Patient satisfaction, perceived empathy, and quality of recovery among elderly postoperative patients: a cross-sectional study

The aging population is a global issue, and in Vietnam, the Ministry of Health recognizes individuals aged 60 and older as elderly, leading to significant social and healthcare challenges.¹ One of these challenges is the high occurrence of osteoporosis-related fractures, especially those affecting the lower extremities. This places a heavy burden on both healthcare providers and elderly patients. Furthermore, they represent a significant burden of disease, impacting the physical health and well-being of older individuals and placing strain on healthcare resources and providers.^2,3 Despite recognizing these challenges, limited research has comprehensively examined the specific perceptions of healthcare services and recovery outcomes for elderly Vietnamese patients who undergo surgery for lower extremity fractures.

Patient perception of healthcare has increasingly been recognized as a structural indicator of healthcare service quality. Research by Asamrew et al.⁴ and Manzoor et al.⁵ underscore the importance of understanding patient perspectives to enhance healthcare service quality. In the realm of elderly patient care, the role of empathy and the relationships formed between healthcare providers and elderly patients assume paramount importance. Healthcare providers who exhibit empathy and cultivate positive rapport with patients have the potential to assuage patient anxieties, enhance their satisfaction, and positively influence the quality of their recovery. While existing research predominantly addresses general patient satisfaction and care quality, a significant knowledge gap persists regarding the influence of patient perceptions of empathy, particularly within the cohort of elderly postoperative patients.

The Synergy model underscores the importance of grasping patients’ perspectives, preferences, and values and integrating these into healthcare decision-making and delivery.^6–8 Furthermore, this model acknowledges the patient as an active participant in their care and emphasizes collaboration between healthcare providers and patients to attain optimal health outcomes. In the context of evaluating the postsurgical period, adopting a multimodal, patient-centered approach is essential for a thorough assessment of recovery quality.⁹ This approach involves considering various aspects of the patient’s experience. By integrating the pertinent components into the assessment process, healthcare providers can comprehensively comprehend the recovery journey of patients and devise customized interventions to optimize outcomes. Incorporating the principles of the Synergy model, coupled with a patient-centric approach to post-surgical care, can pave the way for delivering more personalized and effective healthcare services.

In addition, addressing the healthcare needs of the elderly in Vietnam requires a comprehensive approach that considers not only medical treatment but also the healthcare provider’s competence, and the overall capacity of the healthcare system to meet the needs of an aging population. This may involve implementing policies and programs aimed at improving preventive measures, increasing healthcare resources targeted toward geriatric care, and enhancing the coordination of services to ensure timely and effective treatment for elderly patients. As a consequence, the Synergy model is a valuable framework to ensure providing personalized and patient-centric care.

Therefore, the primary objective of this study was to determine patient satisfaction, empathy, and quality of recovery in elderly patients who underwent surgery for lower extremity fractures and spinal anesthesia. A secondary objective was to explore the correlation between patients’ perception of empathy and patient satisfaction and quality of recovery. This study aims to provide a more comprehensive understanding of the recovery process and offer evidence-based insights that could inform improvements in geriatric care.

This cross-sectional study was conducted on 138 elderly patients who underwent lower extremity fracture surgery with spinal anesthesia at X hospital from October 2021 to April 2022. The study included individuals who were 60 years of age or older and had undergone surgery for the lower extremity fracture. They must have received spinal anesthesia during surgery and been in a stable postoperative recovery condition. The study excluded individuals who were unable to communicate due to language barriers, severe hearing loss, or speech impairments. It also excluded individuals with cognitive impairments such as dementia, those diagnosed with psychiatric disorders, and medically unstable patients or those experiencing postoperative complications.

The sample size was estimated based on the G*power 3.1.3 program (Heinrich-Heine-University, Düsseldorf, Germany) with multiple regression. We assumed a significance level of 0.05, effect size of 0.30, and statistical power of 95%. After a 10% drop-out rate was added, 150 elderly patients were selected and agreed to participate in the study. While conducting the survey, 12 patients did not complete the study survey. Finally, 138 patients were involved in this study.

This study adopted a structured questionnaire to collect participant information, patient perceptions of health care providers’ empathy, patient satisfaction, and quality of recovery after surgery. The participant information forms included age, living place, hospital history, treatment costs, comorbidities, and surgical method.

Patient perception of health care providers’ empathy: The Jefferson Scale of Patient Perceptions of Physician Empathy includes 5 items to measure patients’ perception of clinicians’ empathy. This scale plays an important role in assessing the relationship between patients and doctors/nurses.¹⁰ The tool is scored on a 5-point Likert scale ranging from completely agree (5) to strongly disagree (1), scores range from 5 points to 25 points, and the higher the score is, the greater the patient’s agreement about the healthcare provider’s empathy. Cronbach’s alpha showed acceptable reliability (α = 0.65) in this study.

Quality of recovery after surgery: The Quality of Recovery-15 questionnaire (QoR15) is a global measure used to assess the health status of patients after surgery.¹¹ The QoR15 questionnaire consists of 15 items with 2 dimensions: physical and mental well-being. This tool uses an 11-point Likert scale, and scores range from 0 to 150, with higher scores indicating good recovery. The QoR-15 score is classified into four classes: excellent, good, moderate, and poor recovery (136–150, 122–135, 90–121, and 0–89, respectively).¹² In this study, the reliability coefficient of the QoR15 was Cronbach’s α (0.85). The Jefferson Scale of Patient Perceptions of Physician Empathy and Quality of Recovery-15 was translated from English into Vietnamese through the back translation process of the World Health Organization.¹³

Patient satisfaction: The measurement instrument was developed by researchers to assess the satisfaction level of elderly patients after lower limb fracture surgery and included 40 items in four dimensions: accessibility of medical services/information transparency (9 items), medical facilities and equipment (10 items), nursing care (13 items), communication attitude, behavior, and health education (8 items). In this study, we used a 5-point Likert scale ranging from 40 to 200 to assess patient satisfaction, ranging from very dissatisfied (1) to very satisfied (5). The content validity of the questionnaire was assessed by four health experts using the Content Validity Index.¹⁴ Acceptable CVI scores of 0.96 and 0.8.5 for the scale-CVI and item-CVI were recorded, respectively. The final questionnaire was piloted with a group of 35 elderly patients belonging to the target population in which the questionnaire was to be used. The reliability of the scale (Cronbach’s alpha) was 0.75. These results showed that this instrument had good reliability and validity in representing patient satisfaction.

After obtaining ethics approval and institutional permission, we visited the wards of the participating hospital to identify patients who met the inclusion criteria. We sought permission from the ward doctors and nurses before conducting face-to-face interviews with the participants. To ensure consistency and reduce inter-observer bias during data collection, all data collectors received training. The study’s researchers and assistants conducted interviews with the participants. The assistants who possessed prior experience in health education underwent a one-day training session. Before data collection, we explained the study’s objectives and procedures to all participants and obtained written informed consent from them. During the interview, participants were encouraged to ask questions about the study and assured that their participation was voluntary. The participants completed the survey within a 30-60 min time frame, with support from the researcher and assistants. In some cases, we read out the questionnaire to them and recorded their responses. Participants were allowed to complete the questionnaire at their convenience. Unfortunately, 12 patients were unable to complete the study due to discomfort.

The data analysis was performed using SPSS version 26.0. Descriptive statistics, such as absolute frequency distribution and frequency percentile, mean and standard deviation, frequency distribution tables, numerical indices calculation, and inferential statistics were used to describe the samples’ characteristics. To determine the patients’ satisfaction levels, we calculated the average total scores of all items. This resulted in a range of scores from 40 to 200. Finally, we conducted a multivariable linear regression model to establish the relationship between patient satisfaction, empathy, and quality of recovery. The statistical consultant approved the data analysis.

We obtained ethical approval for this study from the Medical Ethics Committee of Hue University of Medicine and Pharmacy, Hue University under the ethics code (H2021/267). All procedures used in this study adhere to the principles of the Declaration of Helsinki. Each participant was asked to sign an informed consent form on the cover sheet of the questionnaires. We explained the purpose of the study, as well as its potential benefits and risks, to the participants before collecting data. We also informed the participants that they could withdraw from the study at any time, even after giving their consent. Additionally, we assured them that refusal to participate in the study would not affect the quality of service they received from the hospitals.

This study offers foundational data for assessing patient perceptions of empathy, satisfaction, and recovery quality among elderly postoperative patients. Our research revealed that the overall mean patient perception of empathy, satisfaction, and quality of recovery was average (20.30 ± 1.18, 156.86 ± 5.44, 110.11 ± 8.26, respectively). Empathy is a fundamental aspect of healthcare that contributes to building relationships between healthcare providers and patients and ultimately leads to better patient outcomes and a higher quality of care.¹⁵ These results contrast with those of a previous study in which the mean score for healthcare provider’s empathy was greater than that of the other scores.^16,17 It is possible that the perceived level of empathy might not align with the actual experience of patients. Patient perceptions can be influenced by various factors, including patient expectations, cultural backgrounds, and personal biases. Therefore, even in cases where the mean score is high, it is still valuable to prioritize empathy as a critical component for further enhancing the healthcare experience and outcomes. Continued efforts to cultivate and promote empathy among healthcare providers could further strengthen provider-patient relationships and improve healthcare experiences and outcomes.

Our results indicated that there is a significant relationship between patients’ perception of empathy and their satisfaction, particularly in aspects of accessibility of medical services/information and communication attitude, behavior, and health education. These results are similar to those of other studies.^4,18–20 Empathetic care is essential in healthcare, both ethically and practically. Receiving empathy makes medical services more accessible, and the provided information becomes easier to understand and more relevant to patients’ situations. This perception can build trust and improve communication, leading to patients feeling more informed and involved in their care. The connection between empathy and satisfaction in health education indicates that when healthcare providers make an effort to grasp patients’ individual situations and personalize health education accordingly, it can result in more impactful patient engagement and empowerment. As a result, patients may feel more capable of managing their health, leading to increased satisfaction with the care they receive.

The strong correlation between patients’ perceptions of healthcare providers’ empathy and their satisfaction aligns with the Synergy Model’s focus on acknowledging and addressing patient needs. Empathy is a key component of the model, allowing healthcare providers to comprehend and attend to the unique emotional and psychological requirements of elderly postoperative patients. These findings also underscore the essential nature of effective communication, patient education, and the quality of healthcare facilities in achieving optimal patient outcomes. The significant association between empathy and communication attitudes, behavior, and health education highlights the importance of these skills in meeting patients’ needs. By delivering clear information and engaging in empathetic communication, healthcare providers could improve patients’ understanding of their condition and recovery process, ultimately increasing their satisfaction and perceived quality of care.

This study findings demonstrate a significant association between patient satisfaction and the quality of postoperative recovery. Specifically, we observed a positive correlation between the quality of recovery and the aspects of patient satisfaction related to the medical facility and equipment (p < 0.05). Medical facilities equipped with a broad range of services and advanced equipment are capable of delivering comprehensive care during the recovery phase. Patients’ confidence and trust in the care they receive are often reinforced by well-equipped medical facilities. The provision of access to advanced medical facilities and the maintenance of high-quality environments could further optimize patient outcomes and contribute to the overall satisfaction with healthcare services. Moreover, the Synergy Model emphasizes the significance of the healthcare environment in aiding patient recovery. The demonstrated link between recovery quality and the availability of medical facilities and equipment suggests that a well-equipped environment leads to improved outcomes. This discovery aligns with the model’s assertion that the healthcare setting should be conducive to effectively meeting patient needs.

The results of this study reveal a significant connection between patient satisfaction and both the perception of empathy and the quality of postoperative recovery. Previous analysis showed that patient satisfaction was related to quality recovery.²¹ Several researches have shown that physician empathy is strongly correlated with patient satisfaction.^22,23 Our research highlights the pivotal role of empathy and recovery quality in shaping patients’ overall satisfaction with their healthcare experiences. The findings of this study are in alignment with the Synergy Theory, emphasizing the significance of harmonizing patient needs with healthcare providers’ competencies to attain optimal outcomes. Empathy extends beyond understanding patients’ emotions and encompasses providing tailored support that enhances the quality of care and recovery. Furthermore, the correlation between recovery quality and patient satisfaction reaffirms the theory’s emphasis on integrating patient-centered care with clinical competencies. Well-coordinated care encompassing adequate medical facilities, equipment, efficient communication, and empathy is imperative in meeting patients’ needs and ensuring favorable outcomes. Our results indicate that patients perceiving high levels of empathy from their healthcare providers, particularly nurses, are likely to experience heightened satisfaction with their care and improved postoperative recovery outcomes.

The study limitations were the specific subset of individuals who met the criteria of being elderly and having undergone surgery with spinal anesthesia. As a result, the findings of this study might only apply to this specific group and cannot be generalized to the broader population. Thus, further research using more diverse and representative samples would be beneficial to strengthen the generalizability of these findings. Longitudinal studies could also be carried out to assess how changes in empathy and recovery quality affect patient satisfaction over time.

In conclusion, this study revealed moderate patient satisfaction, quality of recovery, and patient perception of empathy among elderly patients who underwent surgery for lower extremity fractures and spinal anesthesia. These findings offer practical insights for healthcare providers, emphasizing the importance of integrating empathetic interactions with high-quality recovery environments to improve patient outcomes. By emphasizing empathy as part of healthcare education, healthcare professionals could enhance patient satisfaction and the overall quality of recovery for elderly patients undergoing surgery with spinal anesthesia. Our findings suggest that empathy training should be urgently integrated into healthcare curricula. Additionally, improving the quality of medical services is critical to ensure accessible and equitable healthcare for the population.