Including patients in medical decision-making is thought to improve patient satisfaction and health. However, patient preferences regarding such decisions vary, depending on both the population and the type of decision being made. Generally, patients want to receive information but defer to health care providers when making decisions. Because previous studies have been limited by small sample size, didn't adjust for important confounding factors, and focused on educated populations, researchers studied the association between preferences for participation in decision-making and satisfaction with care among a predominantly minority racial-ethnic sample of patients hospitalized in an urban medical center.
The sample comprised 13,902 patients admitted to the general internal medicine service who completed an initial inpatient survey that included questions about patient preference for medical decision-making, as well as a 30-day follow-up survey that included questions about quality and satisfaction with hospital care. Mean patient age was 56.7 years, 60.4% were women, and 74.2% were African American. Among those surveyed, 53.2% had no higher education, 22.7% were insured by Medicaid, and 51.1% rated their health status as fair or poor.
The proportions of patients who agreed and disagreed with delegating decisions to the responsible physician were 71.1% and 28.9%, respectively. Compared with patients who definitely agreed with delegating, those who definitely disagreed were significantly more likely to be dissatisfied with the overall care they received (14.2% versus 7.3%), express dissatisfaction with physician care (9.2% versus 4.9%), and lack confidence and trust in their physicians (7.9% versus 3.9%).
The authors suggest that greater expectations of care and communication may result in a desire to participate in decision-making and create the potential for dissatisfaction and distrust. Efforts to involve patients in decision-making should be sensitive to differences in patients' preferences about participation, they advise.
They note that the study was conducted in a single medical center, about one-third of admitted patients didn't participate in the survey, and the study included only hospitalized patients, so the results may not be generalizable to other settings.