Understanding patient satisfaction: the predictive value of quality of life and patient self-selected goals

Patient satisfaction is acknowledged as an important outcome measure for
aesthetic surgery. However, knowledge of the relationship between
psychosocial variables and satisfaction is limited. In the area of bilateral breast
reduction (BBR), there has been research showing high satisfaction rates
alongside improvements in health-related quality of life (HRQOL) and
appearance-related quality of life (ARQOL). Furthermore, in other surgical
disciplines, achievement of patient self-selected goals has positively correlated
with patient satisfaction. This study, therefore, investigates HRQOL, ARQOL
and patient goals in relation to satisfaction following BBR surgery.
Data was collected from 49 participants over four time-points; two prior to
surgery and two post-surgery. The Short-Form 36 health survey measures
HRQOL and the Derriford Appearance Scale 24 measures ARQOL. Patient
goals were collected using a semi-structured interview and rated out of 100%
for achievement post-BBR. The study adopts a single item measure of postsurgery
satisfaction, rated from 0 - 100%. Content analysis of patient goals
reveals eight categories. High frequencies of 'pain' goals are noted, but there
was no significant difference between the frequency of pain compared to
clothes, appearance, activity or emotional goals. Importance ratings suggest
equal value is given to all goal categories. This appears to contrast with
previous research and the dominant discourses surrounding BBR surgery.
Consistent with previous findings, HRQOL and ARQOL are shown to improve
significantly at 6 - 8 weeks and 3-4 months post-surgery. Multiple regression
analyses suggest a possible role for achievement of patient self-selected goals
and post-surgery ARQOL for predicting satisfaction at 6 - 8 weeks post-BBR.
Methodological difficulties are acknowledged and thus the conclusions provided
are tentative. Provisional implications are suggested for audit, clinical and
research purposes.

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