From the PACE Trial
Overall, how satisfied are you with the treatment you received?
(Please tick one only)
Very satisfied
Moderately satisfied
Slightly satisfied
Neither
Slightly satisfied
Moderately dissatisfied
Very dissatisfied
At 52 weeks, participants rated satisfaction with treatment received on a 7-point scale, condensed into three categories to aid interpretation (satisfied, neutral, or dissatisfied).
[For other things, neutral meant the three middle ones but that's not spelled out hereP
View attachment 13591
No satisfaction figures in main FINE Trial paper. Can't remember whether covered in any of the other papers.
Is it not true that SMC actually means Got No ME Treatment (GNOME Treatment

)? It was just what one ordinarily gets from a GP in the UK, right? So who's freakin' surprised people were not satisfied with that? "Oh, yeah, I'm really happy I'm dreadfully sick and got no treatment."

At least the people in the other arms got some sense that the therapists were trying to help them. That should automatically lead to a difference in satisfaction with "treatment".
These satisfaction ratings remind me of the Faculty Evaluations I used to see back in the day. Truth is, unless a student is really pissed off, they rarely rate a teacher Poor. You have to be really awful to get more than one or two Poor ratings. It's like grade inflation. A 'C' these days isn't really a sign your work in the course was necessarily average. Teachers don't like to give D's and F's unless the work was so very poor that they have no choice. Bell curves be hanged.
It seems to be the nature of most people to be unwilling to be highly critical of a teacher/therapist/authority figure in ratings questionnaires. Maybe it's an empathy thing -- they don't want to be mean and hurt the ratee's feelings. Or maybe they're afraid at some level that they'll be identified and don't want to be seen as a bad student/patient. The PACE designers as faculty themselves, and psychologists to boot, had to know about this effect and used it to their advantage. Only in the case where there wasn't a clear therapist (SMC) were the patients willing to express their dissatisfaction -- there was no face associated with the treatment.
I'd love to see the actual breakdown of the satisfaction scores. If most of them were Slightly Satisfied, I'd call that an artefact of ratings questionnaire answering behavior. If most patients claimed to be Very Satisfied, then I'd believe they were actually happy with treatment.
Based on what we've heard from PACE participants in the time since, do we really believe that less than 5% of the patients were actually dissatisfied? I have to admit that I don't know what to think....