Patients' Preference for Participation in Medical Decision-Making: Secondary Analysis of the BEDSIDE-OUTSIDE Trial

Christoph Becker; Sebastian Gross; Martina Gamp; Katharina Beck; Simon A Amacher; Jonas Mueller; Chantal Bohren; René Blatter; Rainer Schaefert; Philipp Schuetz; Joerg Leuppi; Stefano Bassetti; Sabina Hunziker

doi:10.1007/s11606-022-07775-z

Patients' Preference for Participation in Medical Decision-Making: Secondary Analysis of the BEDSIDE-OUTSIDE Trial

J Gen Intern Med. 2023 Apr;38(5):1180-1189. doi: 10.1007/s11606-022-07775-z. Epub 2022 Sep 9.

Authors

Christoph Becker^{1

2}, Sebastian Gross¹, Martina Gamp¹, Katharina Beck¹, Simon A Amacher^{1

3}, Jonas Mueller¹, Chantal Bohren¹, René Blatter¹, Rainer Schaefert^{1

4}, Philipp Schuetz^{4

5}, Joerg Leuppi^{4

6}, Stefano Bassetti^{4

7}, Sabina Hunziker^{8

9}

Affiliations

¹ Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland.
² Emergency Department, University Hospital Basel, Basel, Switzerland.
³ Intensive Care Unit, University Hospital Basel, Basel, Switzerland.
⁴ Faculty of Medicine, University of Basel, Basel, Switzerland.
⁵ Division of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
⁶ Division of Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland.
⁷ Division of Internal Medicine, University Hospital Basel, Basel, Switzerland.
⁸ Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland. [email protected].
⁹ Faculty of Medicine, University of Basel, Basel, Switzerland. [email protected].

Abstract

Background: Patients may prefer different levels of involvement in decision-making regarding their medical care which may influence their medical knowledge.

Objective: We investigated associations of patients' decisional control preference (DCP) with their medical knowledge, ward round performance measures (e.g., duration, occurrence of sensitive topics), and perceived quality of care measures (e.g., trust in the healthcare team, satisfaction with hospital stay).

Design: This is a secondary analysis of a randomized controlled multicenter trial conducted between 2017 and 2019 at 3 Swiss teaching hospitals.

Participants: Adult patients that were hospitalized for inpatient care.

Main measures: The primary outcome was patients' subjective average knowledge of their medical care (rated on a visual analog scale from 0 to 100). We classified patients as active, collaborative, and passive according to the Control Preference Scale. Data collection was performed before, during, and after the ward round.

Key results: Among the 761 included patients, those with a passive DCP had a similar subjective average (mean ± SD) knowledge (81.3 ± 19.4 points) compared to patients with a collaborative DCP (78.7 ± 20.3 points) and active DCP (81.3 ± 21.5 points), p = 0.25. Regarding patients' trust in physicians and nurses, we found that patients with an active vs. passive DCP reported significantly less trust in physicians (adjusted difference, - 5.08 [95% CI, - 8.69 to - 1.48 points], p = 0.006) and in nurses (adjusted difference, - 3.41 [95% CI, - 6.51 to - 0.31 points], p = 0.031). Also, patients with an active vs. passive DCP were significantly less satisfied with their hospital stay (adjusted difference, - 7.17 [95% CI, - 11.01 to - 3.34 points], p < 0.001).

Conclusion: Patients with active DCP have lower trust in the healthcare team and lower overall satisfaction despite similar perceived medical knowledge. The knowledge of a patient's DCP may help to individualize patient-centered care. A personalized approach may improve the patient-physician relationship and increase patients' satisfaction with medical care.

Trial registration: ClinicalTrials.gov (NCT03210987).

Keywords: decision-making; decisional control preference; hospital medicine; quality of care; satisfaction.

Publication types

Randomized Controlled Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Clinical Decision-Making
Decision Making*
Hospitals, Teaching
Humans
Patient Participation
Patient Preference*
Patient Satisfaction

Associated data

ClinicalTrials.gov/NCT03210987