Managing Patient Expectations while Improving Surgical Outcomes

Surgical Rounds®, March 2014,

Patients with unreasonable or uninformed expectations are often unprepared for the postoperative period and dissatisfied with their outcomes. As a result, healthcare professionals are dedicating more time to studying and managing patient expectations, including making sure all involved have a clear understanding of what to expect in terms of risks and benefits.

Patients with unreasonable or uninformed expectations are often unprepared for the postoperative period and dissatisfied with their outcomes. As a result, healthcare professionals are dedicating more time to studying and managing patient expectations, including making sure all involved have a clear understanding of what to expect in terms of risks and benefits.

Those extra efforts are paying off, as surgeons and medical staff who manage patients’ expectations well and tailor information to specific recipients usually have better surgical outcomes than those who do not.

The January 2014 issue of Health Expectations included a study that underscored the importance of patient expectations in the preoperative period. The authors asked their study population of 143 hernia and gallbladder patients who were scheduled for surgery to describe their expectations. Previous studies have reported that approximately 50% of cholecystectomy patients were dissatisfied after surgery, experiencing unexpected flatulent dyspepsia, dull abdominal pain, and diarrhea. Similar results have been reported in hernia patients.

The researchers categorized expectations into 8 specific outcomes: functional improvement, symptom relief, quality-of-life improvement, emotional improvement, general health, no effect expected, no response (or unsure), and negative expectations. The most common expectations included functional improvement (46%) and symptom relief (37%), although 6% of patients verbalized negative expectations.

There was a significant difference between Hispanic and non-Hispanic patients’ expectation. Although Hispanic patients tended to report fewer expectations than others, they were more likely to have positive outcome expectations and less likely to verbalize functional or emotional expectations.

Expectations also varied among the patients’ levels of health literacy, since patients with greater health literacy were less likely to cite emotional or symptom improvements as expectations. The researchers interpreted this to mean patients who communicate clearly with their surgeons have different expectations than patients who have language barriers or low health literacy.

Today, many surgeries include complex interventions and advanced technology, which are concepts that can be difficult for clinicians to explain and for patients to understand. The researchers concluded surgeons and their staff should take the time to assess patients’ understanding and manage their expectations, in order to produce optimal outcomes.