Patient-Reported Satisfaction, Experiences, and Preferences: Same but Different?

Safety, efficacy, and treatment satisfaction in adults with ITP who switched to avatrombopag from another TPO-RA

ABSTRACT

This phase 4, multicenter, open-label study was conducted to evaluate the safety, efficacy, and treatment satisfaction of switching to avatrombopag from another thrombopoietin receptor agonist (TPO-RA) in patients with immune thrombocytopenia (ITP). Adults who had received ≥90 days of treatment with eltrombopag or romiplostim and had a response (2 platelet counts [PCs] ≥50 × 109/L) switched to avatrombopag with no protocol-defined washout period. The primary end point was the incidence of treatment-emergent adverse events (TEAEs) and serious TEAEs. Secondary end points were the proportion of patients who had a PC between ≥50 × 109/L and ≤200 × 109/L (days 15, 30, 60, and 90) and change from baseline in each domain of the self-administered Treatment Satisfaction Questionnaire for Medication (TSQM) to day 90. Among 60 enrolled patients, 58.3% experienced TEAEs and 10.0% experienced serious TEAEs (1 related to avatrombopag [thrombocytopenia that resolved]; 5 unrelated [1 unrelated death]). A PC ≥50 × 109/L to ≤200 × 109/L was reported for 51.7%, 31.7% (mean PC, 256.2 × 109/L [standard deviation, 176.7 × 109/L]), 55.0%, 60.0%, and 55.0% at baseline and on days 15, 30, 60, and 90, respectively. TSQM scores increased from baseline to day 90 across all domains (mean change: convenience, +13.5; effectiveness, +14.4; global satisfaction, +14.2; side effects, +8.3). There was no correlation between stable avatrombopag dose (day 90) and previous TPO-RA dose (high or low). Patients with ITP may safely switch from another TPO-RA to avatrombopag and maintain adequate PCs while experiencing improved treatment satisfaction. This trial was registered at www.ClinicalTrials.gov as #NCT04638829.

Patient Satisfaction in Primary and Specialised Ambulatory Healthcare: A Web-Based Cross-Sectional Study in the Polish Population

Background: Patient satisfaction is one of the key patient-reported indicators of healthcare quality. In the study, we assess satisfaction with visits to primary healthcare (POZ) and specialised ambulatory healthcare (AOS). Methods: This web-based cross-sectional study was conducted in a representative sample of 725 patients from the Polish population in June 2023. The study employed the Patient Expectations Scale, comprising 18 statements addressing various aspects of a medical visit. Results: The average satisfaction rating for the medical visit was 7.41 (±2.34) out of 10, with a median of 8. Strong correlations were found between overall visit satisfaction and specific aspects of the doctor-patient interaction. The highest correlations were observed for expressions of empathy and support, such as "showed concern" (r = 0.73) and "encouraged me" (r = 0.68), as well as for clear communication about treatment ("presented a probable course of treatment" (r = 0.62) and disease consequences (r = 0.55). Presenting test results (r = 0.51) and treatment recommendations (r = 0.63) were also significantly associated with overall satisfaction (all p < 0.001). Conclusions: This study shows that patients reported higher satisfaction with specialised ambulatory care (AOS) than with family medicine (PR), mainly due to better communication, encouragement and concern from AOS doctors. Improving healthcare quality in Poland requires not only financial and organisational efforts but also a focus on patient expectations, supported by regular use of satisfaction measurement tools.

Drugs and patient's dissatisfaction reporting: From a disproportionality pharmacovigilance analysis to social pharmacology

INTRODUCTION

Patient satisfaction is a key element in medical practice. Few studies have investigated patient satisfaction or dissatisfaction with their drug treatment.

METHOD

Using the World Health Organization (WHO) global pharmacovigilance database, we investigated, through disproportionality analyses, potential associations between exposure to drugs and "patient dissatisfaction with treatment" reports. All reports of "patient dissatisfaction with treatment" in adults until 31/12/2024 were included.

RESULTS/DISCUSSION

Results are expressed as reporting odds ratio (ROR). Among 506 reports, three quarters came from consumers, involving mainly women aged between 45 and 64. The main coreported term was drug inefficacy (before adverse drug reactions). The first anatomical therapeutic chemical (ATC) group was dermatological drugs (25.5%) followed by alimentary tract and metabolism (24.3%), nervous system (22.5%) drugs. A significant association was found with 22 drugs with the highest ROR values for plecanatide, efinaconazole and avatrombopag.

CONCLUSION

Despite its mandatory limitations (underreporting, selective reporting…), this study shows that pharmacovigilance data could help to understand some aspects of social pharmacology, here, patient dissatisfaction with their drug treatment.

The measurement properties of patient experience scales in the intensive care unit: A systematic review

BACKGROUND

As health care recipients, patients play an essential role in evaluating health care quality. Critical care patients have specific experiences that differ from those of regular patients. Existing instruments of patient experience to improve intensive care quality and their measurement properties should be defined.

AIM

To review the existing tools for measuring patient experience in the intensive care unit (ICU) and evaluate their measurement properties.

STUDY DESIGN

This is a systematic review. The PubMed, CINAHL complete, Ovid: Embase, ProQuest Health and Medical complete and Cochrane Library databases were systematically screened from their inception to 9 November 2022. All the research that reported the development and measurement properties of instruments for ICU patient-perceived care was included. The COnsensus-based Standards for the selection of health Measurement Instruments risk of bias checklist (COSMIN-RoB-Checklist) was applied to assess the psychometric indicators of the included studies.

RESULTS

The search yielded 565 documents, of which 15 scales described in 17 studies met the inclusion requirements. Of the 15 scales, seven assessed ICU patient satisfaction and eight assessed patient experience. We categorized the items from existing scales into different elements based on the National Health Service (NHS) framework. The most frequently assessed elements are 'Respect for patient-centred values, preferences and expressed needs', 'Information, communication and education' and 'Physical comfort' (93.33%, 14/15), while 'Transition and continuity' (33.33%, 5/15) is the least frequently measured. There are no studies presenting all the criteria of measurement properties outlined by the COSMIN. In the scale development part, only eight of the items met the requirements of the pilot test. Among all the measurement properties, internal consistency (80%, 12/15) and structural validity (80%, 12/15) were the two most frequently measured attributes. The three most uncommon measurement properties were retest reliability (five, 33.33%), responsiveness (four, 26.67%) and measurement error (three, 20%).

CONCLUSIONS

To enhance the quality of intensive care, it is essential to use professional scales to gather feedback from ICU patients. This systematic review examines existing tools and evaluates their measurement properties using the COSMIN-RoB-Checklist. Further research is needed to develop a strong patient experience framework and reliable psychometric properties.

RELEVANCE TO CLINICAL PRACTICE

Given the insufficient attention to critical care patients' experience, this review summarizes current patient experience scales in the intensive care unit and presents their measurement properties. This helps clinicians select more appropriate tools, develop better intensive care patient experience scales, enhance the understanding of intensive care quality and ultimately improve the excellence of work in ICUs.

Psychometric evaluation of patient-reported experience measures for peri-anesthesia care: A systematic review based on COSMIN guidelines

BACKGROUND

Patient Reported Experience Measures (PREM) have become a critical component in assessing healthcare quality from the patient's perspective. Accurate and reproducible assessment tools are essential for generating robust and reliable results for evaluating peri-anesthesia patient experiences, identifying associated factors, and assessing the impact of healthcare interventions. However, there is currently no systematic review that consolidates all existing peri-anesthesia PREMs and evaluates their psychometric properties.

OBJECTIVE

To identify and assess the psychometric properties of PREMs for peri-anesthesia patients.

DESIGN

Systematic review of measurement properties following the COSMIN guidelines.

METHODS

Systematic searches were conducted in China National Knowledge Infrastructure, Wanfang, PubMed, Embase, Web of Science, CINAHL, and PsycINFO databases from January 1, 1993, to April 15, 2024. Studies reporting on the development and/or validation of any PREMs for use in the peri-anesthesia period were considered eligible. The measurement properties extracted included data on the item development process, content validity, structural validity, internal consistency, cross-cultural validity, reliability, hypothesis testing and responsiveness. For the same PREM across different studies, reliability coefficients were analyzed using a meta-analysis. The quality assessment, rating of measurement properties, synthesis, and modified grading of the evidence were carried out following the COSMIN methodology for systematic reviews.

RESULTS

A total of 26 studies encompassing 16 PREMs were included. Among them, the Patient Satisfaction with Perioperative Anesthetic Care questionnaire (PSPACq), Perception of Quality in Anesthesia (PQA), Sindhvananda General Anesthesia Satisfaction questionnaire, and Daycare Anesthesia Satisfaction (DAS) demonstrated moderate to high-quality evidence of adequate content validity and internal consistency, resulting in strong recommendations. Five PREMs exhibited high-quality evidence of inadequate structural validity and internal consistency, receiving a "not recommended" status. The remaining PREMs were weakly recommended.

CONCLUSIONS

This systematic review identified PSPACq and PQA as effective tools for assessing peri-anesthesia experiences in surgical patients, suitable for both research and clinical use. Future studies should focus on thoroughly evaluating the measurement properties of these two PREMs, as many aspects remain underexplored. A high risk of bias was noted in other PREMs, particularly in content validity, structural validity, and reliability, which increases uncertainty in the evidence base.

REGISTRATION

This study's protocol has been registered at PROSPERO under the registration number CRD42024537900.

Routine measurement of patient experience

Patient experience is a key pillar of healthcare quality. We describe a framework of three short generic measures covering Patient Experience, Result Satisfaction and Service Integration. The Result Satisfaction measure is described for the first time.These measures capture twelve aspects of patient experience covering the relationship between patients and clinicians (Patient Experience), the immediate results of the consultation or treatment as perceived by patients (Result Satisfaction) and collaboration between different healthcare services and silos (Service Integration). Each measure has four items.These measures are compared with three national measures: the Friends and Family Test and the General Practice Patient Survey used in England, and HCAHPS used in US hospitals. The expected benefits of national measures are not being achieved and we need to think again about how best to tailor health services to meet patients' expectations.The three measures described (Patient Experience, Result Satisfaction and Service Integration) are generic, short and have low reading ages. They share common forms and scoring schemes, which mean that they can be used individually or in combination at all levels of a healthcare provider.