Association of Preferences for Participation in Decision-making With Care Satisfaction Among Hospitalized Patients.
Association of Preferences for Participation in Decision-making With Care Satisfaction Among Hospitalized Patients.
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DOI：
10.1001/jamanetworkopen.2020.18766
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Meltzer DO
中科院分区：
文献类型：
--
作者：
Ruhnke GW;Tak HJ;Meltzer DO
本调查研究探讨住院病人的愿望，委托决定，他们的医生与护理不满的关联。患者参与医疗决策的偏好是否与满意度相关？在这项对13902名住院患者的调查研究中，与不愿意委托的患者相比，更愿意将决定委托给医生的患者对他们的护理感到满意的比例在统计学上显著更高。根据观察到的患者特征进行调整，那些具有非委托偏好的患者对整体服务和医生护理更不满意，并且对提供治疗的医生缺乏信心和信任。这项研究的结果表明，期望的护理和沟通，伴随着参与决策的愿望可能与病人的不满或不信任。患者参与医疗保健决策的愿望与护理满意度之间的关系尚不清楚。这种愿望的贡献，期望的护理，和护理质量在评估病人的满意度是未知的。探讨住院病患委托医师决定之意愿与照护不满意度之相关性。在学术研究环境中进行调查研究。作为芝加哥大学住院医师研究的一部分，收集了2004年7月1日至2012年9月30日期间在芝加哥大学医学中心普通内科住院的13902例住院患者的数据，这些患者在入院后不久接受了住院调查，并接受了30天的随访调查。分析日期为二零一四年一月至二零一五年六月。患者报告偏好将医疗决定留给他们的医生（绝对同意或有点同意vs有点不同意或绝对不同意）。主要结果是患者报告的对整体服务的不满意，对医生护理的不满意，以及对提供治疗的医生缺乏信心和信任，这些结果是从30天的随访调查中获得的。样本人群包括完成两项调查的13902例患者（平均[SD]年龄，56.7 [19.1]岁; 60.4%为女性[n = 8397]，74.2%为非洲裔美国人[n = 10310]）。总体而言，53.2%的人没有更高的教育程度，22.7%的人有医疗补助保险，51.1%的人报告了一般自我评估的健康状况为一般或较差。同意和不同意将决定权委托给责任医生的受访者比例分别为71.1%和28.9%。与不同意的人相比，同意的人将他们的整体护理评为优秀或非常好的比例在统计学上显著更高（68.0%对62.5%; P <0.001）。同样，在同意的人中，对医生治疗非常满意的比例在统计学上显著较高（67.8%对62.5%; P <0.001）。在多因素Logistic回归模型中，与明确同意委托的患者相比，明确不同意委托的患者对总体服务的不满意程度更高（比值比[OR]，1.86; 95% CI，1.54-2.24）和接受的医生护理（OR，1.78; 95%CI，1.42-2.22），对提供治疗的医生缺乏信心和信任（OR，2.05; 95%CI，1.62-2.59）。研究结果表明，患者参与医疗决策的偏好与住院患者的不满意度在统计学上显著相关。临床医生应该个性化地鼓励患者参与诊断和管理决策，以最大限度地提高患者满意度。
This survey study investigates the association of hospitalized patients’ desire to delegate decisions to their physician with care dissatisfaction. Are patient preferences for participation in medical decisions associated with measures of satisfaction? In this survey study of 13 902 hospitalized patients, a statistically significantly greater proportion of patients who preferred to delegate decisions to their physician were satisfied with their care compared with patients who preferred not to delegate. Adjusting for observed patient characteristics, those with a nondelegating preference were more dissatisfied with overall service and physician care and lacked confidence and trust in the physicians providing treatment. The findings of this study suggest that expectations of care and communication that accompany a desire to participate in decisions may be associated with patient dissatisfaction or distrust. The association of patient desire to participate in health care decisions with care satisfaction is poorly understood. The contributions of such desire, expectations of care, and quality of care in assessing patient satisfaction are not known. To investigate the association of hospitalized patients’ desire to delegate decisions to their physician with care dissatisfaction. Survey study in an academic research setting. As part of The University of Chicago Hospitalist Study, data were collected on 13 902 hospitalized patients admitted to the general internal medicine service of The University of Chicago Medical Center between July 1, 2004, and September 30, 2012, who answered an inpatient survey administered soon after the time of admission and a 30-day follow-up survey. The dates of analysis were January 2014 to June 2015. Patient-reported preference to leave medical decisions to their physician (definitely agree or somewhat agree vs somewhat disagree or definitely disagree). The main outcomes were patient-reported dissatisfaction with overall service, dissatisfaction with physician care, and lack of confidence and trust in the physicians providing treatment, which were obtained from the 30-day follow-up survey. The sample population included 13 902 patients (mean [SD] age, 56.7 [19.1] years; 60.4% female [n = 8397] and 74.2% African American [n = 10 310]) who completed both surveys. Overall, 53.2% had no higher educational attainment, 22.7% were insured by Medicaid, and 51.1% reported a general self-assessed health status of fair or poor. The proportions of respondents who agreed and disagreed with delegating decisions to the responsible physician were 71.1% and 28.9%, respectively. A statistically significantly higher proportion of those who agreed rated their overall care as excellent or very good compared with those who disagreed (68.0% vs 62.5%; P < .001). Similarly, a statistically significantly higher proportion of those who agreed were extremely satisfied with the physician care received (67.8% vs 62.5%; P < .001). In the multivariable logistic regression models, compared with those patients who definitely agreed with delegation, patients who definitely disagreed were more likely to be dissatisfied with overall service (odds ratio [OR], 1.86; 95% CI, 1.54-2.24) and the physician care received (OR, 1.78; 95% CI, 1.42-2.22) and lack confidence and trust in the physicians providing treatment (OR, 2.05; 95% CI, 1.62-2.59). The findings suggest that patient preferences to participate in medical decision-making are statistically significantly associated with dissatisfaction of hospitalized patients. Clinicians should individualize their encouragement of patient participation in diagnostic and management decisions to maximize patient satisfaction.
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