title: A qualitative inquiry of patient-reported outcomes: the case of lower urinary tract symptoms.
abstract: BACKGROUND
  Patient-reported outcomes are a valuable tool for assessing healthcare, particularly for symptom-based conditions that lack definitive physiological measures of treatment efficacy.
  
  
  OBJECTIVE
  To explore the value of qualitative methods for understanding and developing patient-reported outcomes of medical care for symptom-based conditions by examining the case of lower urinary tract symptoms.
  
  
  METHODS
  Semistructured interviews were conducted with a diverse community sample of 90 respondents who had spoken with a provider about their urinary symptoms. Content and thematic analyses were conducted for the areas of symptom relief, patient adherence, and satisfaction with care according to gender, race or ethnicity, and socioeconomic status.
  
  
  RESULTS
  Across social groups, most patients experienced either no symptom relief or partial relief, reported that they adhered to recommendations, and were satisfied with the care received. The primary reason for no symptom relief was not receiving a treatment recommendation. For patients, even partial relief made symptoms more manageable both physically and emotionally. Satisfaction with care was mediated by the quality of the patient-provider relationship as well as expectations other than symptom relief, particularly for patients of low socioeconomic status.
  
  
  CONCLUSIONS
  Patients' assessments of the outcomes of seeking medical care for this symptom-based condition broadened the criteria for quality of care beyond providing a cure. For healthcare providers, this can widen the path for meeting patient needs, even without complete symptom relief. For providers and researchers, as the evidence base expands to include patient reports, the context provided by a qualitative approach can enhance understanding of patients' perspectives and the ability to construct meaningful quantitative measures.
authors.affiliation: New England Research Institutes, Watertown, Massachusetts 02472, USA. lwelch@neriscience.com
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Welch
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Botelho
authors.forename: Jean Journel
authors.initials: JJ
authors.lastname: Joseph
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Tennstedt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011788:Quality of Life; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000628:therapy; D014570:Urologic Diseases / Q000628:therapy*