Patient-reported healthcare expectations in inflammatory bowel diseases

Background: Patient-reported experience is an important component of a holistic approach to quality of care. Patients’ expectations of treatments and global disease management may indicate their illness representations and their satisfaction and hopes regarding quality of care. Objective: To study expectations of patients with inflammatory bowel disease. Methods: Two focus groups were conducted with 14 patients to explore their expectations about treatments and disease management. From qualitative content analyses of focus group discussions, we built a 22-item expectations questionnaire that was sent to 1756 patients of the Swiss IBD cohort. Answers were collected on a visual analog scale from 0 to 100, and medians (interquartile range [IQR]) calculated. Factor analysis identified main expectation dimensions, and multivariate analyses were performed to describe associations with patient characteristics. Results: Of 1094 patients (62%) included in the study, 54% were female, 54% had Crohn’s disease, 35% had tertiary education, and 72% were employed. Expectation dimensions comprised realistic, predictive, and ideal expectations and were linked to information, communication, daily care, and disease recognition. Half (11 of 22) of the expectations were ranked as very high (median score > 70), the 2 most important being good coordination between general practitioners and specialists (median score: 89, IQR: 71–96) and information on treatment adverse events (89, IQR: 71–96). Women had overall higher levels of expectations than did men. Expectations were not associated with psychosocial measures, except those related to disease recognition, and most of them were highly associated with increased concerns on disease constraints and uncertainty. Conclusions: Patients have high expectations for information and communication among caregivers, the levels varying by gender and region. Patients also appear to request more active participation in their disease management.