Satisfaction With Specific and Nonspecific Diagnoses

Ottenhoff, Janna S.E.; Derkzen, Lindy; Reichel, Lee M.; Vagner, Gregg A.; Loeb, Michael D.; Ring, David

doi:10.1016/j.jhsa.2018.10.012

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…Asking to rate satisfaction of the process of care or treatment outcome may give different scores (29). Sixth, we did not perform separate analysis for different diagnoses because none of the diagnoses had sufficient numbers and—based on prior work—we did not feel diagnosis was likely to be important (30,31). Differentiating between preoperative and postoperative patients and between acute and chronic disorders may lead to different results.…”

Section: Discussionmentioning

confidence: 99%

Attempts to Limit Censoring in Measures of Patient Satisfaction

Nguyen

Kortlever

Gonzalez

et al. 2020

Journal of Patient Experience

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Background: Measures of patient satisfaction are increasingly used to measure patient experience. Most satisfaction measures have notable ceiling effects, which limits our ability to learn from variation among relatively satisfied patients. This study tested a variety of single-question satisfaction measures for their mean overall score, ceiling and floor effect, and data distribution. In addition, we assessed the correlation between satisfaction and psychological factors and assessed how the various methods for measuring satisfaction affected net promoter scores (NPSs). Methodology: A total of 212 patients visiting orthopedic offices were enrolled in this randomized controlled trial. Patients were randomized to 1 of 5 newly designed, single-question satisfaction scales: (a) a helpfulness 11-point ordinal scale from 0 to 10, (b) a helpfulness ordinal 11-point scale from 0 to 5 (ie, with 1.5, 2.5, etc), (c) a helpfulness 100-point slider, (d) a satisfaction 11-point ordinal scale from 0 to 10, and (e) a willingness to recommend 11-point ordinal scale from 0 to 10. Additionally, patients completed the 2-item Pain Self-Efficacy Questionnaire (PSEQ-2), 5-item Short Health Anxiety Inventory (SHAI-5) Scale, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression. We assessed mean and median score, ceiling and floor effect, and skewness and kurtosis for each scale. Spearman’s correlation tests were used to test correlations between satisfaction and psychological status. Finally, we assessed the NPS for the various scales. Results: Ceiling effects ranged from 29% to 68%. The 11-point ordinal helpfulness scale from 0 to 10 had the least ceiling effect (29%). All of the scales were asymmetrically distributed, with the 11-point ordinal scale from 0 to 5 having the most Gaussian distribution (skew = 0.64 and kurtosis = 2.3). Satisfaction scores did not correlate with psychological factors: PSEQ-2 ( r = 0.04; P = .57), SHAI-5 ( r = 0.01; P = .93), and PROMIS Depression ( r = −0.04; P = .61). Net promoter scores varied substantially by scale design, with higher scores corresponding with greater ceiling effects. Conclusions: Variations in scale types, text anchors, and lead-in statements do not eliminate the ceiling effect of single-question measures of satisfaction with a visit to an orthopedic specialist. Further studies might test other scale designs and labels. Level of Evidence: Diagnostic; Level II

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Section: Discussionmentioning

confidence: 99%

Attempts to Limit Censoring in Measures of Patient Satisfaction

Nguyen

Kortlever

Gonzalez

et al. 2020

Journal of Patient Experience

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“…Some qualitative evidence suggests that people may not achieve the meaning they desire from applying a diagnostic label [2,14]. Overall, patients receiving upper extremity specialty care have comparable experiences, regardless of whether they receive a specific or nonspecific diagnosis [26]. The bias toward specific pathophysiology and away from nonspecific illness may result from aspects of clinician discomfort and perhaps some unpleasant experiences of a relatively small group of patients who have a notable aversion to a nonspecific diagnosis.…”

Section: Factors Associated With the Degree Of Implicit Preference Fo...mentioning

confidence: 99%

“…However, this approach may not work as well for patients with symptoms and signs that are not characteristic of a specific, common pathophysiology (nonspecific illness). Nonspecific illness is characterized by discomfort and incapability that is not accounted for by objective, measurable impairment and pathophysiology (physical examination findings, imaging results, or laboratory values) [2,21,22,26]. Some examples include fibromyalgia, chronic fatigue syndrome, radial tunnel syndrome, complex regional pain syndrome, and repetitive strain injury [3].…”

Section: Introductionmentioning

confidence: 99%

“…Many symptoms brought to medical attention are never associated with a specific pathophysiology [16,23]. Nonspecific illness, particularly nonspecific pain, is common in musculoskeletal specialty care [15,26]. Nonspecific illness is associated with feelings of distress (symptoms of anxiety and depression) [24,31] and tends to be associated with higher healthcare use [4,8] and worse quality of life than illnesses with measurable pathophysiology [1].…”

Section: Introductionmentioning

confidence: 99%

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Surgeons Have an Implicit Preference for Specific Disease Over Nonspecific Illness

Terzo,

Rajagopalan,

Nguoe

et al. 2023

Clin Orthop Relat Res

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Background Many symptoms are not associated with a specific, measurable pathophysiology. Such nonspecific illnesses may carry relative social stigma that biases humans in favor of specific diseases. Such a bias could lead musculoskeletal surgeons to diagnose a specific disease in the absence of a specific, measurable pathology, resulting in potential overdiagnosis and overtreatment. Questions/purposes (1) What factors are associated with surgeon implicit preference for specific disease over nonspecific illness? (2) What factors are associated with surgeon explicit preference for specific disease over nonspecific illness? (3) Is there a relationship between surgeon implicit and explicit preferences for specific disease over nonspecific illness? Methods One hundred three members of the Science of Variation Group participated in a survey-based experiment that included an Implicit Associations Test (IAT) to assess implicit preferences for specific, measurable musculoskeletal pathophysiology (specific disease) compared with symptoms that are not associated with a specific, measurable pathophysiology (nonspecific illness), and a set of four simple, face valid numerical ratings of explicit preferences. The Science of Variation Group is an international collaborative of mostly United States and European (85% [88 of 103] in this study), mostly academic (83% [85 of 103]), and mostly fracture and upper extremity surgeons (83% [86 of 103]), among whom approximately 200 surgeons complete at least one survey per year. The human themes addressed in this study are likely relatively consistent across these variations. Although concerns have been raised about the validity and utility of the IAT, we believe this was the right tool, given that the timed delays in association that form the basis of the measurement likely represent bias and social stigma regarding nonspecific illness. Both measures were scaled from -150, which represents a preference for nonspecific illness, to 150, which represents a preference for specific disease. The magnitude of associations can be assessed relative to the standard deviation or interquartile range. We used multivariable linear regression to identify surgeon factors associated with surgeon implicit and explicit preference for specific disease or nonspecific illness. We measured the relationship between surgeon implicit and explicit preferences for specific disease or nonspecific illness using Spearman correlation. Results Overall, there was a notable implicit bias in favor of specific diseases over nonspecific illness (median [IQR] 70 [54 to 88]; considered notable because the mean value is above zero [neutral] by more than twice the magnitude of the IQR), with a modestly greater association in the hand and wrist subspecialty. We found no clinically important explicit preference between specific disease and nonspecific illness (median 8 [-15 to 37]; p = 0.02). There was no correlation between explicit preference and implicit bias regarding specific disease and nonspecific illness (Spearman correlation coefficient -0.13; p = 0.20). Conclusion Given that our study found an implicit bias among musculoskeletal specialists toward specific diseases over nonspecific illness, future research might address the degree to which this bias may account, in part, for patterns of use of low-yield diagnostic testing and the use of diagnostic labels that imply specific pathophysiology when none is detectable. Clinical Relevance Patients and clinicians might limit overtesting, overdiagnosis, and overtreatment by anticipating an implicit preference for a specific disease and intentionally anchoring on nonspecific illness until a specific pathophysiology accounting for symptoms is identified, and also by using nonspecific illness descriptions until objective, verifiable pathophysiology is identified.

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“…So far, the evidence is that these do not have an independent association with greater pain intensity of magnitude of incapability relative to that of unhelpful thinking. 25,26 Perhaps adversity alone does not have an independent association with comfort and capability independent of unhelpful thinking because for some people difficult events are a catalyst toward developing greater resilience, but more study is needed.…”

Section: Introductionmentioning

confidence: 99%

Recovery After Musculoskeletal Injury: Mental and Social Health

Ring

2022

Journal of Orthopaedic Trauma

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Recovery from injury involves painful movement and activity, painful stretches and muscle strengthening, and adjustment to permanent impairment. Recovery is facilitated by embracing the concept that painful movement can be healthy, which is easier when one has more hope, less worry, and greater social supports and security. Evolution of one's identity to match the new physical status is a hallmark of a healthy outcome and is largely determined by mental and social health factors. When infection, loss of alignment or fixation, and nerve issues or compartment syndrome are unlikely, greater discomfort and incapability that usual for a given pathology or stage of recovery signal opportunities for improved mental and social health. Surgeons may be the clinicians most qualified to make this discernment. A surgeon who has gained a patient's trust can start to noticed despair, worry, and unhelpful thinking such as fear of painful movement. Reorienting people to greater hope and security and a healthier interpretation of the pains associated with the body's recovery can be initiated by the surgeon and facilitated by social workers, psychologist, and physical, occupational and hand therapists trained in treatments that combine mental and physical therapies.

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Satisfaction With Specific and Nonspecific Diagnoses

Cited by 6 publications

References 27 publications

Attempts to Limit Censoring in Measures of Patient Satisfaction

Attempts to Limit Censoring in Measures of Patient Satisfaction

Surgeons Have an Implicit Preference for Specific Disease Over Nonspecific Illness

Recovery After Musculoskeletal Injury: Mental and Social Health

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