Matching Illness Expectations with Clinical Reality

Article for Discussion

Ebell MH, Lundgren J, Youngpairoj S. How long does a cough last? Comparing patient expectations with data from a systematic review of the literature. Ann Fam Med. 2013;11(1):5–13.

Discussion Tips

An important and under-appreciated role of the savvy clinician is to help patients to match their illness expectations with what is likely to happen. This study finds a huge mismatch between what the general public expects about the course of acute illnesses with cough, and how long acute coughs last on average. The study also identifies personal characteristics associated with expectations for shorter than usual cough duration and expectations that antibiotics will help. How can we use this knowledge?

Discussion Questions

• What question is asked by this study and why does it matter?

• How does this study advance beyond previous research and clinical practice on this topic?

• How strong is the study design for answering the question? How helpful is it to bring together the 2 sources of data (population survey and systematic literature review)?

• To what degree can the findings be accounted for by:

  1. How patients were selected, excluded, or lost to follow-up?

  2. How the main variables were measured?

  3. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?

  4. Chance?

  5. How the findings were interpreted?

• What are the main study findings?

• How comparable are the study samples (for the survey and the literature review) to similar patients in your practice? What is your judgment about the transportability of the findings?

• What contextual factors are important for interpreting the findings?

• How might this study change your practice? Policy? Education? Research?

• Who are the constituencies for the findings, and how they might be engaged in interpreting or using the findings?

• What are the next steps in interpreting or applying the findings in clinical or public health settings?

• What researchable questions remain?