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Patient expectations are not always the same

¹ Andalusian School of Public Health, Granada, Spain
² Department of Biostatistics, School of Medicine, Granada, Spain
³ Family Physicians, Family Medicine Teaching Unit, Granada, Spain

Correspondence to:
Dr A Delgado Sánchez, C/Alquería, 66, Carmenes de San Miguel, 18010 Granada, España; ana.delgado.easp{at}juntadeandalucia.es

Objective: To validate a scale that measures patients’ expectations when seeking advice for health problems of different types.

Methods: 360 patients who had consulted their general practitioner (GP) during the previous 12 months were randomly selected from the lists of 30 GPs. A questionnaire, including a 13-item expectation scale, was administered by interview in the patient’s home to assess expectations in relation to five health problems, three biomedical (strong chest pain, genital discharge and the common cold) and two psychosocial (depression/sadness and serious family problem), repeating the expectation scale for each one. The frequency distribution of items was analysed, multi-level factorial analysis was performed and the reliability of the expectation scale was tested for each hypothetical clinical condition.

Results: The response rate was 90%. Mean age of patients was 47.3 years (SD 16.5); 51% were women. Expectations were high but varied according to the nature and severity of the condition. The percentage of patients wanting the doctor alone to make decisions ranged from 50% for "family problem" to 68% for "chest pain". The five factorial structures differed and explained 49.3–63.9% of the variance. Similarities were observed depending on the type of problem. "Communication" and "Experience of disease" were thus separate dimensions for the biomedical diseases but mixed for the psychosocial conditions.

Conclusions: The factorial structure of expectations varied, indicating that expectations are not homogeneous in all clinical situations. The desire of the patient to participate in decision-making also differs according to the type of health problem.