The majority of survey respondents (85%) who attended an appointment in one of the Thrombosis Service clinics were satisfied or very satisfied with the care they received. Most of the respondents were 50 years or older (88%), reflective of patients with conditions requiring thrombosis and anticoagulation management. Patients with post-secondary education were more likely to be satisfied with their care, whereas patients receiving warfarin as their anticoagulant were less likely to be satisfied with their care.
Studies that have measured patient satisfaction related to thrombosis care have shown similar satisfaction results to this study, however the tools used have varied and may not have been validated. Webb et al. examined patient satisfaction with VTE treatment across multiple health care settings via the use of patient self-completed online survey [14]. As part of the survey, patients indicated their overall level of satisfaction with the provider who provided the majority of their VTE care. Of an eligible sample of 1000, 907 completed the survey. Most patients (87.2%) were satisfied or very satisfied with their VTE care experience across all health care settings, and 74.9% were satisfied or very satisfied with their VTE care when provided by specialized thrombosis services. Zed et al. evaluated the efficacy, safety and patient satisfaction of a pharmacist-managed, emergency department based outpatient treatment for VTE disease [15]. Of the 305 patients, 231 returned the survey, and 96.9% of the patients were very satisfied or satisfied with the treatment they received in the outpatient DVT program.
In our study, patients with post-secondary education were more likely to be satisfied with their care. A number of patient factors, including patient age, income, education and comorbidity, may influence patient satisfaction [16]. A systematic review of determinants of patient satisfaction showed inconsistent results of the strength and direction of associations with patient factors, including level of education [17]. Webb et al. showed no difference in patient demographics and level of satisfaction with overall VTE care [14]. Given that there are inconsistent results for the influence of post-secondary education on patient satisfaction, our result of increased satisfaction may not be reliable.
Patients in our study receiving warfarin as their anticoagulant were less likely to be satisfied with their care, however our study was not designed to probe additional details regarding specific anticoagulant therapy. Published studies examining satisfaction of patients receiving warfarin versus DOACs have shown those receiving warfarin are less satisfied with their anticoagulant therapy [8, 9, 18], particularly if they have switched from warfarin to a DOAC [8]. Improved patient convenience, reduced frequency of medical contact, and fewer side effects have been noted as reasons why patients are more satisfied with DOACS [8].
Future study should explore the areas where patients indicated they were dissatisfied to assess the reasons for, and possible initiatives to address the dissatisfaction. Patients receiving warfarin as their anticoagulant medication were less likely to be satisfied with their care, and the specific reasons for this in our patient population should be explored further. Our study primarily assessed the patient satisfaction with the Thrombosis Service; future work could also include measurement of patient experience to more fully assess the quality of care from a patient’s viewpoint [2].
Patient satisfaction studies have been criticized for lack of standardized or validated measures, as well as the potential inaccurate perception of patient satisfaction as a measure for quality care [19]. The terms patient satisfaction and patient experience are at times used interchangeably in the literature [20], however may not refer to the same measure, leading to confusion. A recent publication provided a framework for person-centered measures of health system quality and responsiveness, and provided more clear definitions: patient satisfaction is the patients’ evaluation of the care provided relative to their expectations (an outcome measure), and patient experience is the interactions patients have with the health care system (process indicator) [21]. The two terms can been seen as related, with patient experience of care influencing patients satisfaction with care. Defining the purpose of the measurement (improving quality of care and/or system accountability) will help define which measurement to use, with a potential role for both types of data.
Satisfaction surveys are noted to have a number of biases. Social-desirability bias may cause respondents to answer questions in a manner that will be viewed favorably by others, and could overestimate satisfaction. However, strategies used to minimize social desirability biases in our study included the use of anonymous surveys, as well as the use of researchers not involved in direct patient care to coordinate and collect data. Acquiescence bias is the tendency of respondents to agree to the statement they are presented, regardless of its content [22]. Thus surveys with all positively framed questions may result in a high satisfaction rating. The SAPS survey addresses this through having a combination of positive and negative worded statements.
Study limitations
Given that this was an observational, retrospective cross-sectional study, causal inferences cannot be made. Additionally, our study may have been subject to recall bias, as some patients may have difficulty remembering the details of their encounter, particularly if there was a delay between the clinical encounter and the survey receipt. The use of SAPS may overestimate/underestimate responses owing to social-desirability bias common to self-reported instruments. However, we adopted strategies to reduce social desirability bias. First, surveys were anonymous to avoid pressure on participants to respond in a socially acceptable way. Secondly, researchers involved in direct patient care at the TS were neither involved in data collection nor coordination of the survey but only contributed to the preparation of the manuscript. This was to reduce any impact healthcare provider–patient relationships might have on participants’ responses to the survey.
It was a single-center study based on one model of care, which may limit its generalizability. Just under half (47.5%) of patients did not respond to the survey, and it is unknown if this would change the results. However, previous data showed that over an approximately seven and half month period, patients attending the Thrombosis Service had an average age of between 55 and 65 years, and 40 to 57% were male, which is similar to the population in this study [23]. As this was intended to be an anonymous survey, we did not link a survey to patient specific data, e.g., number of clinic visits, time since attendance at clinic, which limited the possible analysis.