Patient Assessments of the Most Important Medical Decision During a Hospitalization

BackgroundHow medical decisions are made in real-life situations is largely unexplored. We explored patients’ perceptions of decision-making during a hospitalization and examined the conformity of the decision process with expert recommendations.ObjectiveTo describe the conformity of the decision-making process with current expert opinion and examine the associations between various aspects of the decision-making process and a global assessment of the decision.MethodsMail survey of patients discharged from a teaching hospital in Geneva, Switzerland. Patients identified the main medical decision during their stay, and rated the decision process (11-item “decision process score”) and their satisfaction with the decision (five-item “decision satisfaction score”). Both scores were scaled between 0 (worst) and 100 (best).ParticipantsThe survey had 1467 respondents.Main ResultsIn total 862 (58.8%) of 1467 respondents reported having made a medical decision while in the hospital. The decision process score (mean 78.5, SD 21.5) and the decision satisfaction score (mean 86.5, SD 20.4) were moderately correlated (r = 0.62). Men, healthier patients, patients discharged from the department of surgery, and those who reported sharing the decision with their doctor gave the highest ratings on both scales. Five process variables were independently associated with high satisfaction with the decision: the doctor explained all possible treatments and examinations, the patient was aware of risks at the time of the decision, the doctor’s explanations were easy to understand, the patient was involved in the decision as much as desired or more, and the patient was not pressured into the decision.ConclusionsA majority of patients discharged from a general hospital were able to identify and rate a medical decision. Recommended features of the process of medical decision-making were associated with greater satisfaction with the decision.

[1]  K C Carriere,et al.  Information needs and decisional preferences in women with breast cancer. , 1997, JAMA.

[2]  H. Taylor.  Barriers to informed consent. , 1999, Seminars in oncology nursing.

[3]  Angela Fagerlin,et al.  Patient involvement in surgery treatment decisions for breast cancer. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  T. Perneger,et al.  The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. , 1998, Journal of clinical epidemiology.

[5]  A. McGuire,et al.  Missed Expectations?: Physicians’ Views of Patients’ Participation in Medical Decision-Making , 2005, Medical care.

[6]  Glyn Elwyn,et al.  The development of COMRADE--a patient-based outcome measure to evaluate the effectiveness of risk communication and treatment decision making in consultations. , 2003, Patient education and counseling.

[7]  Stephan D. Fihn,et al.  How Doctors and Patients Discuss Routine Clinical Decisions: Informed Decision Making in the Outpatient Setting , 1997, Journal of General Internal Medicine.

[8]  Barbara Gandek,et al.  Characteristics of Physicians with Participatory Decision-Making Styles , 1996, Annals of Internal Medicine.

[9]  C. Jenkinson,et al.  Assessment of the SF-36 version 2 in the United Kingdom. , 1999, Journal of epidemiology and community health.

[10]  Barbara Leake,et al.  Impoverished diabetic patients whose doctors facilitate their participation in medical decision making are more satisfied with their care , 2002, Journal of General Internal Medicine.

[11]  A. O'Connor.  Validation of a Decisional Conflict Scale , 1995, Medical decision making : an international journal of the Society for Medical Decision Making.

[12]  B. Carlsen,et al.  Patient involvement in clinical decision making: the effect of GP attitude on patient satisfaction , 2006, Health expectations : an international journal of public participation in health care and health policy.

[13]  E. Guadagnoli,et al.  Patient participation in decision-making. , 1998, Social science & medicine.

[14]  D. Strouse.  Patient-centered medicine. , 1996, JAMA.

[15]  W. Levinson,et al.  Informed decision making in outpatient practice: time to get back to basics. , 1999, JAMA.

[16]  T. Hope,et al.  Observing decision‐making in the general practice consultation: who makes which decisions? , 2006, Health expectations : an international journal of public participation in health care and health policy.

[17]  V. Entwistle,et al.  Assessing patients' participation and quality of decision-making: insights from a study of routine practice in diverse settings. , 2004, Patient education and counseling.

[18]  T. Perneger,et al.  Nonresponse Bias in a Survey of Patient Perceptions of Hospital Care , 2005, Medical care.

[19]  P Kinnersley,et al.  Measuring the involvement of patients in shared decision-making: a systematic review of instruments. , 2001, Patient education and counseling.

[20]  M. Holmes-Rovner,et al.  Patient Satisfaction with Health Care Decisions , 1996, Medical decision making : an international journal of the Society for Medical Decision Making.

[21]  S. Flocke,et al.  Facilitating Participatory Decision-Making: What Happens in Real-World Community Practice? , 2000, Medical care.

[22]  A Laupacis,et al.  A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: a randomized controlled trial. , 1999, JAMA.

[23]  Deb Feldman-Stewart,et al.  Validation of a Decision Regret Scale , 2003, Medical decision making : an international journal of the Society for Medical Decision Making.

[24]  V. Entwistle,et al.  Women's perceptions of decision‐making about hysterectomy , 2004, BJOG: an International Journal of Obstetrics and Gynaecology.

[25]  Stephan D. Fihn,et al.  How Doctors and Patients Discuss Routine Clinical Decisions: Informed Decision Making in the Outpatient Setting , 1997 .

[26]  R. Thomson,et al.  Patients' preference for involvement in medical decision making: a narrative review. , 2006, Patient education and counseling.

[27]  Thomas Agoritsas,et al.  Patient reports of undesirable events during hospitalization , 2005, Journal of general internal medicine.

[28]  B. Lo,et al.  Do patients want to participate in medical decision making? , 1984, JAMA.

[29]  G. Elwyn,et al.  Shared decision making: developing the OPTION scale for measuring patient involvement , 2003, Quality & safety in health care.

[30]  F. Davidoff,et al.  Patient-Centered Medicine: A Professional Evolution , 1996 .

[31]  Angela Fagerlin,et al.  Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. , 2005, Health services research.

[32]  C. Charles,et al.  Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. , 1999, Social science & medicine.

[33]  Peter Watson,et al.  Do patients benefit from participating in medical decision making? Longitudinal follow‐up of women with breast cancer , 2006, Psycho-oncology.

[34]  Lisa V Rubenstein,et al.  Primary Care Patients’ Involvement in Decision-Making Is Associated With Improvement in Depression , 2006, Medical care.

[35]  P. Cleary,et al.  Patients evaluate their hospital care: a national survey. , 1991, Health affairs.

[36]  Stacey L. Sheridan,et al.  Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision Making , 2005, Annals of Internal Medicine.

[37]  Faye Flintoff.  Time to get back to basics. , 2006, Nursing New Zealand.

[38]  R. Kravitz,et al.  Patient Participation in Medical Consultations: Why Some Patients are More Involved Than Others , 2005, Medical care.

[39]  T. Perneger,et al.  Women’s Preferences for Doctor’s Involvement in Decisions about Mammography Screening , 2004, Medical decision making : an international journal of the Society for Medical Decision Making.