How Setting Appropriate Expectations May Play a Role in Patient Outcomes

How Setting Appropriate Expectations May Play a Role in Patient Outcomes

Patient Experience: Acknowledging the Expectation Gap

Patient expectations can be a difficult concept to quantify — but setting appropriate expectations plays an important role in patient outcomes, especially overall patient satisfaction with their surgical experience. However, there is often a gap in expectations between a surgeon and patient but it can be acknowledged upfront, prior to surgery, in order to minimize negative consequences of unmet expectations.

The Nature and Importance of Patient Expectations
The nature of patient expectations can sometimes be challenging to define, but typically involves the patient’s anticipation of an event –such as an increase in joint function — that will occur after a surgery or medical treatment.1

Patients, for example, may have a higher expectation of recovery than their surgeon. These expectations can be clinically significant because they may affect a variety of patient outcomes, including recapturing joint function, level of pain control, and overall satisfaction with the surgery itself. Variables such as age, gender, and health status can also influence a patient’s
expectation for recovery after surgery.2

The Expectation Gap
There is a host of literature on the discrepancies between what patients and their doctors expect from medical treatment. Even on the basic understanding of what constitutes “quality of life,” doctor and patient perceptions may significantly diverge. If quality of life issues and the potentially divergent perspectives are not acknowledged and integrated into the patient’s assessment, it can result in a lack of understanding about the efficacy of treatment or even lack of compliance.3

One study examined the expectation gap among joint replacement patients to better understand its nature: 168 patients undergoing either a total hip or total knee replacement filled out a questionnaire regarding their expectations of how surgery would affect pain levels, function and overall well-being. At the same time, their surgeons filled out an identical questionnaire about their own expectations for their patients. The study revealed a substantial gap between the expectations of these two groups, with 52.5% of TKA patients having expectations that exceeded that of their surgeon.1 The challenge for surgeons then becomes finding ways to effectively deal with this divergence.

How to Minimize the Gap
There are ways to minimize this gap, however. It is recommended that surgeons sit down with their patients ahead of surgery and do a thorough risk-benefit analysis of a total knee arthroplasty. Patients and their doctors can then collaboratively make can informed decision about whether surgery is the best choice for their individual needs. This process is time consuming but can help patients to create realistic expectations and decrease the risk of dissatisfaction after surgery.4

There are other steps surgeons can take to help ameliorate this issue. In one study, patients undergoing cardiac surgery underwent a psychology-based, pre-surgical intervention to help manage their expectations of surgery. Compared to the control group who did not undergo a pre-surgical intervention, these patients showed an increased recovery from their disability, an increased ability to return to work and an increased mental quality of life.5

While these interventions might represent an investment of time and resources, they may also pay off in terms of positive patient outcomes. Patient expectations do play a significant role in patient’s perception of how they have benefited from surgery. These expectations can affect important patient outcomes, including their satisfaction from the surgical experience. Surgeons who acknowledge the gap between their expectations and their patients — with patients tending to be overly optimistic about surgical results — can help minimize unrealistic expectations through education and frank communication during the consultation process.


  1. Ghomlawi HM, Fernando NF, Mandl LA, Do H, Noor N, Gonzalez della Volle A. How often are patient and surgeon recovery expectations for total knee arthroplasty aligned? Results of a pilot study. HSS J. 2011 Oct; 7(3): 229-234
  2. Achaval MS, Kallen MA, Amick B, Landon G, Siff S, Edelstein D, Zhang H, Suarez-Almazor ME. Patent expectations about total knee arthroplasty outcomes. Health Expect.. 2015 Feb; 19(2) 299-308.
  3. Janse AJ, Gemke RJ, Viterwaal CS, van der Turl I, Kimpen JL, Sinnema G. Quality of life: patients and doctors don’t always agree: a meta-analysis. J. Clin. Epidem., 2004 Jul; 87(7) 653-661.
  4. Choi, YJ and Ra, HJ. Patient Satisfaction after a Total Knee Arthroplasty. Knee Surg. Relat. Res. 2016. 28(1) 1-15.
  5. Riof W, Shedder-Mora MC, Laferton JAC, Aver C, Pewee KJ, Salzmann S, Schedlowski M, Moosdorf R. Preoperative optimization of patient expectation improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial. BMC Med. 2017 Jan; 15(4)