How Patient Decision-Making Characteristics Affect Satisfaction in Facial Plastic Surgery

A Prospective Pilot Study

Jeremie D. Oliver, B.S., B.A.; Deanna C. Menapace, M.D.; Jeffrey P. Staab, M.D., M.S.; Oren Friedman, M.D.; Chelsey Recker, P.A.-C.; Grant S. Hamilton, M.D.


Plast Reconstr Surg. 2019;144(6):1487-1497. 

In This Article

Patients and Methods

After Mayo Clinic Institutional Review Board approval was obtained, patients older than 18 years scheduled to undergo aesthetic, functional, or reconstructive facial surgery were recruited for this study. A total of 60 subjects (20 in each group) were recruited equally into aesthetic, functional, and reconstructive cohorts. Exclusion criteria for the study included subjects unwilling to complete the provided questionnaires, subjects requiring interpreter services, or subjects who would not be completing follow-up at the Mayo Clinic.

All subjects were asked to complete several surveys at their preoperative clinic visit. As a measure of depressive symptoms, the validated nine-item self-report, Patient Health Questionnaire was used. The Generalized Anxiety Disorder questionnaire was used as a validated seven-item self-reported measure of anxiety symptoms. The Health Anxiety Inventory–Short Form, a 14-item self-report tool that measures worries about health and consequences of physical symptoms, was also employed. The five major dimensions of personality—neuroticism, extraversion, agreeableness, openness, and conscientiousness—were measured using the 240-item NEO Personality Inventory-Revised. To delineate specific decision-making style in our subjects the maximizer and satisficer survey,[46] a 13-item self-report questionnaire, was administered. The maximizer/satisficer survey rates each of the 13-items on a scale from 1 (totally disagree) to 7 (totally agree) (Figure 1), and takes less than 5 minutes to complete. Finally, the Postoperative Satisfaction Questionnaire, five-item postoperative questionnaire, was given to each subject to assess satisfaction following surgical intervention at the 3-, 6-, and 12-month postoperative interval. This scale uses an eight-point scale (0 = not satisfied at all, 8 = extremely satisfied) and typically takes patients less than 2 minutes to complete. Additional data, such as demographics, were abstracted from the electronic medical record system. Participants received remuneration of $50.00 for completing the study. Due to time considerations, subjects had the option to opt out of completing the NEO Personality Inventory-Revised, which takes approximately 60 to 90 minutes. Opting out of the NEO Personality Inventory-Revised reduced the subject's remuneration to $10.00, but did not change any other aspects of study participation.

Figure 1.

Maximizer/satisficer survey.

Regarding psychiatric symptoms detected through the Patient Health Questionnaire, Generalized Anxiety Disorder, and Health Anxiety Inventory–Short Form questionnaires, Patient Health Questionnaire and Generalized Anxiety Disorder scores were calculated on administration. If the scores on either of these instruments suggested that the patient was experiencing clinically significant psychiatric symptoms (total score of 10 or more), she or he was offered an opportunity for consultation in the Behavioral Medicine Program in the Department of Psychiatry and Psychology at our institution. Special attention was given to question 9 on the Patient Health Questionnaire, which inquires about suicidal thoughts. Any subject who scored 1 or higher on question 9 was evaluated for safety by a clinician on the study team before leaving the Division of Facial Plastic and Reconstructive Surgery. If there was any uncertainty about the subject's safety, the findings were reviewed with the study psychiatrist, and appropriate interventions were undertaken to address the clinical situation in accordance with established institutional policies. Patients requiring psychiatric intervention were not withdrawn from the study for that reason.

Data Analysis and Study Design

Data analysis began with calculations of means, medians, and standard deviations of each survey instrument and plots of the ranges and distributions of response patterns. The distribution of Health Anxiety Inventory–Short Form scores was normalized by a logarithmic transformation. Patient satisfaction scores were grouped into categories of extremely satisfied (average question response, >7.5 of 8), very satisfied (average question response, >6.5 to 7.5), satisfied (average question response, >5.5 to 6.5), and less than satisfied (average question response, ≤5.5). Scores for depression and anxiety were grouped into categories based on established cutoffs for clinically significant psychological distress (negative, 0 to 9; positive, 10 or above for Patient Health Questionnaire and Generalized Anxiety Disorder scores). Parametric statistics including Pearson correlations, t tests, and one-way analyses of variance were used to analyze normally distributed variables. The Kruskal-Wallis test was used to analyze nonnormalized continuous variables and chi-square tests were used for categorical variables.