Acceptance of diagnosis and management satisfaction of patients with "suspected Lyme borreliosis" after 12 months in a multidisciplinary reference center: a prospective cohort study

Key messagesWhat is already known on this topic?Among patients with a suspicion of Lyme borreliosis (LB), less than 15% have confirmed LB, and more than 80% a differential diagnosis, confirming the need for multidisciplinary structures.To our knowledge, there are not any studies about the satisfaction of the patients with these proposed multidisciplinary care paths.What this study adds?Acceptance of diagnosis (80.2%) was associated with satisfaction with the care paths and the current medical condition of the patients.The high satisfaction with the information given by the doctors was a key element of the management satisfaction, confirming the importance of shared medical decisions to meet the patients' expectancies and reduce misinformation.How this study might affect research, practice and policy?Provided that this satisfaction survey is externally assessed by additional studies, it could be useful to regularly assess patients' satisfaction in the context of multidisciplinary management for suspected LB, and these multidisciplinary structures might be generalized for other complex diseases. IntroductionBecause patients with a "suspicion of Lyme borreliosis (LB)" may experience medical wandering and difficult care paths, often due to misinformation, multidisciplinary care centers were started all over Europe a few years ago. The aim of our study was to prospectively identify the factors associated with the acceptance of diagnosis and management satisfaction of patients, and to assess the concordance of the medical health assessment between physicians and patients 12 months after their management at our multidisciplinary center.MethodsWe included all adults who were admitted to the Tick-Borne Diseases Reference Center of Paris and the Northern Region (TBD-RC) (2017-2020). A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains and 13 items rated between 0 (lowest) and 10 (highest grade): (1)Reception; (2)Care and quality of management; (3)Information/explanations given to the patients; (4)Current medical condition and acceptance of the final diagnosis; (5)Overall appreciation. Factors associated with diagnosis acceptance and management satisfaction at 12 months were identified using logistic regression models. The concordance of the health status as assessed by doctors and patients was calculated using a Cohen's kappa test.ResultsOf the 569 patients who consulted, 349 (61.3%) answered the questionnaire. Overall appreciation had a median rating of 9 [8;10] and 280/349 (80.2%) accepted their diagnoses. Patients who were "very satisfied" with their care paths at TBD-RC (OR = 4.64;CI95%[1.52-14.16]) had higher odds of diagnosis acceptance. Well-delivered information was strongly associated with better satisfaction with the management (OR = 23.39;CI95%[3.52-155.54]). The concordance between patients and physicians to assess their health status 12 months after their management at TBD-RC was almost perfect in the groups of those with confirmed and possible LB (kappa = 0.99), and moderate in the group with other diagnoses (kappa = 0.43).ConclusionPatients seemed to approve of this multidisciplinary care organization for suspected LB. It helped them to accept their final diagnoses and enabled a high level of satisfaction with the information given by the doctors, confirming the importance of shared medical decisions, which may help to reduce health misinformation. This type of structure may be useful for any disease with a complex and controversial diagnosis.