How Do Patients Define Satisfaction? The Role of Patient Perceptions of Their Participation and Health Provider Emotional Expression.

Patient satisfaction is important to patient outcomes. Previous attempts to conceptualize satisfaction have often taken an atheoretical approach and focused on doctors' communication skills. Patients are becoming more active health consumers involved in their health care and current definitions of patient satisfaction may not accurately reflect patient expectations about their health consultations. Earlier research found that meeting patients' emotional needs - through empathy and patient-centered communication - is important to patient satisfaction. New research is needed to explore how those needs can be met given the changing trend in patient behaviors and the focus on patient-centredness. This study employed two communication theories - the Willingness to Communicate Model and Communication Accommodation Theory - to consider both patients' communicative decisions, and the intergroup features of the health context that can influence communicative behaviors. Two hundred and fifty-three patients from health clinics in Canada and Australia described what satisfaction meant to them, and identified what aspects of their health consultation were satisfying (or not), and we investigated their perceptions of doctor's emotional expression. Results suggest that patient perceptions of their participation in the consultation predicts their perceptions of doctor emotional expression, and their satisfaction with the consultation. Patients want both emotional and medical needs met in an environment that balances interpersonal and intergroup communication. Our findings suggest the need to expand current definitions of patient satisfaction, patient-centredness and emotional expression. We discuss the implications of these findings for health practitioners and consider future research that addresses the need for more individualized health care.

Clinical Inquiries: Which drugs should post-MI patients routinely receive?

Patients should be placed on the following medications: antiplatelet agents, (meta-analysis for aspirin, multiple randomized controlled trials [RCTs] for aspirin plus clopidogrel); a statin; atorvastatin has the best evidence (a single RCT); a beta-blocker (meta-analysis); renin-angiotensin-aldosterone system blockers, whether or not the ejection fraction is diminished after myocardial infarction (MI) (SOR: A, meta-analysis for angiotensin-converting enzyme [ACE] inhibitor; B, single RCT for ACE inhibitor plus aldosterone blocker).

Clinical inquiries: what's the best way to manage upper extremity venous thrombosis?

Standard management is best: start with unfractionated heparin or low-molecular-weight heparin and follow with long-term therapy with a vitamin K antagonist. Some evidence supports thrombolytic therapy, placement of a superior vena cava filter, or surgical thrombectomy in selected patients. Whether to remove venous catheters during initial treatment for catheter-induced venous thrombosis remains unclear, because limited studies address this issue specifically.

FPIN's Clinical Inquiries. Aspirin use in children for fever or viral syndromes.

Aspirin should not be used to treat acute febrile viral illness in children. (Strength of Recommendation [SOR]: C, based on case-control studies). Although no causal link has been proven, data from case-control and historic cohort studies demonstrate an association between aspirin use and Reye syndrome. The risk of Reye syndrome decreases with age, becoming extremely rare by the late teenage years. Other nonsteroidal anti-inflammatory drugs are effective antipyretics and are not associated with the constellation of symptoms seen in Reye syndrome, which includes nausea, vomiting, headache, excitability, delirium, combativeness, and coma. Aspirin use in children younger than 19 years should be limited to diseases in which aspirin has a proven benefit, such as Kawasaki disease and the juvenile arthritides. (SOR: C, based on expert opinion).

Clinical inquiries: How can you help prevent a recurrence of diverticulitis?

EVIDENCE-BASED ANSWER: A high-fiber diet may help; available evidence does not support other interventions. A high-fiber diet is often prescribed after recovery from acute diverticulitis, based on extrapolation from epidemiologic data showing an association between low-fiber diets and diverticulosis. No direct evidence establishes a role for fiber in preventing recurrent diverticulitis, however. No evidence supports the common advice to avoid nuts and seeds to prevent diverticulitis. Eating nuts, corn, and popcorn does not increase the risk; in fact, nuts and popcorn may have a protective effect. There is not enough evidence to recommend the anti-inflammatory drug mesalamine or a polybacterial lysate for immunostimulation. Retrospective data do not support routine prophylactic colectomy after 1 or 2 episodes of acute diverticulitis.