Chronic pain patients' evaluations of consultations: A matter of high expectations or expectations unmet?

Abstract

This study tests two hypotheses about spine pain patients' expectations for consultations and their negative evaluations. High expectations may be impractical or unachievable and can set patients up for disappointment. Unmet expectations are the absolute difference between expectations before the visit and perceptions of expectations actually enacted. We conducted a single-site prospective study using pre- and post-consultation surveys. Patients (N = 200) were English-speaking individuals aged 18-75 presenting for an initial consultation for musculoskeletal pain. Analyses were conducted in SPSS v. 28.0 using mixed modeling to account for interdependence among cases. Contrary to initial predictions, higher pre-consultation expectations for shared decision-making were positively linked to post-consultation satisfaction, trust, and agreement. Exceeding expectations in shared decision-making, history-taking, examination, and interpersonal skills significantly enhanced post-consultation outcomes. Results support the unmet expectations hypothesis over the high expectations hypothesis. Increased expectations and exceeding these expectations in key areas of patient-physician interaction were positively associated with improved consultation outcomes. Findings highlight the importance of exceeding multifaceted patient expectations in physician evaluations. Yet, physicians must first understand the nature and source of each patient's expectations pre-consultation, which vary across individuals in aspirational and realistic dimensions.