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Patient satisfaction with anaesthesia care: what is patient satisfaction, how should it be measured, and what is the evidence for assuring high patient satisfaction?

Patient satisfaction is a part of outcome quality. Many theories of satisfaction include patients' expectation. One definition of satisfaction is therefore the degree of congruence between expectation and accomplishment. The involvement of patients as well as experts is therefore an important step in the development of an instrument to measure patient satisfaction. Results of single-item ratings or overall satisfaction surveys are over-optimistic and do not represent the true indication of care. The construction of highly standardized (psychometric) questionnaires should include elements of content validity, criterion and construct validity, reliability and practicability. Based on the few available studies in anaesthesia, patient satisfaction is primarily determined by information and communication. There is great potential for improvement in this area. However, we do not know the best way to continuously improve patient satisfaction with anaesthesia care, or to what extent decisions should be shared between the anaesthetist and the patient.

Anesthesia↗

The Newcastle Satisfaction with Nursing Scales: a valid measure of maternal satisfaction with inpatient postpartum nursing care.

AIM: To test the validity of The Newcastle Satisfaction with Nursing Scales as measures of patient satisfaction with nursing care in an inpatient postpartum unit. BACKGROUND: The Newcastle Satisfaction with Nursing Scales (Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale) were developed to measure the satisfaction of medical-surgical inpatients with nursing care. METHODS: The Newcastle Satisfaction with Nursing Scales were administered by interviewers to 189 postpartum women prior to hospital discharge. We tested the construct validity of the scales by making five a priori predictions: mothers who were more satisfied would be more likely to have one nurse caring for them and to recommend the postpartum unit to a friend. We also predicted that the Experience of Nursing Care and Satisfaction with Nursing Care Scales would be positively correlated with each other, with a global question about satisfaction with nursing care, and with a global question about satisfaction with overall postpartum stay. RESULTS: Four of the five a priori predictions were supported by the data. The mean Newcastle Satisfaction with Nursing Scale scores of mothers who would recommend the unit to a friend were higher (more satisfied) than those who would not (P < 0.001). The Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale were positively and significantly correlated with each other (r = 0.9, P < 0.001). There was a positive and significant correlation between the scales and global ratings of nursing care (Experience Scale r = 0.79, P < 0.001; Satisfaction Scale r = 0.82, P < 0.001) and overall postpartum stay (Experience Scale r = 0.64, P < 0.001; Satisfaction Scale r = 0.68, P < 0.001). CONCLUSION: The Newcastle Satisfaction with Nursing Scales are valid measures of maternal satisfaction with inpatient postpartum nursing care.

Adolescent↗

Relationship satisfaction and sexual satisfaction: a longitudinal study of individuals in long-term relationships.

This study examined the association between relationship satisfaction and sexual satisfaction over time to provide evidence about possible causal explanations for the association between two variables. Eighty-seven individuals in long-term relationships completed measures of sexual satisfaction and relationship satisfaction at 2 times 18 months apart. There was only limited evidence, based on exploratory analysis, to support either the hypothesis that changes in a relationship satisfaction lead to changes in sexual satisfaction or the hypothesis that changes in sexual satisfaction lead to changes in relationship satisfaction. However, sexual satisfaction and relationship satisfaction wer found to change concurrently. The quality of intimate communication accounted for part of the concurrent changes in relationship satisfaction and sexual satisfaction. I discuss the results in terms of the need to develop more complex models depicting the longitudinal associations between relationship satisfaction and sexual satisfaction.

Adult↗

Satisfaction and correlates of patients' satisfaction with physicians' services in primary health care centers.

OBJECTIVE: To estimate quantitatively consumers' satisfaction and correlates of satisfaction with physicians' services provided by Ministry of Health Primary Health Care Centers in attending consumers. METHODS: Consumers (n = 540) attending the selected Primary Health Care Centers in Riyadh were asked about their satisfaction with physician's services. Eight Primary Health Care Centers were randomly selected according to the geographical location, two from each geographical zone. Seventy-five subjects were selected systematically where every tenth Saudi aged 15 years and above who visited the selected Primary Health Care Centers during the study period was chosen. Data was collected via a self administered pilot tested, internally consistent patient satisfaction questionnaire which included socio-demographic characteristics as well as the overall and differential satisfaction with the different aspects of physicians' services in the selected Primary Health Care Centers rated in a scale of 1 5 points, the higher the score the higher the satisfaction. RESULTS: The results revealed that males constituted 60%, and 58% of all patients were married, more than 60% were employees and more than 70% have a monthly income of less than 6000 Saudi Riyals. Almost 95% have an open file in the Primary Health Care Center and 39% think that the distance to the Primary Health Care Center is far or very far. The summary satisfaction score was 3.77 points and the mean satisfaction with the services provided by physicians was 2.56 points out of a maximum of 5 points The highest satisfaction was for discussing psychological aspects of patients' problems (2.96 points) and the lowest was for attentive listening to patients' complaints (2.22 points). Physicians' communication skills were more satisfactory to patients than their professional skills and satisfying patients' wishes scored the lowest satisfaction- Unskilled laborers, literate patients and patients with higher income showed significantly higher mean satisfaction while students, illiterates, those aged less than 50 years and patients with income less than 6000 Riyals per months scored the lowest satisfaction. The longer the distance travelled the lower the satisfaction scores but having a file or not was not related to satisfaction. CONCLUSION: Some physicians' service items need corrective intervention and students and young patients appear to need more attention.

Adolescent↗

Is the professional satisfaction of general internists associated with patient satisfaction?

BACKGROUND: The growth of managed care has raised a number of concerns about patient and physician satisfaction. An association between physicians' professional satisfaction and the satisfaction of their patients could suggest new types of organizational interventions to improve the satisfaction of both. OBJECTIVE: To examine the relation between the satisfaction of general internists and their patients. DESIGN: Cross-sectional surveys of patients and physicians. SETTING: Eleven academically affiliated general internal medicine practices in the greater-Boston area. PARTICIPANTS: A random sample of English-speaking and Spanish-speaking patients (n = 2,620) with at least one visit to their physician (n = 166) during the preceding year. MEASUREMENTS: Patients' overall satisfaction with their health care, and their satisfaction with their most recent physician visit. MAIN RESULTS: After adjustment, the patients of physicians who rated themselves to be very or extremely satisfied with their work had higher scores for overall satisfaction with their health care (regression coefficient 2.10; 95% confidence interval 0.73-3.48), and for satisfaction with their most recent physician visit (regression coefficient 1.23; 95% confidence interval 0.26-2.21). In addition, younger patients, those with better overall health status, and those cared for by a physician who worked part-time were significantly more likely to report better satisfaction with both measures. Minority patients and those with managed care insurance also reported lower overall satisfaction. CONCLUSIONS: The patients of physicians who have higher professional satisfaction may themselves be more satisfied with their care. Further research will need to consider factors that may mediate the relation between patient and physician satisfaction.

Adult↗

Factors affecting patient and clinician satisfaction with the clinical consultation: can communication skills training for clinicians improve satisfaction?

The provision of adequate information in a clear and sensitive manner can improve cancer patients' experience of care. Satisfaction with the cancer consultation may impact on satisfaction with care in general and adjustment to the disease. This study aims to identify factors that influence patient and clinician satisfaction with the cancer consultation and whether satisfaction can be improved with communication skills training. 160 doctors from 34 UK cancer centres participated. Half were randomized to attend a communication skills training course. Patient satisfaction data are presented at baseline and following a communication skills course or in the case of the control doctors, three months after baseline. Clinicians also rated their satisfaction with the consultations. Overall patient satisfaction was not related to the speciality, seniority or sex of the clinician or patient, site of primary cancer or type of treatment. Satisfaction was related to patients' age, psychological morbidity and, most significantly, satisfaction with the length of wait in clinic. Clinician satisfaction was not related to age, sex or cancer site but clinicians were less satisfied following consultations with patients being treated palliatively. Communication skills training had a non-significant positive effect on patient satisfaction. The subtle benefits of improved communication may be overshadowed by practical problems such as waiting too long to see the doctor, which have an adverse effect on satisfaction.

Adult↗

Erectile function and assessments of erection hardness correlate positively with measures of emotional well-being, sexual satisfaction, and treatment satisfaction in men with erectile dysfunction treated with sildenafil citrate (Viagra).

We aimed to determine whether erectile function (EF) and assessments of erection hardness correlate positively with measures of psychosocial outcomes (ie, emotional well-being, sexual satisfaction, and satisfaction with erectile dysfunction [ED] treatment) in men treated with sildenafil citrate (Viagra; Pfizer Inc, New York, NY). Data were collected from 33 worldwide phase 2, 3, and 4 sildenafil clinical trials, which included almost 10,000 men with ED. Most of these trials were randomized, double-blind, and placebo-controlled (n = 27) and were undertaken to assess doses of 50 mg adjustable to 25 mg or 100 mg, depending on efficacy and tolerability (n = 32). Doses were taken approximately 1 hour before anticipated sexual activity but not more often than once daily. EF was assessed with use of the EF domain of the International Index of Erectile Function (IIEF) and with assessments of erection hardness (Erection Hardness Grading Scale [EHGS] and IIEF Q2 [the frequency of erections hard enough for penetration]). Change (baseline to end point) in emotional well-being in men treated for ED was assessed with the Self-Esteem and Relationship (SEAR) questionnaire, which consisted of the Confidence domain (ie, the Self-Esteem subscale and Overall Relationship subscale) and the Sexual Relationship domain. End point treatment satisfaction (overall, speed of onset, and duration of action) was assessed with the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). The IIEF was used to assess change and end point sexual satisfaction by means of the Intercourse Satisfaction domain, Q7 (frequency of satisfactory sexual intercourse), and the Overall Satisfaction domain (ie, Q13, satisfaction with sex life, and Q14, satisfaction with sexual relationship). In men treated with sildenafil for ED, scores for measures of EF (IIEF EF domain, IIEF Q2) and the percentage of erections graded completely hard and fully rigid (EHGS grade 4) correlated positively with scores for measures of psychosocial outcomes (SEAR emotional well-being, IIEF sexual satisfaction, and EDITS ED treatment satisfaction), indicating that when EF improved and erection hardness increased, these measures of psychosocial function also improved.

Clinical Trials as Topic↗

Use of the consultation satisfaction questionnaire to examine patients' satisfaction with general practitioners and community nurses: reliability, replicability and discriminant validity.

BACKGROUND: Primary health care services are the most frequently used in the health care system. Consumer feedback on these services is important. Research in this area relates mainly to doctor-patient relationships which fails to reflect the multidisciplinary nature of primary health care. AIM: A pilot study aimed to examine the feasibility of using a patient satisfaction questionnaire designed for use with general practitioner consultations as an instrument for measuring patient satisfaction with community nurses. METHOD: The questionnaire measuring patient satisfaction with general practitioner consultations was adapted for measuring satisfaction with contacts with a nurse practitioner, district nurses, practice nurses and health visitors. A total of 1575 patients in three practices consulting general practitioners or community nurses were invited to complete a questionnaire. Data were subjected to principal components analysis and the dimensions identified were tested for internal reliability and replicability. To establish discriminant validity, patients' mean satisfaction scores for consultations with general practitioners, the nurse practitioner, health visitors and nurses (district and practice nurses) were compared. RESULTS: Questionnaires were returned relating to 400 general practitioner, 54 nurse practitioner, 191 district/practice nurse and 83 health visitor consultations (overall response rate 46%). Principal components analysis demonstrated a factor structure similar to that found in an earlier study of the consultation satisfaction questionnaire. Three dimensions of patient satisfaction were identified: professional care, depth of relationship and perceived time spent with the health professional. The dimensions were found to have acceptable levels of reliability. Factor structures obtained from data relating to general practitioner and community nurse consultations were found to correlate significantly. Comparison between health professionals showed that patients rated satisfaction with professional care significantly more highly for nurses than for general practitioners and health visitors. Patients' rating of satisfaction with the depth of relationships with health visitors was significantly lower than their ratings of this relationship with the other groups of health professionals. There were so significant differences between health professional groups regarding patients' ratings of satisfaction with the perceived amount of time spent with health professionals. CONCLUSION: The pilot study showed that it is possible to use the consultation satisfaction questionnaire for both general practitioners and community nurses. Comparison between health professional groups should be undertaken with caution as data were available for only a small number of consultations with some of the groups of health professionals studied.

Community Health Nursing↗

Relationship of service satisfaction to life satisfaction and perceived well-being.

Two procedures for gaining patients' evaluations of health services were compared: (a) the Client Satisfaction Questionnaire (CSQ-18B), a direct approach assessing the setting and services actually encountered, and (b) the Patient Satisfaction Questionnaire (PSQ), an approach that indirectly assesses satisfaction with service by inquiring about general health care attitudes. Results from 148 public health patients indicated that the PSQ produced the most acceptability problems and was tapping aspects of life satisfaction other than service satisfaction. However, the PSQ produced significantly lower reports of satisfaction. Additional comparison and interpretation of typical responses generated from the two approaches suggested, on the whole, that the CSQ-18B data provided clearer, more efficient, and more useful information for program planning and evaluation. In this study, service satisfaction measured by the CSQ-18B did not have any significant relationship to global or multidimensional (LDQ-30) measures of life satisfaction and well-being. In contrast, over a third of the variance in PSQ scores was accounted for by measures of life satisfaction. It appears that the PSQ elicits attitudes toward the more generalized health care delivery system as well as aspects of life satisfaction rather than reactions to specific services actually received.

Analysis of Variance↗

Exploring relationships among communication, sexual satisfaction, and marital satisfaction.

This study examined relationships among couple communication, sexual satisfaction, and marital satisfaction in 387 married couples. Regression analyses demonstrated that communication and sexual satisfaction independently predict marital satisfaction. However, there is a significant interaction between communication and sexual satisfaction; if couples are successful at communicating constructively, sexual satisfaction fails to contribute to marital satisfaction. Alternatively, if couples have difficulty communicating but are sexually satisfied, they will experience greater marital satisfaction than if they have a less satisfying sexual relationship. Thus, sexual satisfaction may partially compensate for the negative effects of poor communication on marital satisfaction.

Adult↗

Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males.

PURPOSE: This study addresses the question, "Does body satisfaction matter?" by examining longitudinal associations between body satisfaction and weight-related health-promoting and health-compromising behaviors five years later among adolescents. METHODS: Project EAT-II followed an ethnically and socioeconomically diverse sample of 2516 adolescents from 1999 (Time 1) to 2004 (Time 2). Associations between body satisfaction at Time 1 and health behaviors at Time 2 were examined, adjusting for sociodemographic characteristics and Time 1 health behaviors, with and without adjustment for body mass index (BMI). RESULTS: In females, lower body satisfaction predicted higher levels of dieting, unhealthy and very unhealthy weight control behaviors and binge eating, and lower levels of physical activity and fruit and vegetable intake. After adjusting for BMI, associations between body satisfaction and dieting, very unhealthy weight control behaviors, and physical activity remained statistically significant. In males, lower body satisfaction predicted higher levels of dieting, healthy, unhealthy, and very unhealthy weight control behaviors, binge eating, and smoking, and lower levels of physical activity. After adjusting for BMI, associations between body satisfaction and dieting, unhealthy weight control behavior, and binge eating remained statistically significant. CONCLUSIONS: The study findings indicate that, in general, lower body satisfaction does not serve as a motivator for engaging in healthy weight management behaviors, but rather predicts the use of behaviors that may place adolescents at risk for weight gain and poorer overall health. Interventions with adolescents should strive to enhance body satisfaction and avoid messages likely to lead to decreases in body satisfaction.

Adolescent↗

The efficacy of tadalafil in improving sexual satisfaction and overall satisfaction in men with mild, moderate, and severe erectile dysfunction: a retrospective pooled analysis of data from randomized, placebo-controlled clinical trials.

BACKGROUND: Satisfaction with the sexual experience is considered important when evaluating the impact of treatments for erectile dysfunction (ED), yet satisfaction has been infrequently assessed in clinical trials. OBJECTIVE: To evaluate satisfaction with, and enjoyment of, the sexual experience in men with ED enrolled in 11 placebo-controlled clinical trials of tadalafil. STUDY DESIGN AND METHODS: Retrospective pooled analysis of data from 11 randomized, double blind, placebo-controlled clinical trials of tadalafil. Men with mild (N = 838), moderate (N = 558), or severe (N = 703) ED who were randomized to tadalafil 10 mg or 20 mg or placebo taken as needed for 12 weeks were included in this analysis. Efficacy measures included the International Index of Erectile Function (IIEF). Reported herein are the scores on the IIEF overall satisfaction domain and individual IIEF questions (IIEF-Q7, satisfaction with intercourse; and IIEF-Q8, enjoyment of intercourse). RESULTS: At least moderate satisfaction (IIEF overall satisfaction domain) was reported by 55% and 72% of patients with mild ED taking tadalafil 10 mg and 20 mg, respectively, compared with 33% taking placebo (p < 0.002); 60% and 65% vs. 19% of patients with moderate ED (p < 0.001); and 32% and 49% vs. 9% with severe ED (p < 0.001). Satisfactory intercourse during most attempts or almost always/always (IIEF-Q7) was reported by 59% and 79% of patients with mild ED taking tadalafil 10 mg and 20 mg vs. 32% taking placebo (p < 0.001); 52% and 65% vs. 18% with moderate ED (p < 0.001); and 28% and 49% vs. 5% with severe ED (p < 0.001). Highly or very highly enjoyable intercourse (IIEF-Q8) was reported by 45% and 63% of patients with mild ED taking tadalafil 10 mg and 20 mg vs. 21% taking placebo (p < 0.001); 43% and 56% vs. 16% with moderate ED (p < 0.001); and 19% and 44% vs. 5% with severe ED (p < 0.001). CONCLUSIONS: Compared with placebo, tadalafil 10 mg and 20 mg improved overall satisfaction with the sexual experience, intercourse satisfaction, and intercourse enjoyment in men with mild, moderate, and severe ED.

Adult↗

Distinguishing patient satisfaction with treatment delivery from treatment effect: a preliminary investigation of patient satisfaction with symptoms after physical therapy treatment of low back pain.

OBJECTIVE: To investigate the discrepancy between ratings of pain intensity and patient satisfaction by evaluating a questionnaire item that assesses patient satisfaction with treatment effect. DESIGN: Inception cohort. SETTING: Ambulatory care. PARTICIPANTS: Sixty-six consecutive patients referred to outpatient physical therapy (PT) with acute low back pain (LBP). INTERVENTION: PT using treatment-based classification guidelines. MAIN OUTCOME MEASURE: Patient satisfaction 6 months after receiving PT for LBP. RESULTS: Patient satisfaction with symptoms was considerably lower than the other patient satisfaction items. Patient satisfaction with symptoms was responsive to measures of treatment effect (Spearman rho range, .36-.44, P < .01) and with whether expectations were met (Spearman rho = .45, P < .01). Patients who were satisfied with symptoms reported higher physical function, lower pain intensity, and less symptom bothersomeness (P < .01) at 6 months. The 2 strongest absolute and unique predictors of patient satisfaction with symptoms at 6 months were whether treatment expectations were met and change in symptom bothersomeness. CONCLUSIONS: This study suggested that a questionnaire item assessing patient satisfaction with symptoms allows patients to distinguish between satisfaction with treatment effect and treatment delivery.

Adolescent↗

Sexual satisfaction in premarital relationships: associations with satisfaction, love, commitment, and stability.

This investigation focused on how sexual satisfaction is associated with relationship quality and stability in premarital couples. With data collected at multiple times over several years from a sample of heterosexual couples (who were all dating at Time 1), we examined how sexual satisfaction was associated with relationship satisfaction, love, commitment, and stability. At each wave of the study, sexual satisfaction was associated positively with relationship satisfaction, love, and commitment for both men and women. In addition, change in sexual satisfaction between Time 1 and Time 2 was associated with change over the same period in relationship satisfaction, love, and commitment. Furthermore, some evidence was found that sexual satisfaction was associated with relationship stability. Overall, sexual satisfaction had stronger links with relationship quality for men than for women.

Adult↗

Patient satisfaction with health care decisions: the satisfaction with decision scale.

Patient satisfaction measures have previously addressed satisfaction with medical care, satisfaction with providers, and satisfaction with outcomes, but not satisfaction with the health care decision itself. As patients become more involved in health care decisions, it is important to understand specific dynamics of the decision itself. The Satisfaction with Decision (SWD) scale measures satisfaction with health care decisions. It was developed in the context of postmenopausal hormone-replacement therapy decisions. The six-item scale has excellent reliability (Cronbach's alpha = 0.86). Discriminant validity, tested by performing principal-components analysis of items pooled from the SWD scale and two conceptually related measures, was good. Correlation of the SWD scale with measures of satisfaction with other aspects of the decision-making process showed the SWD scale was correlated most highly (0.64) with "decisional confidence," and least with "desire to participate in health care decisions" and "satisfaction with provider." The SWD scale predicts decision certainty in this study. Use in an independent study showed that the SWD scale was correlated with the likelihood of patients' intentions to get a flu shot. Further investigation in relation to other health decisions will establish the utility of the SWD scale as an outcome measure.

Adult↗

Relationship of nurses' assessment of organizational culture, job satisfaction, and patient satisfaction with nursing care.

This exploratory study investigated the relationship among staff nurses' assessment of organizational culture, job satisfaction, inpatient satisfaction with information about home care and follow-up, and general inpatient satisfaction with nursing care. A conceptual path model was tested using a secondary data analysis research design. Staff nurses and inpatients were sampled from inpatient units. The unit of analysis was patient care units. Pearson correlation and regression analyses were used. We found that strength of organizational culture predicted job satisfaction well and positively; job satisfaction predicted inpatient satisfaction significantly and positively; and inpatient satisfaction predicted general inpatient satisfaction well and positively. Methodological challenges of this study are discussed.

Adult↗

Jordanian nurses' job satisfaction, patients' satisfaction and quality of nursing care.

PURPOSE: To study nurses' job satisfaction, patients' satisfaction, and quality of nursing care in a Jordanian educational hospital. DESIGN: A descriptive cross-sectional comparative design was used. The total populations at the educational hospital where the study was conducted were: 200 nurses (response rate 60%), 510 patients (response rate 49%), and 26 head nurses (NHs) (response rate 92%). Mueller/McCloskey Satisfaction Scale (MMSS) 1990; Eriksen's (1988) scale of The Satisfaction with Nursing Care; and Quality of Nursing Care Questionnaire-Head Nurse of Safford & Schlotfeldt (1960) were used to measure the phenomena of interest. FINDINGS: Nurses were 'neither satisfied nor dissatisfied' in their jobs, nurses who work in wards reported a slightly better job satisfaction than nurses who work in critical care units. Patients reported that they were 'moderately' satisfied, and head nurses reported that nurses 'usually (practically)' provide a high of quality of nursing care. There were no significant differences between critical care units and wards in regard to patients' satisfaction and quality of nursing care. CONCLUSIONS: Jordanian nurses' job satisfaction is on the borderline, which arguably requires more interventions. Patients' satisfaction and quality of nursing care have to be enhanced to reach the levels of 'very satisfied' and 'always' consecutively.

Adult↗

A descriptive, correlational study of patient satisfaction, provider satisfaction, and provider workload at an army medical center.

Strong national interest in health care delivery systems and a highly competitive marketplace have mandated that military hospital commanders be increasingly aware of organizational performance. Historically, one variable that has been used to assess such performance is patient satisfaction with the care received. The purpose of this study was to measure patient satisfaction at a major military medical center and to assess how patient satisfaction correlated with the variables of provider satisfaction and nurse/patient ratio. One hundred eighty-eight patients completed the LaMonica-Oberst Patient Satisfaction Scale. Data analysis revealed that, although overall patient satisfaction was high, it was significantly higher on the intensive care units and in other areas where the nurse/patient ratio was high. Interestingly, there was no correlation between the staff's perceptions of their work environment and patient satisfaction. Findings from this study serve to highlight the continued need for a low nurse/patient ratio and are suggestive of the need for refinement of patient satisfaction survey tools available at present.

Female↗