The authors present a timely well-written article applying Donabedian's science of quality of care to patient satisfaction. The use of longitudinal health-related quality of life (HRQoL) data and a validated satisfaction questionnaire separate this manuscript from previous cross-sectional studies. Resnick et al.  found that both general HRQoL and disease-specific HRQoL were associated with long-term patient satisfaction across all the domains measured (overall, amount of contact, communication, humanness and competence). It is important to note that baseline HRQoL and fear of recurrence both influenced post-treatment satisfaction, such that more anxiety or worse baseline health were associated with less satisfaction.
The nuances of the present study must be appreciated in the age of quality initiatives. The Centers of Medicare and Medicaid are currently implementing quality initiatives to assure quality healthcare through accountability and public disclosure [1, 2]. In response, medical centres are establishing quality benchmarks and service outcomes. It is hoped that this work is placed in the appropriate context. It would not be appropriate to create a surgeon ‘report card’ based on these patient satisfaction scores even though the instrument is validated. As mentioned above, patients with more fear of recurrence were less satisfied and, although this may be a modifiable risk factor, it is not directly related to the surgery or surgeon's care. Similarly, the postoperative urinary or erectile function may or may not be related to the surgeon's skill but rather disease burden and pretreatment function.
Improving patient satisfaction with treatment outcome is a worthy objective and the present study provides a nice blueprint as to what factors must be accounted for when measuring satisfaction. The present study suggests that clinicians can improve patient satisfaction by targeting those in poor general health preprocedure and addressing their psychological and functional deficits. It should not, however, be taken as a standalone quality metric.