Meeting patient expectations: patient expectations and recovery after hip or knee surgery

Abstract

Background: Although patient-centred care could help increase the value of healthcare, practice variations in hip and knee surgery suggest that physicians guide clinical decisions more than patients do. This raises the question whether treatment outcomes still meet patients' expectations. This study investigated whether treatment outcomes measured by patient-reported outcome measures fulfil patients' main expectations (i.e. decreased pain or improved functioning).

Methods: Patients who underwent hip or knee surgery in 20 Dutch hospitals in 2014 were invited to a survey consisting of the KOOS Physical Function Short Form or the HOOS Physical Function Short Form, the NRS pain and the EQ-5D. Patients were asked their main reason for surgery and whether the expectations regarding this reason were fulfilled.

Results: A total of 2776 patients completed the survey. The most common reason for surgery was improved functioning (43.7%). Patients who were unable to choose between pain relief and improved functioning and patients who aimed for pain relief experienced more problems before surgery. However, patients who were unable to choose improved more than patients who wanted to improve their functioning on the NRS pain during use and the EQ-5D. More patients who aimed for pain relief felt that their expectations were fulfilled compared to other patients.

Conclusions: Although an expectation for an outcome was not related to a greater improvement on that outcome, patient expectations were an indication of patients' improvement due to surgery. Differences in expectation fulfilment may be due to unrealistic expectations. To achieve optimal value, tailoring treatment using patient preferences and managing patient expectations is vital.

Keywords: Hip and knee surgery; Patient expectations; Patient preferences; Patient-reported outcome measures.

Fig. 1

Improvement in PROM scores for patients who underwent surgery to improve their functioning, decrease their pain level or could not choose between either reasons after surgery. For all PROMs except the EQ-5D a lower score means less pain or better functioning