Print Print RSS

A qualitative inquiry of patient-reported outcomes: the case of lower urinary tract symptoms.

Welch LC, Botelho EM, Joseph JJ, Tennstedt SL.
Nursing Research
    View Full Citation

Background

Patient-reported outcomes are a valuable tool for assessing healthcare, particularly for symptom-based conditions that lack definitive physiological measures of treatment efficacy.

Objective

To explore the value of qualitative methods for understanding and developing patient-reported outcomes of medical care for symptom-based conditions by examining the case of lower urinary tract symptoms.

Methods

Semistructured interviews were conducted with a diverse community sample of 90 respondents who had spoken with a provider about their urinary symptoms. Content and thematic analyses were conducted for the areas of symptom relief, patient adherence, and satisfaction with care according to gender, race or ethnicity, and socioeconomic status.

Results

Across social groups, most patients experienced either no symptom relief or partial relief, reported that they adhered to recommendations, and were satisfied with the care received. The primary reason for no symptom relief was not receiving a treatment recommendation. For patients, even partial relief made symptoms more manageable both physically and emotionally. Satisfaction with care was mediated by the quality of the patient-provider relationship as well as expectations other than symptom relief, particularly for patients of low socioeconomic status.

Discussion

Patients' assessments of the outcomes of seeking medical care for this symptom-based condition broadened the criteria for quality of care beyond providing a cure. For healthcare providers, this can widen the path for meeting patient needs, even without complete symptom relief. For providers and researchers, as the evidence base expands to include patient reports, the context provided by a qualitative approach can enhance understanding of patients' perspectives and the ability to construct meaningful quantitative measures.

View Publication Details





Marceau, L., McKinlay, J. B., Shackelton, R., & Link, C. (Epub ahead of print). The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus. Journal of Evaluation in Clinical Practice.

Siegrist, J., Shackelton, R., Link, C., Marceau, L., von dem Knesebeck, O., McKinlay, J. (2010). Work stress of primary care physicians in the US, UK and German health care system. Social Science and Medicine, 71(2), 298-304.

Von dem Knesebeck, O., Bonte, M., Siegrist, J., Marceau, L., Link, C., & McKinlay, J. (2010). Diagnosis and therapy of depression in the elderly--influence of patient and physician characteristics. Psychother Psychosom Med Psychol, 60(3-4), 98-103.

Konrad, T. R., Link, C. L., Shackelton, R. J., Marceau, L. D., von dem Knesebeck, O., Siegrist, J., et al. (2010). It's about time: Physicians' perceptions of time constraints in primary care medical practice in three national healthcare systems. Medical Care, 48(2), 95-100.

Von dem Knesebeck, O., Gerstenberger, E., Link, C., Marceau, L., Roland, M., Campbell, S., et al. (2010). Differences in the diagnosis and management of type 2 diabetes in 3 countries (US, UK, and Germany): Results from a factorial experiment. Medical Care, 48(4), 321-326.

Grant, R. W., Lutfey, K. E., Gerstenberger, E., Link, C. L., Marceau, L. D., & McKinlay, J. B. (2009). The decision to intensify therapy in patients with type 2 diabetes: results from an experiment using a clinical case vignette. The Journal of the American Board of Family Medicine, 22(5), 513-520.

Maserejian, N. N., Lutfey, K. E., & McKinlay, J. B. (2009). Do physicians attend to base rates? Prevalence data and statistical discrimination in the diagnosis of coronary heart disease. Health Services Research, 44(6), 1933-1949.

Shackelton, R. J., Marceau, L. D., Link, C. L., & McKinlay, J. B. (2009). The intended and unintended consequences of clinical guidelines. Journal of Evaluation in Clinical Practice, 15(6), 1035-1042.

Shackelton, R., Link, C., Marceau, L., & McKinlay, J. (2009). Does the culture of a medical practice affect the clinical management of diabetes by primary care providers? Journal of Health Services Research and Policy, 14(2), 96-103.

Jackson, C.B., Botelho, E.M., Welch, L.C., Joseph J., & Tennstedt, S.L. (2012). Talking With Others About Stigmatized Health Conditions: Implications for Managing Symptoms. Qualitative Health Research, Epub ahead of print.

Link, C.L., Stern, T.A., Piccolo, R.S., Marceau, L.D., Arber, S., Adams, A., Siegrist, J., von dem Knesebeck, O., McKinlay, J.B. (2011). Diagnosis and Management of Depression in 3 Countries: Results From a Clinical Vignette Factorial Experiment. The Primary Care Companion for CNS Disorders, 13(5), e1-e7.

Lutfey, K.E., Campbell, S.M., Marceau, L.D., Roland, M.O., McKinlay, J.B. (2012). Influences of organizational features of healthcare settings on clinical decision making: Qualitative results from a cross-national factorial experiment. Health, 16(1), 40-56.

Marceau L, McKinlay J, Shackelton, R, Link C. (2011). The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus. Journal of Evaluation in Clinical Practice, 17(6),1122-8.

McKinlay, J.B., Marceau, L.D., Piccolo, R.J. (2012). Do doctors contribute to the social patterning of disease? The case of race/ethnic disparities in diabetes mellitus. Medical Care Research and Review, 69(2),176-93.

McKinlay J.B., & Marceau, L.D. (2011). New wine in an old bottle: does alienation provide an explanation of the origins of physician discontent? International Journal of Health Services, 41(2), 301-35.

Oka, M., Link, C.L., Kawachi, I. (2011). Disparities in the prevalence of obesity in Boston: results from the Boston Area Community Health (BACH) survey. Public Health Reports, 126(5), 700-7.

Shackelton-Piccolo, R., McKinlay, J.B., Marceau, L.D., Goroll, A.H., Link, C.L. (2011). Differences between internists and family practitioners in the diagnosis and management of the same patient with coronary heart disease. Medical Care Research and Review, 68(6), 650-66.

Welch, L.C., Lutfey, K.E., Gerstenberger, E., Grace, M. (2012). Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms". Journal of Health and Social Behavior, 53(3), 313-28.

Welch, L.C., Botelho, E.M., Joseph, J.J., Tennstedt, S.L. (2012). A qualitative inquiry of patient-reported outcomes: the case of lower urinary tract symptoms. Nursing Research, 61(4), 283-90.

Welch, L.C., Botelho, E.M., Tennstedt, S.L. (2011). Race and ethnic differences in health beliefs about lower urinary tract symptoms. Nursing Research, 60(3), 165-72.

McKinlay, J.B. & Marceau, L.D. (2012). From cottage industry to a dominant mode of primary care: stages in the diffusion of a health care innovation (retail clinics). Social Science & Medicine, 75(6), 1134-41.

Heretic's Corner
10/4/2011 - Posted by NERI Upstream
For example, how useful is it to encourage households in poverty (experiencing food insecurity) to consume more costly “healthful” diets (lean meats, whole grains and fresh vegetables and fruit). The examples are endless............