CHAPTER 4
Patient Preferences and Expectations
For treatment evaluation, patient self-perceived health and treatment satisfaction are used to measure outcome effectiveness. These values are usually referred to as patient-based measures because they are based on patients’ treatment perceptions.1-3 In the last decade, more studies have measured patients’ perceptions of oral prostheses, including implant-supported overdentures, rather than solely considering clinical outcomes such as survival rates of implants and anatomical changes. While satisfactory clinical outcomes are important factors in the evaluation of the effectiveness of implant overdentures, these outcomes involve only the technical aspect of the prostheses. Consequently, they do not reflect the patient’s opinion and degree of satisfaction with the treatment. This is an important aspect to consider, as edentulism is a chronic condition and therapy is palliative, aimed at improving function and quality of life.1
The patient’s point of view is important in light of reported results that show a poor association between patients’ satisfaction with their prosthesis and the clinical qualities of the prosthesis as assessed by the clinicians.4-9 For example, reports show that, although there is a weak association between patient satisfaction and clinical evaluation of the denture fit, there is a stronger association between patients’ perceived masticatory ability and satisfaction with their prostheses.9 Similar findings suggest that laboratory results of masticatory efficiency, rather than patient satisfaction ratings, should determine the presence of denture problems. Other findings have suggested that masticatory efficiency tests were poor predictors of patients’ choice of prostheses; however, satisfaction ratings of different treatment aspects, such as comfort and stability, were associated with patient preferences. Furthermore, most studies that attempted to correlate patient satisfaction ratings of treatment and the clinician’s opinion of the same treatment have found these correlations to be poor8; also, clinicians’ ratings were not predictive of patient satisfaction. These discrepancies were attributed to the fact that clinicians usually apply predetermined criteria to their treatment evaluation that do not take into consideration the behavioral and psychosocial impact of therapy. For these reasons, there has been considerable interest in understanding and evaluating patients’ preferences, expectations, and perceived ability to function with oral prostheses.
Patient Preferences
There is an increased appreciation among the medical community for the need to incorporate patient preferences into the medical decision-making process. This necessity came about as a result of the dramatic shift toward patient-centered care, in which health care is suited to patients’ long-term needs.10 Health care providers’ interest has broadened beyond survival into the areas of psychosocial function and perceived health; in fact, it is believed that when patients participate in decisions regarding their health care, they tend to respond better to treatment.11 Patient-based measures, such as quality of life, become an important outcome of treatment.1
Better understanding of patient preferences and the possible consequence of treatment satisfaction can be important in predicting patient behaviors, including demand for particular services.
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