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A Qualitative Inquiry of Patient-Reported Outcomes: The Case of Lower Urinary Tract Symptoms

Welch, Lisa C.; Botelho, Elizabeth M.; Joseph, Jean Journel; Tennstedt, Sharon L.

doi: 10.1097/NNR.0b013e318251d8f6

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.

Discussion: 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.

Lisa C. Welch, PhD, is Senior Research Scientist; Elizabeth M. Botelho, MS, is Senior Research Associate; Jean Journel Joseph, BA, BS, is Research Associate; and Sharon L. Tennstedt, PhD, MSN, is Vice President of Behavioral and Social Sciences, New England Research Institutes, Watertown, Massachusetts.

Accepted for publication February 23, 2012.

This publication was made possible by Grant DK073835 from the National Institute of Diabetes and Digestive and Kidney Diseases. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health.

The authors have no conflicts of interest to disclose.

Corresponding author: Lisa C. Welch, PhD, New England Research Institutes, 9 Galen Street, Watertown, MA 02472 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.