Association of Preferences for Participation in Decision-making With Care Satisfaction Among Hospitalized Patients
Authors: Gregory W. Ruhnke, Hyo Jung Tak, David O. Meltzer
Journal: JAMA Network Open (2020)

<h3>Importance</h3> 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. <h3>Objective</h3> To investigate the association of hospitalized patients' desire to delegate decisions to their physician with care dissatisfaction. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposure</h3> Patient-reported preference to leave medical decisions to their physician (definitely agree or somewhat agree vs somewhat disagree or definitely disagree). <h3>Main Outcomes and Measures</h3> 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. <h3>Results</h3> 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%;<i>P</i> &lt; .001). Similarly, a statistically significantly higher proportion of those who agreed were extremely satisfied with the physician care received (67.8% vs 62.5%;<i>P</i> &lt; .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). <h3>Conclusions and Relevance</h3> 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.