Understanding Why Certain Patients With Hand and Wrist Conditions Are Dissatisfied Despite Achieving Their Expressed...

The Personal Meaningful Gain (PMG) is a construct identifying a patient's self-defined improvement goal, capturing the individual's threshold to be satisfied with treatment results. Previous research shows that patients who achieve their expressed PMG should be satisfied with their treatment results, but this is not always the case. This study explored the lived experiences of patients who were dissatisfied with their treatment results despite having achieved their expressed PMG.

We conducted a qualitative study comprising semistructured interviews using Interpretative Phenomenological Analysis. Data were collected in a specialized hand surgery and therapy clinic in the Netherlands. The validated PMG was identified before the initial surgeon consultation and treatment. We interviewed patients who had met their expressed PMG (ie, their goal to become satisfied) but responded as being "very" or "extremely" dissatisfied with their treatment results on a validated questionnaire.

We included six patients and identified four main themes. Three themes were directly related to satisfaction with treatment results: (1) the expressed goal was a means to an end (eg, elimination of pain) instead of the true goal (eg, feeling capable to perform activities); (2) disappointment resulting from unexpected, undesirable events; and (3) positive care experiences ameliorate, but do not resolve, dissatisfaction. The fourth theme reflected patients' attempts to cope with dissatisfaction.

Our study shows that, although the PMG is valid and predicts satisfaction, some dissatisfied patients may have expressed a PMG that was only a means to an end. Positive care experiences could ameliorate dissatisfaction, but they rarely resolve it completely. Unexpected and undesirable events, as well as the patient's coping style, influenced satisfaction with treatment results.

Clinicians should prioritize understanding the patients' actual goals and target factors such as coping and care experiences to improve satisfaction in patients who remain dissatisfied despite achieving their expressed PMG.