Patient expectations for management of chronic non‐cancer pain: A systematic review

Abstract

BackgroundChronic pain is a major economic and social health problem. Up to 79% of chronic pain patients are unsatisfied with their pain management. Meeting patients’ expectations is likely to produce greater satisfaction with care. The challenge is to explore patients’ genuine expectations and needs. However, the term expectation encompasses several concepts and may concern different aspects of health‐care provision.ObjectiveThis review aimed to systematically collect information on types and subject of patients’ expectations for chronic pain management.Search strategyWe searched for quantitative and qualitative studies. Because of the multidimensional character of the term “expectations,” the search included subject headings and free text words related to the concept of expectations.Data extraction and synthesisA framework for understanding patients’ expectations was used to map types of expectations within structure, process or outcome of health care.Main resultsTwenty‐three research papers met the inclusion criteria: 18 quantitative and five qualitative. This review found that assessment of patients’ expectations for treatment is mostly limited to outcome expectations (all 18 quantitative papers and four qualitative papers). Patients generally have high expectations regarding pain reduction after treatment, but expectations were higher when expressed as an ideal expectation (81‐93% relief) than as a predicted expectation (44‐64%).Discussion and conclusionsFor health‐care providers, for pain management and for pain research purposes, the awareness that patients express different types of expectations is important. For shared decision making in clinical practice, it is important that predicted expectations of the patient are known to the treating physician and discussed.Structure and process expectations are under‐represented in our findings. However, exploring and meeting patients’ expectations regarding structure, process and outcome aspects of pain management may increase patient satisfaction.

El papel de la sintomatología depresiva, catastrofismo y expectativa en la eficacia de las técnicas intervencionistas para el tratamiento del dolor lumbar crónico

“…En el análisis de asociación la ausencia de sintomatología depresiva solo fue un factor predictivo significativo de mejoría para la reducción de la analgesia pautada (OR 51,86; IC95 % 2,3-1771,12; p = 0,001). (19,20).…”

Patient satisfaction in musculoskeletal medicine

“…Our understanding of the interplay between patient expectations for the management of chronic non-cancer pain and patient satisfaction score is also in its infancy [18]. Three hundred thirty-two of 353 patients in an academic spine surgery clinic in one study were satisfied with their care.…”

Development and validation of the Treatment Expectations in Chronic Pain Scale

“…While structure is an important dimension of expectations, it is also one that is the least replicable across treatment settings (Kravitz, 1996). As such, most studies have focused on outcome-related expectations and a small minority on a combination of process and outcome expectations (Geurts et al, 2017).…”

“…The authors found 3 CNCP-specific expectation questionnaires (Anderson, Dowds, Pelletz, Edwards, & Peeters-Asdourian, 1995;Nicholas, 2007;Robinson et al, 2005), but all of these scales measured patient expectations or selfefficacy and not treatment expectations (van Hartingsveld et al, 2010). A second systematic review specifically on expectation measures among CNCP patients found that not all dimensions of expectations are systematically taken into account (Geurts et al, 2017). Outcome expectations are the most frequently measured, while structure and process expectations are under-represented.…”

“…There is a paucity of literature on process expectations as they related to CNCP treatment. In a systematic review of patient expectations for management of CNCP, only 4 of 23 papers found examined process expectations; the vast majority examined treatment outcome expectations (n = 21; Geurts et al, 2017). These dimensions of expectations are not examined together in the literature, and as such, it is unclear whether they have different contributions to treatment outcome, satisfaction, or other treatment-related responses.…”