associated with decreased self‐confidence in ability to lose weight.

Objectives: Total knee replacement (TKR) procedure is commonly carried out in patients with advanced osteoarthritis to reduce pain and increase mobility, with on average 84% rated satisfactory outcome, but some (some suggest 44%) continue to experience debilitating pain. The study aimed to investigate factors affecting pain and function outcomes (using Oxford Knee Score, OKS) one year after TKR, with normative comparison to a reference population. Design: We recruited TKR patients from one hospital (Nottinghamshire, UK); collected pre- and post-operative OKS; graded radiographs for severity of osteoarthritis (K-L grade) in a sub-group. We also collected OKS by postal survey from the local area, calculated age and sex specific normative scores and z-scores of post-operative OKS (Z-OKS). The associations between K-L grade, pre-operative OKS, age, sex, against change in OKS and Z-OKS were analysed. Results: There were 536 TKR cases, 91 in radiographic sub-group and 360 people in reference cohort. Post-operative Z-OKS was associated with K-L grade (β ​= ​0.368; p

Patient engagement with treatments potentially poses problems for interpreting the results and meaning of Randomised Control Trials (RCTs). If patients are assigned to treatments that do, or do not, match their expectations, and this impacts their motivation to engage with that treatment, it will affect the distribution of outcomes. In turn, this will impact the obtained power and error rates of RCTs. Simple Monto Carlo simulations demonstrate that these patient variables affect sample variance, and sample kurtosis. These effects reduce the power of RCTs, and may lead to false negatives, even when the randomisation process works, and equally distributes those with positive and negative views about a treatment to a trial arm.

Background: Total hip arthroplasty (THA) patients expect pain relief and functional improvement, including return to physical activity. Our objective was to determine the impact of patients' physical activity level on preoperative expectations and postoperative satisfaction and clinical outcomes in patients undergoing THA.Methods: Using an institutional registry of patients undergoing THA between 2007 and 2012, we retrospectively identified patients who underwent unilateral primary THA for osteoarthritis and completed a preoperative Lower Extremity Activity Scale, Hospital for Special Surgery Hip Replacement Expectations Survey, and Hip disability and Osteoarthritis Outcome Score in addition to two-year HOOS and satisfaction evaluations. Active patients (n = 1053) were matched to inactive patients (n = 1053) by age, sex, body mass index, and comorbidities. The cohorts were compared with regard to the association of expectations with Hip disability and Osteoarthritis Outcome Score and satisfaction, the change in Lower Extremity Activity Scale level from baseline to 2 years, complications, and revision surgical procedures.Results: Significantly more active patients (74%) expected to be "back to normal" regarding ability to exercise and participate in sports compared with inactive patients (64%, P < .001). Overall satisfaction was similar. Higher expectations with regard to exercise and sports were associated with higher HOOS sports and recreation subdomain scores in active patients. The inactive patient group improved on baseline activity level at 2 years while the active group did not.Conclusion: At 2 years after THA, active and inactive patients were similarly satisfied and achieved comparable outcomes. Inactive patients showed a greater improvement in physical activity level from preoperative baseline than active patients. Complications and revision rates were similar.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

To examine associations between preoperative fear-avoidance model (FAM) risk subgroup status and patient expectation of surgical success with postoperative outcomes at 6 and 12 months after anterior cruciate ligament reconstruction (ACLR). Cohort study. Academic medical center. 54 patients (25 females) undergoing unilateral ACLR. Cluster analysis distinguished FAM risk subgroups based on preoperative fear of movement/reinjury, self-efficacy, and pain catastrophizing. Preoperative expectation for surgical success was assessed with a numeric rating scale. Six and 12-month outcomes included Subjective Patient Outcomes for Return to Sport, Knee Injury and Osteoarthritis Outcome Score (KOOS) sports/recreation and quality of life, and International Knee Documentation Committee (IKDC) Subjective Knee Form. Thirteen (24%) patients were "moderate-to-high FAM risk." Moderate-to-high FAM risk patients had lower odds of return to sport at 12 months (OR = 0.3, p =.05) and lower KOOS sports/recreation at 6 months (st. beta = −0.27, p =.05), KOOS quality of life at 12 months (st. beta = −0.42, p =.007), and IKDC at 6 (st. beta = −0.29, p =.04) and 12 months (st. beta = −0.47, p =.001). Higher expectation was associated with lower 6-month IKDC (st. beta = −0.36, p =.008) and 12-month KOOS quality of life (st. beta = −0.29, p =.05). Preoperative FAM risk influences patient-reported outcomes and return to sport at 6 and 12 months. • 24% of patients were moderate-to-high risk based on fear-avoidance model (FAM) factors. • Moderate-to-high FAM risk patients had poorer return to sport and patient-reported outcomes. • Expectation of surgical success was an important predictor of 6-month knee function. [ABSTRACT FROM AUTHOR]

The aim of this investigation was to assess the expectations and experiences of chronic pain patients in relation to multimodal pain therapy (MMST). Nineteen patients from the Orthopedic Clinic in Bad Staffelstein were interviewed at the beginning and the end of the MMST using semi-standardized questionnaires. In addition, 6 therapists were asked about their experiences with the patients' expectations. The results show that patients put high expectations in doctors and physiotherapists. At the end of the MMST, the expectations of 6 patients (66 %) were met, while 3 patients (33 %) felt disappointed. On average, pain decreased significantly during the hospital stay, but not as much as expected. Quality of life and general health improved significantly, while perceived mobility remained stable. Four out of 6 therapists stated that the patients' expectations towards the MMST were realistic. Unrealistic high expectations regarding pain reduction, however, would lead to disappointment and thus reduce the success of the treatment. Information prior to therapy could optimize the success of MMST by promoting realistic expectations. [ABSTRACT FROM AUTHOR]