Why the study?
Understanding patient expectations, concerns, and sociodemographic factors prior to elective spinal surgery is important in a patient-centred healthcare system to improve patient experience and outcomes.
What are the expectations and concerns of patients attending a spinal outpatient clinic, and how do they differ between public (NHS) and private patients?
What are the expectations and concerns of patients attending a spinal outpatient clinic, and how do they differ between public (NHS) and private patients?
Patients attending a spinal outpatient clinic primarily expect pain reduction and fear pain worsening, with public (NHS) patients presenting with significantly higher disability, depression, and anxiety scores than private patients.
Patient priorities may shift postoperatively; hypothesis-generating for tailored counseling before elective spine procedures.
Background: Identifying the expectations and concerns of patients is an important part of the clinical consultation in a patient-centred healthcare system.Most spinal surgery is elective and focussed primarily on improving quality of life.Understanding what patients want from treatment and acknowledging the impact of other sociodemographic factors at baseline may be crucial in improving their experience and outcome.Methods: New patient data from the case load of a single orthopaedic spinal surgeon (between April 2012 and April 2018) was compiled and analysed with expectations and concerns reported in the outpatient clinic letter (the surgeon's standard practise is to ask every new patient their expectations and concerns and this is documented on his spinal clerking proforma).Results: Of 940 patients analysed, 498 were NHS and 442 private patients, the mean age was 58.3 years and split 46.0% male and 54.0% female.Nearly 1-in-6 patients had undergone previous surgery.The most common expectation was 'reduce pain' (41.8%) and the most common concern was 'continuation / worsening of pain' (27.0%).The next 3 most frequent expectations were diagnosis (23.0%), treatment options (13.5%) and unsure (10.5%).The next 3 most frequent concerns were loss of function (15.9%), work-related (8.3%) and permanent disability (7.8%).NHS patients were significantly more unsure of their expectations (19.7% vs 4.5%, p < .001)and more frequently raised no concerns (39.0%vs 18.8%, p <.001).NHS patients had significantly higher Oswestry Disability Index (ODI) scores (46.8% (CI95%: 44.8-48.9)vs 42.0% (CI95%: 40.1-43.8),p <.001), were more depressed (PHQ-9: 11.5 (CI95%: 10.8-12.2) vs 8.9 (CI95%: 8.3-9.6),p <.001) and anxious (GAD-7: 8.2 (CI95%: 7.6-8.8)vs 5.9 (CI95%: 5.4-6.5, p <.001) , whilst private patients were significantly more likely to report problems sleeping (79.4% vs 51.0%, p <.001).Patients concerned about subsequent permanent disability (i.e.paraplegia) had significantly worse ODI (51.0%(CI95%: 46.1-56.0)vs 42.7% (CI95%: 41.4-44.0),p <.001), PHQ-9 (12.6 (CI95%: 10.8-14.4)vs 10.2 (CI95%: 9.7-10.8),p ¼ .013)and GAD-7 (9.0 (CI95%: 7.4-10.5)vs 7.1 (CI95%: 6.6-7.5),p ¼ .017)scores.CONCLUSIONS: This study has investigated the concerns and expectations of patients attending a Spinal Outpatient Clinic.We have presented and categorised which are the most frequent and made compared between the public and private sector and with PROMs.FUTURE WORK: To investigate health beliefs in spinal patients and correlate these with expectations, concerns, PROMs and the outcome following spinal surgery.
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Orosz et al. (2022) studied this question.
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