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Health expectancy in Denmark, 1987-2000.
BACKGROUND: While life expectancy quantifies average length of life, health expectancy represents the average lifetime in different health states and offers the possibility to evaluate quality of life with respect to health. The purpose of the study was to estimate changes in health expectancy in Denmark from 1987 to 2000 and to assess theories about the relation between increased total lifetime and lifetime in various health states. METHODS: Data on health status derived from the Danish Health Interview Surveys carried out in 1987, 1991, 1994 and 2000 were combined with life-table data. Expected lifetime in selfrated good health, life expectancy without longstanding illness and disabilityfree life expectancy were estimated by Sullivan's method. RESULTS: In 1987, the life expectancy of a 65-year-old man was 14.1 years, 8.9 years of which were expected to be disabilityfree. In 2000, life expectancy had increased to 15.0 years, 11.3 years of which were disabilityfree. Thus, life expectancy had increased by 0.9 years, whereas disabilityfree life expectancy had increased by 2.4 years. Among 65-year-old women, life expectancy had increased by 0.2 years and disabilityfree life expectancy by 1.1 years. Expected lifetime in selfrated good health had also improved, but the trend in life expectancy without longstanding illness went in the opposite direction, and expected lifetime with longstanding illness had increased. CONCLUSION: The recent rise in life expectancy in Denmark after many years of stagnation appears to be accompanied by generally improved health status among the elderly, but health expectancy trends depend on the health indicator chosen. KEY POINTS: Health expectancy expresses average lifetime in various states of health. The study examines changes in expected lifetime in selfrated good health, lifetime without longstanding illness and lifetime without longterm disability. Among 65-year-olds the percentage of disabilityfree life expectancy increased from 63.4% to 74.9% for men and from 55.6% to 61.0% for women between 1987 and 2000. Health status among elderly Danes has apparently improved, but secular trends in health expectancy depend on the choice of health indicator.
Adult↗
Educational status and active life expectancy among older blacks and whites.
BACKGROUND AND METHODS: Persons of low socioeconomic status are known to have reduced life expectancy. In a study of the relation of socioeconomic status to disability-free or active life expectancy among older persons, we analyzed prospectively gathered data on 2219 blacks and 1838 whites who were 65 years of age or older in the Piedmont region of North Carolina. We defined disability as the inability to perform independently one or more basic functional activities such as walking, bathing, dressing, eating, and using the toilet. For subgroups defined by sex, race, and education, statistical models were used to estimate, for persons at each year of age, the probability of transition from not being disabled or being disabled at base line to not being disabled, being disabled, or having died one year later. These transition probabilities were then entered into increment-decrement life tables to generate estimates of total, active, and disabled life expectancy (with total life expectancy equal to active life expectancy plus disabled life expectancy). RESULTS: Sixty-five-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years), although the differences were reduced after we controlled for education. The estimates for 65-year-old black women (total life expectancy, 18.7 years; active life expectancy, 15.9 years) were similar to those for white women. Black men and women 75 years old and older had higher values for total life expectancy and active life expectancy than whites, and the differences were larger after stratification for education. Education had a substantially stronger relation to total life expectancy and active life expectancy than did race. At the age of 65, those with 12 or more years of education had an active life expectancy that was 2.4 to 3.9 years longer than the values for those with less education in all the four subgroups defined by sex and race. Overall, the subgroups with longer total life expectancy and active life expectancy also lived more years with a disability. CONCLUSIONS: Among older blacks and whites, the level of education, a measure of socioeconomic status, has a greater effect than race on total life expectancy and active life expectancy.
Activities of Daily Living↗
A review of expectancy theory and alcohol consumption.
Research is reviewed on the association between alcohol outcome expectancies and consumption which has led many to argue that manipulating expectancies might be a route to manipulating consumption for problem prevention and treatment. Studies indirectly and directly evaluating this latter position are reviewed. Expectancies predicting treatment outcome: two studies have shown that the more positive expectancies held at treatment, the poorer is treatment outcome, but five other studies have failed to find this. Three related studies have shown that the more negative expectancies held at treatment, the better the treatment outcome. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited support for negative. Expectancy manipulations and ad libitum consumption: three studies in the laboratory have shown that increasing positive expectancies through word priming increases subsequent consumption and two studies have shown that increasing negative expectancies decreases it. A single study in the field showed a similar relationship. This evaluation provides evidence consistent with the main position but is limited by measuring consumption changes over only 1-2 hours. Prevention programmes with expectancy components: seven projects are reviewed in which positive expectancies were targeted, but only two report an expectancy change analysis and in both cases the expectancy change did not relate to subsequent consumption. This evaluation provides evidence inconsistent with the main position. Expectancy challenge: two related studies are reviewed in which positive expectancy challenges reduce subsequent consumption but changes in expectancy were not evaluated as predictors of consumption change. Two studies are reviewed which found a reduction in positive expectancy following expectancy challenge but no reduction in consumption. One study is reviewed in which when negative expectancy was increased in treatment there was a better treatment outcome at 3 months follow-up than when it was not. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited consistent evidence for negative. It is concluded that the research has still to be done that securely links expectancy manipulations with subsequent changes in consumption, and fulfils the early promise from association studies.
Alcohol-Related Disorders↗
The influence of childbirth expectations on Western Australian women's perceptions of their birth experience.
OBJECTIVES: to explore and describe the influence of childbirth expectations on women's perception of their birthing experience and expectations for subsequent births. This was the second phase of a study, the purpose of which its purpose was to determine the childbirth expectations of a cohort of Western Australian women and ascertain factors that influenced these expectations. DESIGN: a qualitative study which used an exploratory descriptive design. Data were collected from in-depth individual interviews. SETTING: Perth, Western Australia. PARTICIPANTS: 20 women, 11 primiparae and nine multiparae, who between them had experienced 31 births. These women had participated in phase one when they were either pregnant or had birthed within the preceding 12 months. Phase two interviews occurred 5-6 months after phase one. FINDINGS: the themes and sub-themes revealed in phase one of the study were supported in phase two. Although women held multiple expectations for birth, specific expectations were regarded as priority. Consequently, to perceive birth as positive, a woman had to achieve her priority expectations. Multiparae reported more positive birth experiences, having altered expectations as a result of previous experiences. Unaffirming birth experiences due to unmet expectations were more common after a first birth. Women with unfulfilled expectations subsequently adapted their expectations to be more achievable thus avoiding disappointment. Supportive behaviours of maternity health-care providers assisted women to evaluate their birth experience as positive even when expectations could not be achieved. IMPLICATIONS FOR PRACTICE: the evaluation of birth experiences as positive or negative is contingent upon achieving most, or at least the priority, childbirth expectation. Knowing a woman's expectations assists the midwife in her advocacy role. This role in assisting women to achieve their expectations is reinforced by this research. Caregivers become even more important when expectations are not able to be realised. Behaviours that encourage involvement and participation in decision-making during birth promote feelings of control, coping and feeling supported, which ultimately are needed for women to assess their birth experience as positive. Achievable expectations, such as 'being flexible' and 'only having a healthy baby' could be regarded as a lessening of ideals. The issue of whether these changing expectations are contributing to the increasing technocratic approach to birth and the resulting devaluing of the normal birth experience requires further debate.
Adult↗
A review of the outcome expectancy construct in physical activity research.
BACKGROUND: Outcome expectancy is a central construct in social cognitive models of health behavior widely used as frameworks for physical activity research. PURPOSE: This article provides a review of the outcome expectancy construct and its application to research on physical activity. METHODS: Theoretical articles describing definitions and placement of outcome expectancy within social cognitive models, as well as empirical research on outcome expectancy and physical activity, were reviewed. RESULTS: Self-efficacy theory, the transtheoretical model, the theory of planned behavior, and protection motivation theory differ in their labeling and conceptualization of outcome expectancy but unanimously include expected outcomes of behavior. Preliminary empirical investigation of the role of outcome expectancy in understanding physical activity has yielded mixed results. Positive outcome expectancy appears to be more predictive of physical activity in older adults than in young to middle-aged adults, and personal barriers appear to be the most predictive subtype of negative outcome expectancy. In addition, a small number of studies indicate relations between outcome expectancy and other theoretical variables, including behavioral intention, stage of change, and self-efficacy. CONCLUSIONS: Further research on the role of outcome expectancy is necessary to design effective physical activity interventions. New directions in outcome expectancy research could involve (a) expanding the conceptualization of outcome expectancy to include expected outcomes of sedentary behavior and affective responses to physical activity, (b) further examination of potential moderators of the relation between outcome expectancy and physical activity (such as outcome value and outcome proximity), (c) distinguishing between the role of outcome expectancy in behavior onset versus behavior maintenance, (d) examining outcome expectancy as a mechanism of change in environmental intervention approaches, and (e) further analysis of interrelations between outcome expectancy and other social cognitive variables.
Attitude to Health↗
Role of expectations in sentence integration.
Three experiments examined the role of causal expectations in sentence integration. Subjects read narratives that did or did not elicit strong expectations about upcoming events (high-expectation vs. low-expectation texts). Subjects were faster to judge a target sentence to be unrelated when it followed a high-expectation text than when it followed a low-expectation text. Subjects were slower to read an unimportant, expectation-violating sentence embedded in a high-expectation text. Subjects were faster both to read and to judge an expectation-fulfilling target sentence when it followed a high-expectation text. Three models of the generation and use of expectations are considered. The results support a model in which expectations are generated selectively. Once generated, expectations become the focus of upcoming sentence integration processes such that correct expectations help and incorrect expectations interfere. A third experiment found no evidence that expectations took the form of highly specific predictions.
Emotions↗
Assessing patients' expectations in ambulatory medical practice. Does the measurement approach make a difference?
To compare three different approaches to the measurement of patients' expectations for care, we conducted a randomized controlled trial. Medical outpatients (n = 318) of a small (six-physician), single-specialty (internal medicine), academically affiliated private practice in Sacramento, California, were contacted by telephone the night before a scheduled office visit and enrolled over a 5-month period in early 1994. Patients were randomly assigned to receive: (1) a self-administered, structured, previsit questionnaire combined with a postvisit questionnaire; (2) an interviewer-administered, semistructured, previsit interview combined with a postvisit questionnaire; or (3) a postvisit questionnaire only. We assessed the number and content of patients' expectations by previsit questionnaire versus interview; the interaction between sociodemographic characteristics and survey method in predicting number of reported expectations; the effect of unfulfilled expectations elicited by questionnaire and interview on visit satisfaction; and the effect of unfulfilled expectations elicited directly and indirectly on visit satisfaction. Patients reported more expectations by structured questionnaire than semistructured interview (median 12 vs 3, p = .0001). Although there was no main effect of sociodemographic characteristics on expectations, nonwhite patients reported more expectations than white patients by questionnaire and fewer by interview. The number of interventions desired before the visit but not received (indirectly reported unfulfilled expectations) was associated with lower visit satisfaction regardless of whether a questionnaire or interview was used to elicit previsit expectations (p value for the interaction between number of expectations and survey method, > .20). Having more indirectly reported unfulfilled expectations was significantly associated with lower visit satisfaction even after controlling for the number of directly reported unfulfilled expectations (p = .021), but the incremental change in classification accuracy was small (increase in receiver-operating characteristic curve area, 3%). In conclusion, studies of patients' expectations for care must content with a substantial "method effect." In this study from a single group practice, patients checked off more expectations using a structured questionnaire than they disclosed in a semistructured interview, but both formats predicted visit satisfaction. Asking patients about interventions received in relation to their previsit expectations added little to simply asking them directly about omitted care. The interaction of survey method with ethnicity and other sociodemographic characteristics requires further study.
Adult↗
Patients' expectations of asthma treatment.
A multicomponent model has been developed to explain patients' unmet expectations of medical care. The model proposes that expectations are related to patients' personal experiences with illness, perceived vulnerability to disease, transmitted knowledge, and perceived severity of disease. The objective of this cross-sectional study was to determine whether this model can be applied to patients' unrealistic expectations of treatment outcomes, specifically expecting to be cured of asthma. In total, 230 patients observed in a primary care practice in New York City were interviewed in person with open-ended questions about their expectations of asthma treatment. Responses were analyzed with qualitative techniques to generate categories of expectations. Patients had a mean age of 41 +/- 11 years, 21% were white, 30% African American, 42% Latino, and 7% other groups. Major categories of expectations were generated from patients' responses and included symptom relief (expected by 52%), cure (36%), improved physical function (21%), and improved psychological well-being (15%). The category of expecting a cure was assessed with patients' responses to the following items representing components of the model: 1) resource utilization and medication requirements for asthma (representing severity of disease); 2) perceived quality of asthma care and satisfaction with care (representing past asthma experiences); 3) the Asthma Self-Efficacy Scale (representing perceived vulnerability to exacerbations); and 4) experiences of social network contacts with asthma and the Check Your Asthma IQ survey (representing transmitted knowledge). In bivariate analysis, patients who expected a cure were more likely to be Latino or Native American or Asian (p = 0.02), to have never required oral corticosteroids (p = 0.004), to be dissatisfied with the status of their asthma (p = 0.008), to know others who were limited by asthma (p = 0.03), to have worse Asthma Self-Efficacy Scale scores (p = 0.002), to have worse Check Your Asthma IQ scores (p = 0.04), and to currently be taking inhaled corticosteroids (p = 0.03). In multivariate analysis, worse asthma self-efficacy (p = 0.008), never having required oral corticosteroids (p = 0.005), and currently taking inhaled corticosteroids (p = 0.05) remained associated with expecting a cure. As a result of this study, we found that patients have multiple expectations of asthma treatment, including realistic expectations such as symptom relief and improved function, as well as unrealistic expectations, specifically to be cured of asthma. A multicomponent model of patient and disease characteristics was associated with this unrealistic expectation. These findings indicate that clinicians can intervene in diverse areas to foster realistic expectations of treatment outcomes among asthma patients.
Asthma↗
Changing expectancies: cognitive mechanisms and context effects.
This article presents the proceedings of a symposium at the 2002 RSA Meeting in San Francisco, organized by Reinout W. Wiers and Mark D. Wood. The symposium combined two topics of recent interest in studies of alcohol expectancies: cognitive mechanisms in expectancy challenge studies, and context-related changes of expectancies. With increasing recognition of the substantial role played by alcohol expectancies in drinking, investigators have begun to develop and evaluate expectancy challenge procedures as a potentially promising new prevention strategy. The two major issues addressed in the symposium were whether expectancy challenges result in changes in expectancies that mediate intervention (outcome relations), and the influence of simulated bar environments ("bar labs," in which challenges are usually done) on expectancies. The presentations were (1) An introduction, by Jack Darkes; (2) Investigating the utility of alcohol expectancy challenge with heavy drinking college students, by Mark D. Wood; (3) Effects of an expectancy challenge on implicit and explicit expectancies and drinking, by Reinout W. Wiers; (4) Effects of graphic feedback and simulated bar assessments on alcohol expectancies and consumption, by William R. Corbin; (5) Implicit alcohol associations and context, by Barry T Jones; and (6) A discussion by Kenneth J. Sher, who pointed out that it is important not only to study changes of expectancies in the paradigm of an expectancy challenge but also to consider the role of changing expectancies in natural development and in treatments not explicitly aimed at changing expectancies.
Alcohol Drinking↗
An examination of the relationships among recalled, expected, and actual intensity and unpleasantness of delayed onset muscle pain.
This investigation assessed the relationships among recalled, expected, and actual muscle pain intensity and unpleasantness during a period of 48 hours. We hypothesized that (1). specific expectations of pain after 24 hours would account for a significant amount of variance in actual pain, (2). recalled pain from the most recent episode of naturally occurring muscle pain would be significantly associated with expected pain, and (3). the accuracy of expectations (ie, the difference between expected and actual pain) would increase across time as the onset of muscle pain occurred. Ninety-five students completed 3 sessions. In Session 1, recalled muscle pain and expected muscle pain in the next 24 hours were collected before exercise. In Sessions 2 and 3, muscle pain during movement and expected pain in the next 24 hours were collected. Recalled muscle pain was associated with expectations at baseline, r values [equals].26 to.47, P [lt ].05. The accuracy of expected intensity increased during the study, t [equals] 3.20, P [lt ].01, and the accuracy of expected unpleasantness was associated with change in expected unpleasantness, r values [equals] [minus ].28, P [lt ].01. The amount of variance in actual intensity and unpleasantness accounted for by expectations increased up to 55% and 52%, respectively, during the study. Expected unpleasantness did not account for variance in actual intensity. Expected intensity accounted for 3% of the variance in actual unpleasantness, but only in the second 24-hour period. Thus, our hypotheses were generally supported, but unanticipated findings regarding changes across time in the relationships among recalled, expected, and actual muscle pain were also detected.
Adolescent↗
Patients' expectations and satisfaction in lumbar spine surgery.
STUDY DESIGN: Prospective consecutive series. OBJECTIVE: To determine patient expectations in lumbar spine surgery and assess the level of fulfillment of those expectations. SUMMARY OF BACKGROUND DATA: Little has been offered in the literature in specific regards to lumbar spine surgery. METHODS: Ninety-eight patients, 49 patients who underwent discectomy for lumbar disc herniation (Group 1) and 49 patients who underwent laminotomy for lumbar spinal stenosis (Group 2), completed the self-report questionnaire. Preoperative expectations, reasons for surgery, and expected postoperative status were inquired before surgery and the satisfaction at 2 years after surgery. RESULTS: Concerning patients' expectations, half of the patients expected to become completely leg pain free, and more than three fourths of the patients expected to become unlimited in their walking ability in both groups. More than half of the patients expected to have a 90% or greater chance of complete success of surgery. With regard to satisfaction, 42 of the 49 patients (86%) in Group 1 and 35 of the 49 patients (71%) in Group 2 chose "Surgery met my expectations" at the follow-up. The remaining patients selected "I did not improve as much as I had hoped." Positive expectations were associated with better satisfaction in Group 1 only. Of the patients who had achieved the expected postoperative status with respect to their no.1 reason for surgery, 2 of 34 patients in Group 1 (6%) and 5 of the 26 patients in Group 2 (19%) nonetheless reported "unfulfilled expectations." In patients whose no. 1 concern was further progression, 3 (38%) of the 8 patients in Group 1 and 2 (40%) of the 5 patients in Group 2 demonstrated unfulfilled expectations. CONCLUSIONS: Even if the clinical expectations were met, some patients were still dissatisfied. Patients with spinal stenosis (Group 2) seem to have more unrealistic expectations than patients with disc herniation (Group 1).
Adult↗
Genetic counselling: the psychological impact of meeting patients' expectations.
We know little about patients' expectations of genetic counselling, the extent to which these are met, and whether meeting expectations is associated with improved patient outcome. This study describes 131 consultations of patients referred to a regional genetics centre, and documents their expectations, the extent to which these are met, and the predictors and consequences of expectations being met. The outcomes assessed were state anxiety, concern about the problem for which the patient was referred, and satisfaction with information given. Patients came to genetic counselling expecting information (79%), explanation (63%), reassurance (50%), advice (50%), and help in making decisions (30%). The majority got what they were expecting: 74% had their expectation for information met, 56% had their expectation for explanation met, 60% had their expectation for reassurance met, 61% had their expectation for advice met, and 73% had their expectation for help with making decisions met. Patient expectations, and whether or not these were met, were not predicted by any of the patient or counsellor variables measured. When patients' expectations for reassurance and advice were met, patients were less concerned and their anxiety level was more reduced than when such expectations were not met. Meeting patients' expectations for information, explanation, or help with decision making were not associated with better outcomes. Explanations for these results and implications for the practice of genetic counselling are discussed.
Adult↗
Expectations of blood pressure management in hypertensive African-American patients: a qualitative study.
In patients with chronic diseases, expectations of care are associated with clinical outcomes. Using open-ended interviews, we elicited the expectations of treatment in 93 hypertensive African-American patients. During routine clinic visits, patients were asked, "What are your expectations of the treatment your doctor prescribed for your high blood pressure?" Their responses were explored with the probes: Do you expect to take your blood pressure medications for the rest of your life? Do you expect to take your medications daily regardless of symptoms? Do you expect a cure for your high blood pressure? Using standard qualitative techniques, patients' responses were grouped into a taxonomy of three categories of expectations reflecting patients' role, physicians' role, and medication effects. They expected to take active role in their treatment, especially as it relates to adoption of healthy behaviors. They expected their physicians to educate them about blood pressure treatment, and they expected medications to lower their blood pressure and prevent heart attack, stroke, and kidney failure. Despite such appropriate expectations, a considerable proportion of patients had nonbiomedical expectations of their treatment-38% expected a cure, 38% did not expect to take their medications for life and 23% take medications only with symptoms. The taxonomy of patient expectations outlined in this study may serve as a useful framework for patient education and counseling about hypertension and its management in this patient population.
Black or African American↗
Causes of declining life expectancy in Russia.
CONTEXT: Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. OBJECTIVE: To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. DESIGN: Mortality and natality data from the vital statistics systems of Russia and the United States. SETTING: Russia, 1990-1994. POPULATION: Entire population of Russia. MAIN OUTCOME VARIABLES: Mortality rates, life expectancy, and contribution to change in life expectancy. METHODS: Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. RESULTS: Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. CONCLUSION: The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.
Adolescent↗
Cancer patients' expectations of experiencing treatment-related side effects: a University of Rochester Cancer Center--Community Clinical Oncology Program study of 938 patients from community practices.
BACKGROUND: Adequate management of treatment-related side effects is important for patients and challenging for clinicians. Side effects generated by various treatments have been characterized reasonably well. However, to the authors' knowledge, less is known regarding what patients expect to experience regarding these side effects and how patient characteristics are related to these expectations. METHODS: Patients with cancer (n = 1015 patients) from 17 Community Clinical Oncology Program (CCOP) institutions affiliated with the University of Rochester Cancer Center CCOP Research Base were surveyed regarding their expectations of experiencing side effects associated with cancer treatment, with 938 patients providing evaluable data. Patients responded to the item, "Indicate your expectations of having this side effect" for 12 common side effects. Patients rated their expectations using a 5-point Likert scale, from 1 ("I definitely will not have this") to 5 ("I definitely will have this"). RESULTS: The median number of symptoms expected (characterized by any value other than one) was nine. The six most expected symptoms were fatigue, nausea, sleep disturbance, weight loss, hair loss, and skin problems. Patients age > 60 years expected to have fewer symptoms than younger patients; female patients expected more side effects than male patients; and patients who had some college education expected more side effects than patients who were high school graduates or had not completed high school. CONCLUSIONS: Patients with cancer clearly exhibit expectations regarding treatment-related side effects; and age, gender, and education level appear to influence these expectations. Further careful characterization of patient expectations and how expectations relate to experience may lead to earlier and more effective management of side effects.
Adult↗
Patient expectations for medical and surgical care: a review of the literature and applications to ophthalmology.
Over the past several decades, emphasis on patient-centered care, the dramatic growth of refractive surgery in the United States, and increasing competition in the eye care marketplace have made patient expectations increasingly important in the field of ophthalmology. Patient-centered care recognizes the obligation to understand and meet patient's expectations. Despite increasing patient expectations for refractive surgery and eye care in general, however, there has been limited research on patient expectations within the field of ophthalmology. The vast majority of existing research on patients' expectations has focused on expectations of primary care physicians. Because ophthalmologists are involved in both surgical and medical care, it is important to expand the consideration of patient expectations beyond the traditional primary care setting. Using elements of the taxonomy developed by Kravitz (Kravitz RL: Patients' expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev 53:3-27, 1996), this article reviews the existing literature on patient expectations and draws attention to the limited research in specialty and surgical fields. This article has the following objectives: 1) provide a context for understanding what patient expectations are, 2) review the different ways that patient expectations are measured, 3) illustrate the content of patient expectations from empirical research, 4) outline potential determinants of patient expectations, and 5) discuss the role of patient expectations in ophthalmology.
Humans↗
Alcohol expectancies and drinking in different age groups.
AIMS: Because expectancies about the effects of alcohol change as drinking experience is accumulated, it is likely that the relationship of expectancy to drinking will differ with age. In this study, we examine the prediction of drinking behavior from positive and negative outcome expectancy at different ages. DESIGN: Data were collected as part of the National Alcohol Survey, using a multi-stage area probability sample of the household population of the 48 contiguous United States. PARTICIPANTS: US residents aged 12 and older (n = 2875). MEASUREMENTS: Survey questions included drinking habits (frequency, quantity, frequency of drunkenness, maximum quantity) and beliefs about the effects of alcohol (alcohol expectancies). FINDINGS: Structural equation models tested the relationship of positive and negative expectancy to drinking behavior in six age groups. Outcome expectancy accounted for a larger portion of the variance in drinking among younger respondents than among older respondents. However, suppression effects were common. When suppression effects were considered, positive expectancy predicted drinking better than negative expectancy only among respondents under 35, while negative expectancy was a better predictor of drinking status in most respondents over 35 years. Among drinkers, positive expectancy predominated over negative expectancy when suppression effects were considered. CONCLUSIONS: These results suggest that negative expectancy predicts abstention, while positive expectancy predicts level of drinking among drinkers. In expectancy research, differences between drinkers and abstainers, age of participants and the presence of suppression effects should be taken into account.
Adolescent↗