title: The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery.
abstract: OBJECTIVE
  The disconfirmation model hypothesizes that satisfaction is a function of a perceived discrepancy from an initial expectation. Our objectives were: (1) to test the disconfirmation model as it applies to patient satisfaction with waiting time (WT) and (2) to build an explanatory model of the determinants of satisfaction with WT for hip and knee replacement.
  
  
  METHODS
  We mailed 1000 questionnaires to 2 random samples: patients waiting or those who had received a joint replacement within the preceding 3-12 months. We used ordinal logistic regression analysis to build an explanatory model of the determinants of satisfaction.
  
  
  RESULTS
  Of the 1330 returned surveys, 1240 contained patient satisfaction data. The sample was 57% female; mean age was 70 years (SD 11). Consistent with the disconfirmation model, when their WTs were longer than expected, both waiting (OR 5.77, 95% CI 3.57-9.32) and post-surgery patients (OR 6.57, 95% CI 4.21-10.26) had greater odds of dissatisfaction, adjusting for the other variables in the model. Compared to those who waited 3 months or less, post-surgery patients who waited 6 to 12 months (OR 2.59, 95% CI 1.27-5.27) and over 12 months (OR 3.30, 95% CI 1.65-6.58) had greater odds of being dissatisfied with their waiting time. Patients who felt they were treated unfairly had greater odds of being dissatisfied (OR 4.74, 95% CI 2.60-8.62).
  
  
  CONCLUSIONS
  In patients on waiting lists and post-surgery for hip and knee replacement, satisfaction with waiting times is related to fulfillment of expectations about waiting, as well as a perception of fairness. Measures to modify expectations and increase perceived fairness, such as informing patients of a realistic WT and communication during the waiting period, may increase satisfaction with WTs.
authors.affiliation: Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada. barbara.spady@ualberta.net
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Conner-Spady
authors.forename: Claudia
authors.initials: C
authors.lastname: Sanmartin
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Johnston
authors.forename: John J
authors.initials: JJ
authors.lastname: McGurran
authors.forename: Melissa
authors.initials: M
authors.lastname: Kehler
authors.forename: Tom W
authors.initials: TW
authors.lastname: Noseworthy
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D012525:Saskatchewan; D011795:Surveys and Questionnaires; D013997:Time Factors; D014850:Waiting Lists