Analysis of the service needs of outpatients undergoing thyroid fine needle aspiration biopsy based on the Kano model

Thyroid nodules are a common endocrine system disease with a high prevalence, and the incidence of malignant nodules should not be ignored [1]. Ultrasound-guided thyroid fine needle aspiration biopsy (FNAB) is a widely used clinical diagnostic method. About 46.7% of nodules show suspicious or malignant cytological results, and 47.5% are confirmed as thyroid carcinoma, aiding in thyroid disease management decisions [2, 3]. As global medical standards continue to improve, the demand for health and medical services is also increasing. In China, the comprehensive advancement of healthcare reform has made nursing quality and service levels important indicators for patients when choosing medical services. Improving patient satisfaction has become a core goal of nursing work [4]. Clinical nursing experts have traditionally focused on improving the satisfaction of inpatients, with less attention given to the nursing service needs of outpatients [5]. Thyroid FNAB involves needle insertion and tissue sampling, which may cause anxiety and fear in many patients due to pain, uncertainty of results, and the potential for malignant findings. If this psychological stress is not effectively managed, it may affect the overall health and experience of a patient during their visit. However, in such a uniquely stressful environment, patients’ service needs are rarely addressed and discussed.

The Kano model is a simple and practical technique used to accurately identify the quality attributes of patients’ service needs [6]. By classifying and ranking patient needs, patient satisfaction can be effectively improved, and the quality of medical services can be enhanced, providing guidance for service quality improvement [7, 8]. This study, which was based on the Kano model, investigated the nursing service needs of outpatients who underwent thyroid FNAB at our hospital. It aimed to enable the provision of more personalized and considerate nursing services for these patients, achieving high-quality and humanized healthcare services.

This study revealed that the service attitude dimension had the highest average score, while the medical environment dimension had the lowest average score. This indicates that service attitudes are central to outpatient FNAB patients. In China, there is generally a lower preference for patient-centered communication among medical personnel, which may exacerbate tension in doctor‒patient relationships [10]. Good service attitudes from medical staff reflect care and respect for patients, which helps establish harmonious doctor‒patient relationships. Additionally, this may stem from China’s unique cultural background and societal values. Influenced by Confucianism, politeness and respect are basic moral principles in Chinese culture [11]. Patient expectations for medical services naturally include these values. FNAB patients had the lowest average score for medical environmental service demands. This result may be caused by several factors: patients are generally less satisfied with outpatient procedures, which overshadow their concerns about the environment [12]. Furthermore, overall satisfaction scores in tertiary hospitals are more influenced by factors such as treatment effectiveness, staff attitudes, and service convenience than by the physical environment [13]. The results of this study have important implications for Chinese healthcare institutions, emphasizing the necessity of improving service attitudes and providing strategies for medical institutions to improve patient satisfaction and treatment cooperation.

In this study, all nine must-be attributes were in the fourth quadrant. The fourth quadrant typically represents the reserved category, and items in this category represent basic service needs. In the outpatient thyroid FNAB diagnostic and treatment environment, patients consider doctor proficiency in operation techniques and the accurate and timely identification of complications as basic needs. The proficiency of operational techniques directly affects treatment outcomes and the control of complications, which are at the core of medical service quality. During outpatient thyroid FNAB, patients are at risk for complications such as bleeding, pain, and vagal syncope. Proficiency in operation techniques can reduce the incidence of complications, and accurately and promptly identifying these complications ensures patient safety. The presence of complications may also lead to lawsuits, loss of confidence in healthcare providers, and increased medical costs for patients [14]. The reasonable placement of service desks and diagnostic check-in locations is also a basic patient need. A well-organized service desk layout can reduce the likelihood of patients getting lost within the hospital and improve patient satisfaction [15]. In the outpatient thyroid FNAB process, timely and accurate communication about possible complications, pain levels, and postprocedure pathological results is a basic need for patients. Patients’ right to understand the medical procedures they are undergoing is a fundamental right, and they should be fully informed and able to make responsible decisions about their treatment. This right is crucial for fostering patient autonomy and trust in healthcare providers. Previous research has shown that patients often rely on medical staff, especially specialists and nurses, for information; however, the information provided can sometimes be difficult for patients to understand, and they may lack access to educational materials [16]. Despite the legal and ethical emphasis on patient rights, many patients are unaware of specific rights, such as those outlined in the Patient Rights Act [17]. The historical evolution of patient rights reflects a shift toward recognizing individuals as central figures in their healthcare [18]. The role of healthcare providers as primary overseers of patient rights highlights the importance of effective communication and education to ensure that patients are fully aware of their medical procedures. The results of this study suggest that healthcare institutions should focus on training doctors in FNAB operation techniques, ensuring that all medical personnel who perform FNAB have a high level of technical proficiency and the ability to handle complications, thereby reducing the incidence of adverse events for patients. Efforts should also be made to ensure patient informed consent, continuously improving patient education and information accessibility, while outpatient medical practice managers should optimize the placement of service desks and diagnostic check-in locations to make the patient visit process more convenient.

Among the 10 one-dimensional attribute service needs, six items were located in the first quadrant. The first quadrant included service needs that have a decisive impact on patient satisfaction. In the thyroid FNAB diagnostic and treatment process, reasonable appointment times, orderly appointments, and advance notice of appointment locations fell into the first quadrant. Maintaining reasonable appointment times, orderliness, and advance notice of appointment locations is crucial. During the waiting period for the FNAB procedure, anxiety, including fears of postprocedure complications, pain, and the possibility of cancer, is a common issue for patients [19, 20]. Ensuring an orderly diagnostic process can minimize waiting times, which may exacerbate patient anxiety [21]. Providing psychological counseling to patients before and during the FNAB procedure is vital. Studies have shown that patients often experience increased anxiety and fear before undergoing FNAB, primarily due to concerns about pain and potential cytology results [22]. A lack of understanding of the FNAB process and insufficient preprocedure education can exacerbate this anxiety [23]. Therefore, in the outpatient thyroid FNAB procedure, ensuring reasonable appointment times, orderly appointments, and advance notice of appointment locations, along with incorporating psychological counseling services into the care plan for patients undergoing thyroid FNAB, plays a crucial role in meeting their emotional needs, alleviating their anxiety, and improving the patient experience.

In this study, 12 service needs were classified as attractive attributes, 91.67% (11/12) of which were in the second quadrant. Meeting these service needs can increase patient satisfaction. All service attitude needs (6 items: Items 11–16) were classified as attractive attributes and were in the second quadrant. Patients undergoing thyroid evaluations often experience significant emotional reactions, such as fear, anxiety, and even shock, and they rely heavily on the expertise and advice of their doctors to manage these emotions [13]. Friendly and positive attitudes from healthcare workers can significantly improve patients’ emotional well-being, while poor attitudes and communication have been shown to negatively affect patients’ emotional states [24]. The study also revealed that health education (including printed materials and video presentations) and patient contact and feedback channels (such as public accounts and suggestion boxes) were classified as attractive attributes and located in the second quadrant. This reflects the high demand for transparency and engagement in medical services. Previous studies have shown that video-based information can enhance patients’ understanding of the procedure and expected outcomes, effectively reducing their anxiety [25]. Similarly, the use of flyers for health education has been shown to lower preoperative anxiety levels, indicating that easily understandable information helps patients better prepare for procedures and reduces their anxiety [26]. Effective health education for patients is crucial for reducing their anxiety and improving their compliance [27]. Contact and feedback mechanisms are important tools in healthcare environments, providing patients with channels to express their opinions and suggestions and greatly enhancing their engagement, trust, and satisfaction with medical institutions. Research has shown that patient feedback is an important indicator for measuring healthcare quality and improving clinical outcomes [28]. A study in a tertiary hospital in China indicated that a unified, transparent, and fair feedback platform greatly encouraged patient feedback, which in turn provided evidence for guiding medical institutions to improve patient experiences and service quality [29, 30]. The results of this study emphasize the importance of health education and effective communication feedback mechanisms in enhancing patient satisfaction. Medical institutions can utilize this finding to strengthen these attractive attribute needs. For example, regularly updating and optimizing health education materials and information dissemination methods, as well as establishing more efficient patient feedback systems, can make patients feel more respected. Medical institutions should emphasize the importance of service attitudes in training and service processes. By improving service attitudes, enhancing overall patient satisfaction with medical services, and building stronger trusting and loyal relationships with patients, institutions can achieve better patient outcomes.

This study revealed that one service need was categorized as an indifferent attribute, playing music (Item 21), and one was categorized as a must-be attribute, autonomous report inquiry (Item 20), both of which were in the third quadrant (Fig. 1). The lack of a significant impact of playing music on patient satisfaction may be related to the nature of the thyroid FNAB procedure itself. During thyroid FNAB, patients experience minimal pain and discomfort. The high tolerance for pain during the procedure may mean that additional measures, such as background music, are sufficient to maintain patient comfort and satisfaction. Moreover, the FNAB procedure is very brief, which may limit the potential for music to have a noticeable calming effect. Our findings align with other studies on the role of music in medical procedures. For example, Kim et al. found no significant difference in patient satisfaction or pain levels between patients who underwent thyroid core needle biopsy and those who underwent FNAB, suggesting that these minimally invasive procedures are well tolerated by patients regardless of whether they receive additional auditory interventions [31]. This study also revealed that providing patients with the ability to autonomously check their test results did not significantly impact their satisfaction in the thyroid FNAB diagnostic environment. This result is consistent with findings from Garry et al. [32]. While providing a results inquiry function can improve patient convenience, it does not necessarily significantly enhance satisfaction. Patients often value listening to their doctor’s explanations and face-to-face interactions more than merely obtaining test results [33]. Additionally, some patients may have difficulty understanding medical test results, making the inquiry function ineffective and thus having no substantial impact on their satisfaction [34]. These results suggest that medical institutions may not need to invest heavily for service needs such as playing music and autonomous report inquiry. Resources and attention can be focused on services that have a significant impact on patient satisfaction, simplifying service processes and reducing costs while maintaining or potentially improving patient satisfaction.

This study has the following limitations. First, the study participants were limited to the outpatient environment of a single tertiary hospital in China, and the number of patients was relatively small. Therefore, the reported results may have selection bias, and these findings need to be validated by larger patient cohorts and multicenter studies. Second, due to the sample size, subgroup analysis was not conducted for different genders and cultural groups in this study, which may limit the generalizability of the findings. Last, the thyroid FNAB service needs questionnaire used in this study was self-designed and is not an internationally recognized scale, which also limits the generalizability of the study results.

In the outpatient thyroid FNAB environment, analyzing patient service needs using the Kano model allows for the classification of the attributes of these needs. This helps healthcare providers optimize and improve service delivery, thereby enhancing patient satisfaction.