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      Investigating determinants for patient satisfaction in women receiving epidural analgesia for labour pain: a retrospective cohort study

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          Abstract

          Background

          Epidural analgesia is a popular choice for labour pain relief. Patient satisfaction is an important patient-centric outcome because it can significantly influence both mother and child. However, there is limited evidence in the correlations between clinical determinants and patient satisfaction. We aim to investigate clinical covariates that are associated with low patient satisfaction in parturients receiving labour neuraxial analgesia.

          Methods

          After institutional ethics approval was obtained, we conducted a retrospective cohort study using electronic and corresponding hardcopy records from 10,170 parturients receiving neuraxial analgesia between the periods of January 2012 to December 2013 in KK Women’s and Children’s Hospital in Singapore. Demographic, obstetric and anesthetic data were collected. The patient satisfaction scores on the neuraxial labour analgesia was reported by the parturient at 24 to 48 h post-delivery during the post-epidural round conducted by the resident and pain nurse. Parturients were stratified into one of three categories based on their satisfaction scores. Ordinal logistic regression models were used to identify potential covariates of patient dissatisfaction.

          Results

          10,146 parturients were included into the study, of which 3230 (31.8%) were ‘ not satisfied’, 3646 (35.9%) were ‘ satisfied’, and 3270 (32.2%) were ‘ very satisfied’. Multivariable ordinal logistic regression analysis showed that instrument-assisted vaginal delivery ( p = 0.0007), higher post-epidural pain score ( p = 0.0016), receiving epidural catheter resiting ( p <  0.0001), receiving neuraxial analgesia at a more advanced cervical dilation ( p = 0.0443), multiparity ( p = 0.0039), and post-procedure complications headache ( p = 0.0006), backache (p <  0.0001), urinary retention ( p = 0.0002) and neural deficit ( p = 0.0297) were associated with patient dissatisfaction. Chinese, compared with other ethnicities ( p = 0.0104), were more likely to be dissatisfied.

          Conclusions

          Our study has identified several clinical determinants that were independent associated factors for low patient satisfaction. These covariates could be useful in developing a predictive model to detect at-risk parturients and undertake time-sensitive precautionary measures for better patient satisfaction.

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          Most cited references38

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          Pain and women's satisfaction with the experience of childbirth: a systematic review.

          To summarize what is known about satisfaction with childbirth, with particular attention to the roles of pain and pain relief. A systematic review of 137 reports of factors influencing women's evaluations of their childbirth experiences. The reports included descriptive studies, randomized controlled trials, and systematic reviews of intrapartum interventions. Results were summarized qualitatively. Four factors-personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making-appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.
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            Patient satisfaction: a valid concept?

            Over the past 10 yr consumer satisfaction has gained widespread recognition as a measure of quality in many public sector services. This has become manifest in the NHS in the call by the 1983 NHS Management inquiry to ascertain how well the service is being delivered at local level by obtaining the experience and perceptions of patients and the community. Patient satisfaction is now deemed an important outcome measure for health services; however, this professed utility rests on a number of implicit assumptions about the nature and meaning of expressions of 'satisfaction'. Through a review of past research findings this paper suggests that patients may have a complex set of important and relevant beliefs which cannot be embodied in terms of expressions of satisfaction. Consequently, many satisfaction surveys provide only an illusion of consumerism producing results which tend only to endorse the status quo. For service providers to meaningfully ascertain the experience and perceptions of patients and the community then research must first be conducted to identify the ways and terms in which those patients perceive and evaluate that service.
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              Factors related to childbirth satisfaction.

              A woman's satisfaction with the childbirth experience may have immediate and long-term effects on her health and her relationship with her infant, but there is a lack of current research in this area. This paper reports a study to examine multiple factors for their association with components of childbirth satisfaction and with the total childbirth experience. A correlational descriptive study was conducted with 60 low-risk postpartum women, aged 18-46 years, with uneventful vaginal deliveries of healthy full-term infants at two medical centres in the south-eastern United States. The Labor Agentry Scale, McGill Pain Questionnaire and Mackey Childbirth Satisfaction Rating Scale and a background questionnaire were completed by women. Obstetrical data were collected from the medical record. Personal control was a statistically significant predictor of total childbirth satisfaction (P = 0.0045) and with the subscale components of satisfaction (self, partner, baby, nurse, physician and overall). In addition, having expectations for labour and delivery met was a significant predictor of satisfaction with own performance during childbirth. Personal control during childbirth was an important factor related to the women's satisfaction with the childbirth experience. Helping women to increase their personal control during labour and birth may increase the women's childbirth satisfaction.
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                Author and article information

                Contributors
                daryltan@u.duke.nus.edu
                rehena.sultana@duke-nus.edu.sg
                han.nianlin@kkh.com.sg
                alex.sia.t.h@singhealth.com.sg
                +65 63941077 , sng.ban.leong@singhealth.com.sg
                Journal
                BMC Anesthesiol
                BMC Anesthesiol
                BMC Anesthesiology
                BioMed Central (London )
                1471-2253
                9 May 2018
                9 May 2018
                2018
                : 18
                : 50
                Affiliations
                [1 ]ISNI 0000 0004 0385 0924, GRID grid.428397.3, Duke-NUS Medical School, ; 8 College Road, Singapore, 169857 Singapore
                [2 ]ISNI 0000 0004 0385 0924, GRID grid.428397.3, Centre for Quantitative Medicine, , Duke-NUS Medical School, ; 8 College Road, Singapore, 169857 Singapore
                [3 ]ISNI 0000 0000 8958 3388, GRID grid.414963.d, Division of Clinical Support Services, , KK Women’s and Children’s Hospital, ; 100 Bukit Timah Road, Singapore, 229899 Singapore
                [4 ]ISNI 0000 0000 8958 3388, GRID grid.414963.d, Department of Women’s Anaesthesia, , KK Women’s and Children’s Hospital, ; 100 Bukit Timah Road, Singapore, 229899 Singapore
                Author information
                http://orcid.org/0000-0001-5374-4271
                Article
                514
                10.1186/s12871-018-0514-8
                5944055
                29743028
                c72d8787-ffac-4bba-ac4e-4cd320bc78bf
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 30 November 2017
                : 27 April 2018
                Funding
                Funded by: National Medical Research Council, Singapore
                Award ID: CTG13feb013
                Award ID: NMRC/CG/006/2013
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Anesthesiology & Pain management
                epidural analgesia,labour pain,patient satisfaction,quality measures

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