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Patient-reported outcomes

Taking the patient’s view into account

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Objective treatment outcomes are measurable and comparable. However, it is also worth taking the patient’s subjective measures into account. This is the goal of “patient-reported outcomes.”

When did you become interested in patient satisfaction from a professional point of view?

Dr. McGuire: When you are in private practice, your patients’ satisfaction is “job one.” Therefore, I have always been interested. Nonetheless, about five or six years ago, I became concerned with the more formal aspects of measuring patient reported outcomes (PRO’s).



Dr. McGuire: Take, for example, a surgery that requires a remote tissue donor site – so a second surgery associated with additional morbidity. It is very easy to say intuitively that this additional surgery is something a patient would rather not have; however, it is hard to find measured reports in the literature – to provide scientific evidence for something that our patients really experience is very challenging.


But is the patient’s own view on his or her treatment really important?

Dr. McGuire: Yes, because we must strive to meet the real need. What a clinician thinks a patient wants is not necessarily what the patient really wants. Let’s have a look again at the surgery with the donor site. We did some studies on recession coverage with autologous soft tissue versus biomaterials. When we measured the esthetic satisfaction, it was exactly the same for both groups, even if the autologous graft was statistically slightly superior. But the difference was so small that the patients didn’t realize it. So, sometimes we, as professionals, beat ourselves up about a tenth of a millimeter, while our patients really don’t care.


What is it that the patient does care about?

Dr. McGuire: Patients largely care about comfort, cosmetics and convenience – the three C’s. If we can provide these, most of the time we satisfy our patients. I think that in the future more and more treatment alternatives will likely be chosen over “gold standard” therapies based off of PROs rather than traditional clinical measurements.


Could this mean that a therapy with a slightly poorer outcome becomes superior?

Dr. McGuire: I was struggling with this question for a very long time. Why would you want to provide your patient something that is not the very, very best of what you can do? It has taken me a while to understand that you have to look at all parts of a procedure, not just at how much root is covered; but rather, how much time did the treatment take, how much discomfort was involved, and what was the esthetic outcome?


Would you say that biomaterials are positive for the patient in that they help achieve positive outcomes?

Dr. McGuire: Yes, I think so. It is surely most important to achieve our treatment goals, for example, to cover a recession defect or fill an osseous defect. Nowadays we can achieve these goals with different options. This is a situation where PROs are really worth considering. We must beware: no single procedure is going to be best for all patients, and the incorporation of PRO’s will allow us to tailor our treatment to each patient.

Interview by Verena Vermeulen

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