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Symptom importance, patient expectations, and satisfaction in chronic rhinosinusitis.

ABSTRACT: BACKGROUND:Sinonasal symptoms and poor quality of life (QOL) prompt chronic rhinosinusitis (CRS) patients to undergo sinus surgery (ESS). However, little is known regarding the symptoms most important to patients and how these impact expectations and postoperative satisfaction. METHODS:A prospective, multi-institutional cohort study of 100 CRS patients undergoing ESS completed a novel adaptation of the 22-item Sino-Nasal Outcome Test (SNOT-22) wherein they rated how important it was for specific symptoms to improve after surgery, along with preoperative expectations and postoperative satisfaction. The primary satisfaction measure was whether a patient would choose to undergo endoscopic sinus surgery (ESS) again. A multivariate, logistic regression model was built using demographics, objective measures, and the adapted SNOT-22 data. Spearman correlation analysis was also performed. RESULTS:Nasal obstruction was rated as "extremely" or "very" important by 93% of patients, followed by smell/taste, thick nasal discharge, need to blow nose, postnasal discharge, and sleep symptoms (range, 61-72%). Symptoms like sadness and embarrassment were not considered important by preoperative patients (?28%). In multivariate logistic regression, postoperative satisfaction depended on preoperative expectations being met and ESS improving their most important symptoms (odds rato, 19.6-27.5; p < 0.005). Postoperative satisfaction was not correlated with achieving a minimal clinically important difference, but it was correlated with magnitude of change in SNOT-22 (r = 0.35; p < 0.05). CONCLUSIONS:Nasal, smell, and sleep-related symptoms were consdidered most important by this cohort. Meeting of preoperative expectations, improvement of the most important symptoms, and the magnitude of change in the SNOT-22 may drive postoperative satisfaction.

SUBMITTER: Mattos JL

PROVIDER: S-EPMC6555643 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Symptom importance, patient expectations, and satisfaction in chronic rhinosinusitis.

Mattos Jose L JL Rudmik Luke L Schlosser Rodney J RJ Smith Timothy L TL Mace Jess C JC Alt Jeremiah J Soler Zachary M ZM

International forum of allergy & rhinology 20190212 6

<h4>Background</h4>Sinonasal symptoms and poor quality of life (QOL) prompt chronic rhinosinusitis (CRS) patients to undergo sinus surgery (ESS). However, little is known regarding the symptoms most important to patients and how these impact expectations and postoperative satisfaction.<h4>Methods</h4>A prospective, multi-institutional cohort study of 100 CRS patients undergoing ESS completed a novel adaptation of the 22-item Sino-Nasal Outcome Test (SNOT-22) wherein they rated how important it w ...[more]

PMID: 30748101

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Project description:BackgroundPatient expectations have been recognized as a factor for patient satisfaction in medical consultations. Although various studies explored the relationship between patient expectations and patient satisfaction in developed countries, there is a lack of research evidence in Ethiopia where the meeting of patient expectations could relate to satisfaction.ObjectiveTo assess the relationship between patients' expectations and their satisfaction in the consultation of patients at the outpatient department.Study designData were collected regarding preconsultation expectations and postconsultation experiences of adult patients attending nine public hospitals. A systematic random sampling method was used where every fifth patient attending an outpatient department was selected. The patients were interviewed before consultation and after consultation to assess whether their pre-consultation expectations were met and to assess how satisfied they were with the consultation. Cronbach's alpha statistic was used to assess the reliability of the expectation questionnaires, and paired t-test was used to assess any differences between previsit expectations and postvisit experiences. Logistic regression techniques were used to assess variables considered as independent factors for patient satisfaction.ResultsA total of 776 patients were interviewed, giving a response rate of 92.3%. About 93.7% mentioned a diagnosis for their condition as a reason for their current hospital visits. There is a significant difference between preconsultation expectation and postconsultation expectation. Postconsultation expectation, perceived health status, and perceived control on health were factors identified as increasing patient satisfaction. In addition, the presence of any disappointments or worries, previous experience in health care, and extent of influence on the consultation had a negative influence on satisfaction.ConclusionPostconsultation expectation impacts patient satisfaction. Health care service providers should emphasize the actual experience of consultation.

Project description:BackgroundChronic rhinosinusitis (CRS) is associated with substantial productivity losses. Prior cross-sectional study has identified risk factors and symptom subdomains contributing to baseline productivity loss. This study evaluates correlations between posttreatment changes in symptom subdomain and productivity loss.MethodsA total of 202 adult patients with refractory CRS were prospectively enrolled into an observational, multi-institutional cohort study between August 2012 and June 2015. Respondents provided pretreatment and posttreatment 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Productivity losses were monetized using measures of absenteeism, presenteeism, lost leisure time, and U.S. government-estimated wage and labor rates.ResultsA total of 39 (19%) participants elected continued appropriate medical therapy (CAMT) and 163 (81%) elected endoscopic sinus surgery (ESS). CAMT patients experienced improvement in SNOT-22 total and rhinologic subdomain scores (both p ≤ 0.039). ESS patients reported improvement in SNOT-22 total scores and all subdomains (all p < 0.001). Mean monetized productivity losses were nearly unchanged following CAMT (-$200, p = 0.887) but significantly reduced following ESS (-$5,015, p < 0.001). Mean productivity losses were reported in CAMT patients reporting worse mean posttreatment extra-rhinologic, psychological, and sleep symptom severity scores; however, no statistically significant linear correlations (r ≤ 0.249; p ≥ 0.126) were reported.ConclusionTreatment modalities associate with different posttreatment productivity changes. Patients electing ESS experienced postoperative improvement in productivity distributed across all SNOT-22 symptom domains, suggesting productivity improvement correlates with multiple symptom domains. Patients electing CAMT had better baseline productivity compared to patients electing ESS, and this productivity level was maintained through treatment. Greater productivity loss occurred in patients with worse SNOT-22 scores in the extra-rhinologic, psychological, and sleep subdomains.

Project description:ObjectivesThe concept of disease control incorporates independent disease characteristics that are longitudinally reflective of disease status and which can be used to make treatment decisions. Chronic rhinosinusitis (CRS) is a chronic condition for which the determination of disease control by both the patient and the treating physician is important. Our objectives were to determine CRS disease characteristics that are associated with patient-reported and physician-rated CRS disease control.Study typeCross-sectional.MethodsA total of 209 participants were prospectively recruited. Participants were asked to rate their global level of CRS control as "not at all," "a little," "somewhat," "very," and "completely." All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) and also reported the number of sinus infections, CRS-related antibiotic courses taken, CRS-related oral corticosteroid courses taken, and missed days of work or school due to CRS, all in the last 3 months. Clinical and demographic characteristics were also collected from each participant. A Lund-Kennedy endoscopy score was calculated for each participant from nasal endoscopy. Two rhinologists were then given each participant's SNOT-22 score (as well as SNOT-22 nasal, sleep, otologic/facial pain, and emotional subdomain scores), endoscopy score, and the number of sinus infections, CRS-related antibiotics, CRS-related oral corticosteroid courses and missed days of work or school due to CRS in the preceding 3 months as reported by the patient. The two rhinologists were blinded to all other participant characteristics and each rhinologist independently rated every participant's global control level as "not at all," "a little," "somewhat," "very," and "completely." Associations were sought between CRS disease characteristics (SNOT-22 score, endoscopy score, sinus infections, CRS-related antibiotic usage, CRS-related oral corticosteroid usage, and lost productivity due to CRS) and patient-reported CRS control as well as mean physician-rated CRS control.ResultsPatient-reported global CRS control was associated only with SNOT-22 (adjusted relative risk [RR]?=?0.99, 95% CI: 0.98-0.99, P?<?.001) but no other CRS disease characteristic. Patient-reported CRS control was specifically associated only with nasal symptoms and not extra-nasal symptoms of CRS. Physician-rated CRS control was associated with SNOT-22 score (adjusted RR [for each 1-unit increase of SNOT-22]?=?0.99, 95% CI: 0.98-0.99, P?<?.001), number of acute bacterial CRS exacerbations-reflected by number of antibiotic courses taken (or sinus infections)-in the last 3 months (adjusted RR?=?0.89, 95% CI: 0.82-0.98, P?=?.014) and the number of CRS-related oral corticosteroid courses taken in the last 3 months (adjusted RR?=?0.87, 95% CI: 0.78-0.97, P?=?.012). Nasal, sleep, and otologic/facial pain symptoms were all associated with physician-rated CRS control. Having used at least one course of antibiotics or oral corticosteroids in the last 3 months was the optimal threshold for detecting poorly controlled CRS.ConclusionsPatients and physicians use different criteria to determine the level of CRS control. While both rely on the burden of CRS symptomatology, patients consider primarily nasal symptoms while physicians include nasal and extra-nasal symptoms of CRS in determining CRS control. Physicians also independently consider CRS-related antibiotic use, as a reflection of acute bacterial CRS exacerbations, and CRS-related oral corticosteroid use in the determination of global CRS control.Level of evidence2c.

Project description:Objectives/hypothesisTo explore possible factors that might impact a patient's choice to pursue endoscopic sinus surgery (ESS) or continue with medical management for treatment of refractory chronic rhinosinusitis (CRS).Study designCross-sectional evaluation of a multicenter prospective cohort.MethodsTwo hundred forty-two subjects with CRS were prospectively enrolled within four academic tertiary care centers across North America with ongoing symptoms despite prior medical treatment. Subjects either self-selected continued medical management (n = 62) or ESS (n = 180) for treatment of sinonasal symptoms. Differences in demographics, comorbid conditions, and clinical measures of disease severity between subject groups were compared. Validated metrics of social support, personality, risk aversion, and physician-patient relationships were compared using bivariate analyses, predicted probabilities, and receiver operating characteristic curves at the 0.05 alpha level.ResultsNo significant differences were found between treatment groups for any demographic characteristic, clinical cofactor, or measure of social support, personality, or the physician-patient relationship. Subjects electing to pursue sinus surgery did report significantly worse average quality-of-life (QOL) scores on the 22-item Sinonasal Outcome Test (SNOT-22; P < .001) compared to those electing continued medical therapy (54.6 ± 18.9 vs. 39.4 ± 17.7), regardless of surgical history or polyp status. SNOT-22 score significantly predicted treatment selection (odds ratio, 1.046; 95% confidence interval, 1.028-1.065; P < .001) and was found to accurately discriminate between subjects choosing endoscopic sinus surgery and those electing medical management 72% of the time.ConclusionsWorse patient-reported disease severity, as measured by the SNOT-22, was significantly associated with the treatment choice for CRS. Strong consideration should be given for incorporating CRS-specific QOL measures into routine clinical practice.Level of evidence2b.

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Symptom importance, patient expectations, and satisfaction in chronic rhinosinusitis.

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Symptom importance, patient expectations, and satisfaction in chronic rhinosinusitis.

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