PATIENT PREFERENCES FOR DISCLOSURE: A NATIONAL SURVEY

在不断变化的医疗保健环境中，以前由患者及其医生做出的重要决定现在受到第三方（如健康计划和保险公司）的强烈影响，这些第三方的入侵导致许多患者质疑他们的医生是否真正为他们的最佳利益行事。 医生报告说，他们面临的挑战是如何与患者就第三方限制进行有效沟通，同时建立信任并保持患者满意度。 本研究建议回答这个问题，引起病人的意见，他们应该如何以及何时被告知第三方的政策，特别是医疗限制和利益冲突。 通过一项基于美国人口代表性样本的全国性调查，受访者将接触到医生用于披露转诊限制和经济利益冲突的不同沟通策略。 这些声明将反映职业行为的最高标准，并将基于医生在道德参数范围内行事的假设。本研究建议的具体目标如下：（1）制定医师披露第三方限制的沟通策略，并评估其真实性和可接受性;（2）试点测试一种调查工具（包含披露第三方限制的录音声明）;（3）通过由国家民意研究中心（NORC）管理的具有全国代表性的综合社会调查（GSS），实验性地评估公众对如何实施第三方限制信息的偏好;（4）评估披露第三方限制如何影响患者信任、满意度和退出健康计划的意图;以及（5）评估披露结果如何根据患者对第三方限制的经历，健康状况，和其他人口特征。研究结果将为立法机构和负责向患者和公众披露的医疗保健组织的政策决定提供依据。 这项研究将成为广泛传播的教育干预措施的基础，帮助医生以加强治疗性医患关系的方式披露有关第三方限制的信息。

In the changing health care environment, important decisions previously made by patients and their physicians are now strongly influenced by third parties such as health plans and insurers whose intrusion has led many patients to question whether their physicians are truly acting in their best interest. Physicians report that they are challenged in knowing how to communicate effectively with patients about third-party restrictions while simultaneously building trust and maintaining patient satisfaction. This study proposes to answer this question by eliciting patient opinions on how and when they should be informed about third-party policies, particularly referral-restrictions and conflicts of interest. Through a national survey based on a representative sample of the US population, respondents will be exposed to different communication strategies used by physicians to disclose referral restrictions and financial conflicts of interest. These statements will reflect the highest standards of professional conduct and will be based on the assumption that physicians act within ethical parameters. The specific objectives of this research proposal are as follows: (1) develop communication strategies for disclosure of third-party restrictions by physicians and evaluate their authenticity and acceptability; (2) pilot test a survey instrument (containing audiotaped statements of disclosure of third-party restrictions) among patients from high and low penetration managed care markets; (3) experimentally evaluate public preferences on how information regarding third-party restrictions should be implemented through the nationally representative General Social Survey (GSS) administered by the National Opinion Research Center (NORC); (4) Evaluate how disclosure of third-party restrictions affects outcomes of patient trust, satisfaction, and intent to disenroll from health plan; and (5) evaluate how disclosure outcomes vary based on patients' experience with third-party restrictions, health status, and other demographic characteristics. The results will provide the basis for policy decisions for both legislative bodies and health care organizations responsible for disclosure to patients and the public at large. The study will form the basis of broadly disseminated educational interventions for physicians helping them to disclose information about third-party restrictions in manner that reinforces the therapeutic patient-physician relationship.