Background 

Satisfaction with treatment results is an important outcome domain in striving for patient-centered and value-based healthcare. Although numerous studies have investigated factors associated with satisfaction with treatment results, most studies used relatively small samples. Additionally, many studies have only investigated univariable associations instead of multivariable associations; to our knowledge, none have investigated the independent association of baseline sociodemographics, quality of life, improvement in pain and function, experiences with healthcare delivery, and baseline measures of mental health with satisfaction with treatment results.

Questions/purposes 

(1) What factors are independently associated with satisfaction with treatment results at 3 months post-treatment in patients treated for common hand and wrist conditions? (2) What factors are independently associated with the willingness to undergo the treatment again at 3 months post-treatment in patients treated for common hand and wrist conditions? Among the factors under study were baseline sociodemographics, quality of life, improvement in pain and function, experiences with healthcare delivery, and baseline measures of mental health.

Methods 

Between August 2018 and May 2020, we included patients who underwent carpal tunnel release, nonsurgical or surgical treatment for thumb-base osteoarthritis, trigger finger release, limited fasciectomy for Dupuytren contracture, or nonsurgical treatment for midcarpal laxity in one of the 28 centers of Xpert Clinics in the Netherlands. We screened 5859 patients with complete sociodemographics and data at baseline. Thirty-eight percent (2248 of 5859) of these patients had complete data at 3 months. Finally, participants were eligible for inclusion if they provided a relevant answer to the three patient-reported experience measure (PREM) items. A total of 424 patients did not do this because they answered “I don’t know” or “not applicable” to a PREM item, leaving 31% (1824 of 5859) for inclusion in the final sample. A validated Satisfaction with Treatment Result Questionnaire was administered at 3 months, which identified the patients’ level of satisfaction with treatment results so far on a 5-point Likert scale (research question 1, with answers of poor, moderate, fair, good, or excellent) and the patients’ willingness to undergo the treatment again under similar circumstances (research question 2, with answers of yes or no). A hierarchical logistic regression model was used to identify whether baseline sociodemographics, quality of life, change in outcome (patient-reported outcome measures for hand function and pain), baseline measures of mental health (including treatment credibility [the extent to which a patient attributes credibility to a treatment] and expectations, illness perception, pain catastrophizing, anxiety, and depression), and PREMs were associated with each question of the Satisfaction with Treatment Result Questionnaire at 3 months post-treatment. We dichotomized responses to our first question as good and excellent, which were considered more satisfied, and poor, moderate, and fair, which were considered less satisfied. After dichotomization, 57% (1042 of 1824) of patients were classified as more satisfied with the treatment results.

Results 

The following variables were independently associated with satisfaction with treatment results, with an area under the curve of 0.82 (95% confidence interval 0.80 to 0.84) (arranged from the largest to the smallest standardized odds ratio [SOR]): greater decrease in pain during physical load (standardized odds ratio 2.52 [95% CI 2.18 to 2.92]; p < 0.001), patient’s positive experience with the explanation of the pros and cons of the treatment (determined with the question: “Have you been explained the pros and cons of the treatment or surgery?”) (SOR 1.83 [95% CI 1.41 to 2.38]; p < 0.001), greater improvement in hand function (SOR 1.76 [95% CI 1.54 to 2.01]; p < 0.001), patients’ positive experience with the advice for at-home care (determined with the question: “Were you advised by the healthcare providers on how to deal with your illness or complaints in your home situation?”) (SOR 1.57 [95% CI 1.21 to 2.04]; p < 0.001), patient’s better personal control (determined with the question: “How much control do you feel you have over your illness?”) (SOR 1.24 [95% CI 1.1 to 1.40]; p < 0.001), patient’s more positive treatment expectations (SOR 1.23 [95% CI 1.04 to 1.46]; p = 0.02), longer expected illness duration by the patient (SOR 1.20 [95% CI 1.04 to 1.37]; p = 0.01), a smaller number of symptoms the patient saw as part of the illness (SOR 0.84 [95% CI 0.72 to 0.97]; p = 0.02), and less concern about the illness the patient experiences (SOR 0.84 [95% CI 0.72 to 0.99]; p = 0.04). For willingness to undergo the treatment again, the following variables were independently associated with an AUC of 0.81 (95% CI 0.78 to 0.83) (arranged from the largest to the smallest standardized OR): patient’s positive experience with the information about the pros and cons (determined with the question: “Have you been explained the pros and cons of the treatment or surgery?”) (SOR 2.05 [95% CI 1.50 to 2.80]; p < 0.001), greater improvement in hand function (SOR 1.80 [95% CI 1.54 to 2.11]; p < 0.001), greater decrease in pain during physical load (SOR 1.74 [95% CI 1.48 to 2.07]; p < 0.001), patient’s positive experience with the advice for at home (determined with the question: “Were you advised by the healthcare providers on how to deal with your illness or complaints in your home situation?”) (SOR 1.52 [95% CI 1.11 to 2.07]; p = 0.01), patient’s positive experience with shared decision-making (determined with the question: “Did you decide together with the care providers which care or treatment you will receive?”) (SOR 1.45 [95% CI 1.06 to 1.99]; p = 0.02), higher credibility the patient attributes to the treatment (SOR 1.44 [95% CI 1.20 to 1.73]; p < 0.001), longer symptom duration (SOR 1.27 [95% CI 1.09 to 1.52]; p < 0.01), and patient’s better understanding of the condition (SOR 1.17 [95% CI 1.01 to 1.34]; p = 0.03).

Conclusion 

Our findings suggest that to directly improve satisfaction with treatment results, clinicians might seek to: (1) improve the patient’s experience with healthcare delivery, (2) try to influence illness perception, and (3) boost treatment expectations and credibility. Future research should confirm whether these suggestions are valid and perhaps also investigate whether satisfaction with treatment results can be predicted (instead of explained, as was done in this study). Such prediction models, as well as other decision support tools that investigate patient-specific needs, may influence experience with healthcare delivery, expectations, or illness perceptions, which in turn may improve satisfaction with treatment results.

Level of Evidence 

Level III, therapeutic study.

中文翻译：

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哪些因素与手部和手腕疾病患者的治疗结果满意度相关？大队列分析

背景 

对治疗结果的满意度是努力实现以患者为中心和基于价值的医疗保健的一个重要结果领域。尽管许多研究调查了与治疗结果满意度相关的因素，但大多数研究使用的样本相对较小。此外，许多研究只调查单变量关联，而不是多变量关联；据我们所知，没有人调查过基线社会人口统计学、生活质量、疼痛和功能改善、医疗保健服务经验以及心理健康基线测量与治疗结果满意度之间的独立关联。

问题/目的 

(1) 对于接受常见手部和腕部疾病治疗的患者，哪些因素与治疗后 3 个月的治疗结果满意度独立相关？(2) 对于接受常见手部和腕部疾病治疗的患者，哪些因素与治疗后 3 个月再次接受治疗的意愿独立相关？研究的因素包括基线社会人口统计学、生活质量、疼痛和功能的改善、医疗保健服务的经验以及心理健康的基线测量。

方法 

2018 年 8 月至 2020 年 5 月期间，我们纳入了在 Xpert 28 个中心之一接受腕管松解术、拇指基部骨关节炎非手术或手术治疗、扳机指松解、掌腱膜挛缩症有限筋膜切除术或腕中松弛非手术治疗的患者荷兰的诊所。我们筛选了 5859 名具有完整社会人口统计学和基线数据的患者。这些患者中有 38%（5859 名患者中的 2248 名）在 3 个月时拥有完整的数据。最后，如果参与者对三个患者报告的体验测量 (PREM) 项目提供相关答案，则他们就有资格入选。共有 424 名患者没有这样做，因为他们对 PREM 项目回答“我不知道”或“不适用”，留下 31%（5859 名患者中的 1824 名）纳入最终样本。3 个月时进行了一份经过验证的治疗结果满意度调查问卷，该调查问卷以 5 点李克特量表（研究问题 1，答案为差、中等、一般、良好或非常好）以及患者在类似情况下再次接受治疗的意愿（研究问题2，回答是或否）。使用分层逻辑回归模型来确定基线社会人口统计学、生活质量、结果变化（患者报告的手部功能和疼痛结果测量）、心理健康基线测量（包括治疗可信度[患者归因的程度]治疗的可信度]和期望、疾病感知、疼痛灾难化、焦虑和抑郁）以及 PREM 与治疗后 3 个月治疗结果满意度调查问卷的每个问题相关。我们将第一个问题的回答分为“好”和“优秀”，这些被认为比较满意，而“差”、“中等”和“一般”则被认为不太满意。二分法后，57%（1824 名患者中的 1042 名）被归类为对治疗结果更满意。

结果 

以下变量与治疗结果的满意度独立相关，曲线下面积为 0.82（95% 置信区间为 0.80 至 0.84）（按从最大到最小标准化比值比 [SOR] 排列）：治疗期间疼痛减轻幅度更大体力负荷（标准化比值比 2.52 [95% CI 2.18 至 2.92]；p < 0.001）、患者对治疗利弊解释的积极体验（通过以下问题确定：“您是否被解释过利弊治疗或手术的效果如何？”）（SOR 1.83 [95% CI 1.41 至 2.38]；p < 0.001），手部功能有更大改善（SOR 1.76 [95% CI 1.54 至 2.01]；p < 0.001），患者阳性接受家庭护理建议的经验（根据以下问题确定：“医疗保健提供者是否就如何在家庭情况下处理您的疾病或投诉提供建议？”）（SOR 1.57 [95% CI 1.21 至 2.04] ；p < 0.001），患者更好的个人控制（通过以下问题确定：“您认为自己对自己的疾病有多少控制力？”）（SOR 1.24 [95% CI 1.1 至 1.40]；p < 0.001）、患者更积极的治疗期望（SOR 1.23 [95% CI 1.04 至 1.46]；p = 0.02）、患者预期的病程更长（SOR 1.20 [95% CI 1.04 至 1.37]；p = 0.01） ，患者认为疾病一部分的症状较少（SOR 0.84 [95% CI 0.72 至 0.97]；p = 0.02），并且对患者所经历的疾病的关注较少（SOR 0.84 [95% CI 0.72 至 0.99] ]；p = 0.04）。对于再次接受治疗的意愿，以下变量与 AUC 0.81（95% CI 0.78 至 0.83）独立相关（按标准化 OR 从最大到最小排列）： 患者对利弊信息的积极体验（通过以下问题确定：“是否已向您解释了治疗或手术的利弊？”）（SOR 2.05 [95% CI 1.50 至 2.80]；p < 0.001），手部功能得到更大改善（SOR 1.80 [95] % CI 1.54 至 2.11]；p < 0.001），体力负荷期间疼痛明显减轻（SOR 1.74 [95% CI 1.48 至 2.07]；p < 0.001），患者对在家建议的积极体验（根据问题确定） ：“医疗保健提供者是否建议您在家庭情况下如何处理您的疾病或投诉？”）（SOR 1.52 [95% CI 1.11 至 2.07]；p = 0.01），患者对共同决策的积极体验（通过以下问题确定：“您是否与护理提供者一起决定您将接受哪种护理或治疗？”）（SOR 1.45 [95% CI 1.06 至 1.99]；p = 0.02），患者对治疗的可信度较高（SOR 1.44 [95% CI 1.20 至 1.73]；p < 0.001），症状持续时间较长（SOR 1.27 [95% CI 1.09 至 1.52]；p < 0.01），以及患者对病情的更好了解（SOR 1.17 [95% CI 1.01 至 1.34]；p = 0.03）。

结论 

我们的研究结果表明，为了直接提高对治疗结果的满意度，临床医生可能会寻求：（1）改善患者的医疗服务体验，（2）尝试影响疾病认知，以及（3）提高治疗期望和可信度。未来的研究应该确认这些建议是否有效，或许还应该调查是否可以预测对治疗结果的满意度（而不是像本研究中所做的那样进行解释）。此类预测模型以及调查患者特定需求的其他决策支持工具可能会影响医疗保健提供、期望或疾病感知的体验，从而可能提高对治疗结果的满意度。

证据水平 

III级，治疗研究。