Patients' perspective on surgical intervention for Dupuytren's disease - experiences, expectations and appraisal of results.

PURPOSE To explore patients' perspectives on surgical intervention for Dupuytren's disease (DD), focusing on patients' appraisal of results, involving previous experiences, expectations and patient characters. METHOD The participants were 21 men, mean age 66 years, scheduled for DD surgery. Qualitative interviews were conducted 2-4 weeks before surgery and 6-8 months after surgery. The model of the Patient Evaluation Process was used as theoretical framework. Data were analyzed using problem-driven content analysis. RESULTS Five categories are described: previous experiences, expectations before surgery, appraisal of results, expectations of the future and patient character. Previous experiences influenced participants' expectations, and these were used along with other aspects as references for appraisal of results. Participants' appraisal of results concerned perceived changes in hand function, care process, competency and organization, and could vary in relation to patient character. The appraisal of results influenced participants' expectations of future hand function, health and care. CONCLUSIONS Patients' appraisal of results involved multidimensional reasoning reflecting on hand function, interaction with staff and organizational matters. Thus, it is not enough to evaluate results after DD surgery only by health outcomes as this provides only a limited perspective. Rather, evaluation of results should also cover process and structure aspects of care. Implications for Rehabilitation To improve health care services, it is important to be aware of the role played by patient's previous experiences, expectations as well as staff and organizational aspects of care. Knowledge about patients' experience and view of the results from surgery and rehabilitation should be established by assessment of care effects on health as well as structure and process aspects of care. Evaluation of structure and process aspects of care can be done by using questions about if the patient felt listened to, received clear information and explanations, was included in decision-making, and their view of waiting time or continuity of care. Improving health care services means not only providing the best treatment method available but also developing individualized care by ensuring good interaction with the patient, providing accurate information, and working to improve the structure of the care process. Before treatment, health care providers should have a dialogue with the patient and consider previous experiences and expectations in order to ensure the patient has balanced expectations of the outcome.