Surveying Patients about Health Care Providers Is Likely of Little Use

Oct 22, 2018

4 min

Keith Sanford, Ph.D.

But a newly developed questionnaire delves more deeply and may provide valuable information, Baylor University study finds


For anyone who has ever taken a survey after a medical appointment and wondered whether the effort was worthwhile, the answer is probably “No,” says a Baylor University psychologist and researcher.


Health care providers are pushing to assess patient satisfaction, and many companies charge millions of dollars to assess patients for the providers. But while the intentions are great, “when I started looking at the instruments currently being used to assess doctor-patient relationships, it became apparent they were highly problematic and not providing useful information,” said Keith Sanford, Ph.D. professor of psychology and neuroscience in Baylor’s College of Arts & Sciences.


After conducting a series of studies to clarify problems with existing scales, Sanford — a scholar of psychometrics who develops assessment instruments — has created a new tool to measure patient experience during consultations, and research findings suggest it works better than others.


The research — “Medical Consultation Experience Questionnaire: Assessing Perceived Alliance and Experienced Confusion During Medical Consultations” — was published in Psychological Assessment, a journal of the American Psychological Association, and funded in part by a grant from Baylor College of Medicine. Working with Baylor University psychologists were physicians with Texas Children’s Hospital and Baylor College of Medicine.


The new instrument — the Medical Consultation Experience Questionnaire (MCEQ) — measures two aspects of patient experience — “alliance” and “confusion.” Researchers stressed that it addresses the consultation, not treatment results.


Practitioners strive for a good alliance, in which the patient sees the practitioner as committed, competent and dedicated to understanding patient desires and views. Another goal is good exchange of information to avoid confusion.


But in attempting to measure how well those goals are being met, some questionnaires have limited options that may result in skewed results, Sanford said.

For example, one survey offers respondents a 4-point scale in which the answers range from “always” to "never” to such questions as “How often did doctors listen carefully to you?”


Another existing assessment instrument asks respondents to use a 5-point scale — from “poor” to “excellent” — to rate practitioner communication in such areas as whether they were treated with respect.


The problem is that most respondents choose the top response for each item, with fewer than 5 percent choosing the bottom option, previous research has shown. While such a scale can identify “highly disgruntled” patients, “it cannot make reliable distinctions between patients having experiences ranging from marginally acceptable to extremely positive,” researchers wrote.


“The key question is whether a ‘good doctor’ is a single thing or whether there is a range of goodness,” Sanford said. “If you ask the right questions, you’re able to get results that show that range.”


To evaluate the new questionnaire, researchers conducted three studies with a total of 576 participants. They compared responses to the new survey with those participants’ responses to other questionnaires.


Respondents ranged from adults with diabetes and/or hypertension to parents of children requiring plastic surgery (for such conditions as a cleft palate or facial injury) to parents of children with medical conditions meeting one or more of such criteria as having to go to an emergency room, spend time in a hospital, cope with a chronic condition or deal with a life-threatening condition.


The study results support the validity of the new questionnaire in several important ways. It allows for measuring a wider range of patient experiences with more extensive and specific responses, making for better assessment of “alliance” and “confusion” — rather than merely identifying only the most dissatisfied or angry patients, Sanford said.


“One of the reasons this is so important is if you don’t form an alliance with your practitioner, they may give you all the wonderful advice in the world, but you might not follow it, or you might be skeptical,” Sanford said. “And if you don’t quite understand what you are supposed to do, that will interfere with your doing the recommended actions.”


Sanford noted that because the study relied on self-reported data and sampled only three groups with varying medical conditions, future research on patients with other health issues could be valuable. Tracking such outcomes as physiological measurements or frequency of attending rehabilitation sessions also could be of value, he said.


“My hope is that people who use these surveys might realize that just as there is a science behind medical treatment, there is a science behind getting good survey reports,” Sanford said. “We want to make this available freely to anyone who wants to administer it.”


*Co-researchers were Alannah Shelby Rivers, doctoral candidate in psychology and neuroscience at Baylor University; Dr. Tara L. Braun and Kelly P. Schultz, Division of Plastic Surgery at Baylor College of Medicine; and Dr. Edward P. Buchanan, Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital in Houston and Division of Plastic Surgery at Baylor College of Medicine.


ABOUT BAYLOR UNIVERSITY

Baylor University is a private Christian University and a nationally ranked research institution. The University provides a vibrant campus community for more than 17,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating University in Texas. Located in Waco, Baylor welcomes students from all 50 states and more than 80 countries to study a broad range of degrees among its 12 nationally recognized academic divisions.


ABOUT BAYLOR COLLEGE OF ARTS & SCIENCES

The College of Arts & Sciences is Baylor University’s oldest and largest academic division, consisting of 25 academic departments and seven academic centers and institutes. The more than 5,000 courses taught in the College span topics from art and theatre to religion, philosophy, sociology and the natural sciences. Faculty conduct research around the world, and research on the undergraduate and graduate level is prevalent throughout all disciplines. Visit www.baylor.edu/artsandsciences.


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Keith Sanford, Ph.D.

Keith Sanford, Ph.D.

Professor of Psychology and Neuroscience

Dr. Sanford studies interpersonal relationships, married couples and the development of assessment instruments.

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9 min

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Especially on campus, I would encourage Baylor community members to follow along with Spiritual Life’s resources and events, or check out Better Together BU, a partnership supported by both Spiritual Life and Multicultural Affairs. Q: How can individuals within the campus community tend to their mental health to close out the semester? Tending to our mental health in this last stretch of the semester will be so important as we move into the stress of finals, the complex emotions tied to the holidays, grief with upcoming celebrations looking different this year (including how we celebrate holidays, who we celebrate with and the reality of many having lost loved ones to COVID-19) and the reality of seasonal affective disorder on the horizon. In fact, in a typical year, about 5% of U.S. adults have seasonal affective disorder (SAD), with another 10-20% having mild forms of it. In light of all of the added transition, uncertainty, complexity of caregiving and homeschooling while working/studying at home, layers of loneliness and grief, I do hope our Baylor students, staff and faculty will actively prioritize taking good care of their mental health and supporting others’ mental health care, too. One way I highlight this with my social work students is by recommending creating a self-care plan that pays attention to our physical health, mental health, social support and spiritual health. If we can identify some strategies to holistically care for ourselves well and be mindful of potential barriers to navigate, we may have more resilience and practices to draw from to cope with challenges and stressors that arise. Finally, although NAMI highlights that 1 in 5 of us are currently facing a mental health struggle, some studies have shown that over 80% of us will meet criteria for a mental illness by young adulthood or middle-age. Therefore, I highly recommend that anyone who is noticing any changes in their mood, diet, sleep habits, behaviors or overall well-being immediately reach out for help. Students are encouraged to reach out to Baylor’s Counseling Center, CARE team or the BARC. Faculty and staff also have resources available through Baylor’s employee assistance program. Other resources for finding a mental health provider include HelpPRO, Psychology Today, Low Cost Help or these additional resources. For those who are deeply struggling, please reach out to the Suicide Prevention Lifeline at 1-800-273-8255 or text ‘HOME’ to 741-741 for the Crisis Text Line. As part of my faith and my social work values, I believe that each of us are worth caring for ourselves, including caring for our mental health alongside our spiritual and physical health. Q: What successes or bright spots have you seen within your campus experience that offer encouragement to how the Baylor Family has handled the crisis throughout the semester? I am regularly amazed by the Baylor students, faculty and staff, the ways we have navigated the crisis together this semester, and I am especially grateful for President Livingstone’s and Provost Brickhouse’s leadership since March. This semester, some bright spots have included Dr. Deborah Birx’s reflections on Baylor’s efforts to keep everyone safe from COVID-19, the Fall Faculty meeting and Dr. Peter Hotez’s appreciation of how Baylor leaders have kept the Baylor and Waco community safe and following along when Baylor students take over Baylor’s Instagram account (like Brandon Nottingham’s takeover on World Mental Health Day!). 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