Following surgery, some patients suffer distress, disappointment, regret, poor adjustment, and poor quality-of-life. Surgeons may define 'success' based on objective clinical outcomes, but patients' perceptions of surgical success rely primarily on a comparison to their initial expectations. We review the literature on the relationship between patients' surgical expectations and psychosocial outcomes and attempt to resolve a conflict in the literature. Specifically, we propose that conflicting conclusions regarding the merits of optimism primarily stem from differing methodological approaches by researchers in the field. Studies that examine preoperative expectations in isolation typically conclude that optimism is positively associated with beneficial psychosocial outcomes. Studies that compare preoperative expectations to objective surgical outcomes typically conclude that optimism, particularly unrealistic optimism, is associated with detrimental psychosocial outcomes. As a whole, the evidence strongly supports an association between optimistic expectations and positive psychosocial outcomes following surgery if those expectations are based in reality. If preoperative optimism ultimately turns out to be unrealistic, however, it is likely to be a postoperative liability.

Waiting for uncertain news is a common and stressful experience. We examined whether experiencing awe can promote well-being during uncomfortable periods of uncertainty. Across two studies (total N = 729), we examined the relationship between trait awe and well-being as participants awaited feedback on a novel intelligence test or ratings from peers following a group interaction. These studies further examined the effect of an awe induction, compared to positive and neutral control conditions, on well-being. We found partial support for a relationship between trait awe and well-being during waiting periods, particularly with positive emotion. We also found partial support for the benefits of an awe induction: People consistently experienced greater positive emotion and less anxiety in the awe condition compared to a neutral control condition, although these benefits did not always improve upon the positive control experience. Importantly, these benefits emerged regardless of one’s predisposition to experience awe.

During healthcare visits, physicians may set communication goals such as providing their patient with information about treatment; however, no recommendations exist regarding which goals physicians should prioritize during their often-brief interactions with patients. Two studies examined five communication goals (providing information, reducing distress, increasing patient satisfaction, increasing patient adherence, and encouraging hope) in the context of physician-patient interactions and their relationship with patient and physician outcomes. In Study 1, audio-recordings of physician-patient interactions were coded by research assistants for goal-related content. In Study 2, patients reported their physician's use of each goal during the interaction. In both studies, patients and physicians reported visit outcomes. Within-study meta-analyses suggested that the goal of reducing distress, but not the other goals, was consistently related to improved outcomes in Study 1. All goals were related to improved outcomes in Study 2. We then computed sample-size-weighted meta-analytic effects of each goal on each outcome across both studies. These results suggested that all of the goals had similar-sized positive relationships with patient and physician outcomes across studies. These findings suggest that physicians should generally approach consultations with communication goals in mind, but prioritizing efforts to reduce distress may be particularly beneficial.

Context

Good patient-provider interactions promote satisfaction with health care, adherence to treatment recommendations and improved health. However, little research has examined patients' emotions and how they relate to patients' experiences with health care and their adherence intentions in acute care settings.

Objective

This study examined the predictors and consequences of two emotions pertinent to the uncertainty of acute health-care experiences: anxiety and hopefulness.

Design

Patients who arrived at a general surgery clinic for an initial consultation were interviewed before and after the consultation. Prior to the consultation with a physician, patients completed baseline measures of their emotional state. Following the consultation, patients completed measures of understanding of the information provided by the surgeon, perceived control over treatment decisions, adherence intentions and emotional state.

Results

Understanding and control predicted less anxiety and greater hopefulness, compared to baseline. Only hopefulness predicted adherence intentions. These relationships remained even after controlling for characteristics of the patients and interactions.

Discussion

These findings identify aspects of psychosocial care that are critical for promoting positive (and mitigating negative) emotional states in patients. Even in a brief consultation in a clinic setting, physicians may be able to improve patients' emotional state by promoting a sense of control and clarifying information they convey, and patients' positive emotional states may be critical for raising adherence intentions.

Objective

Patients' expectations predict important health outcomes. The goal of this study is to describe the types of expectations that hernia and gallbladder patients have for the outcomes of their surgery and to identify relationships between these expectations and both patient- and surgeon-reported variables.

Design

Patients (N = 143) at an out-patient surgery clinic completed self-report questionnaires before and after a pre-surgical consultation in which they learned they would be scheduled for surgery. After indicating their general expectations for their surgical outcomes (positive or negative), patients reported specific outcome expectations, which were coded into eight categories: functional improvement, symptom relief, quality-of-life improvement, emotional improvement, general health, no effect expected, no response (or unsure) and negative expectations.

Results

Functional improvement and symptom relief were the most common types of expectations mentioned by patients. A key finding was a significant difference in the pattern of expectations provided by Hispanic versus non-Hispanic patients, as well as between patients across the range of health literacy.

Conclusions

Patients undergoing hernia and gallbladder surgery have a variety of expectations, and these expectations vary across demographic groups. Patients who are particularly vulnerable to poor physician communication have positive but diffuse expectations.