Dataset Information

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

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).

SUBMITTER: Becker C

PROVIDER: S-EPMC10110786 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Becker Christoph C Gross Sebastian S Gamp Martina M Beck Katharina K Amacher Simon A SA Mueller Jonas J Bohren Chantal C Blatter René R Schaefert Rainer R Schuetz Philipp P Leuppi Joerg J Bassetti Stefano S Hunziker Sabina S

Journal of general internal medicine 20220909 5

<h4>Background</h4>Patients may prefer different levels of involvement in decision-making regarding their medical care which may influence their medical knowledge.<h4>Objective</h4>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).<h4>Design</h4>This ...[more]

PMID: 36085211

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Project description:BackgroundShared decision-making is the gold standard for good clinical practice, and thus, psychometric instruments have been established to assess patients' generic preference for participation (e.g., the Autonomy Preference Index, API). However, patients' preferences may vary depending on the specific disease and with respect to the specific decision context. With a modified preference index (API-Uro), we assessed patients' specific participation preference in preference-sensitive decisions pertaining to urological cancer treatments and compared this with their generic participation preference.MethodsIn Study 1, we recruited (N = 469) urological outpatients (43.1% urooncological) at a large university hospital. Participation preference was assessed with generic measures (API and API case vignettes) and with the disease-specific API-Uro (urooncological case vignettes describing medical decisions of variable difficulty). A polychoric exploratory factor analysis was used to establish factorial validity and reduce items. In Study 2, we collected data from N = 204 bladder cancer patients in a multicenter study to validate the factorial structure with confirmatory factor analysis. Differences between the participation preference for different decision contexts were analyzed.ResultsStudy 1: Scores on the specific urooncological case vignettes (API-Uro) correlated with the generic measure (r = .44) but also provided incremental information. Among the disease-specific vignettes of the API-Uro, there were two factors with good internal consistency (α ≥ .8): treatment versus diagnostic decisions. Patients desired more participation for treatment decisions (77.8%) than for diagnostic decisions (22%), χ2(1) = 245.1, p ≤ .001. Study 2: Replicated the correlation of the API-Uro with the API (r = .39) and its factorial structure (SRMR = .08; CFI = .974). Bladder cancer patients also desired more participation for treatment decisions (57.4%) than for diagnostic decisions (13.3%), χ²(1) =84, p ≤ .001.ConclusionsThe desire to participate varies between treatment versus diagnostic decisions among urological patients. This underscores the importance of assessing participation preference for specific contexts. Overall, the new API-Uro has good psychometric properties and is well suited to assess patients' preferences. In routine care, measures of participation preference for specific decision contexts may provide incremental, allowing clinicians to better address their patients' individual needs.

Project description:BackgroundShared decision-making (SDM) is the gold standard for patient-clinician interaction, yet many patients are not actively involved in medical consultations and hesitate to engage in decisions on their health. Despite considerable efforts to improve implementation, research on barriers to SDM within the patient-clinician relationship and interaction is scant. To identify potential barriers to urological patients' participation in decision-making, we developed two novel scales assessing power asymmetry (PA-ME) and embarrassment in medical encounters (EmMed). The present study validates both scales in a large sample comprising urological patients and non-clinical participants. It further examines the effects of both factors on participation preferences and decisional conflict among patients.MethodsData were collected from 107 urological patients at a university hospital for Urology and Urosurgery in Germany. Patients completed self-report questionnaires before and after their clinical appointments. In addition, 250 non-clinical participants provided data via an online study. All participants rated perceived power asymmetry in the patient-clinician relationship and their experience of embarrassment in medical contexts using the PA-ME and EmMed scales. Urological patients further indicated their participation preference in decisions regarding both general and urological care prior to the consultation. Afterward, they assessed the level of perceived decisional conflict.ResultsFactor analyses yielded power asymmetry and medical embarrassment as unidimensional constructs. Both questionnaires have good (PA-ME; α = 0.88), respectively excellent (EmMed; α = 0.95), internal consistency. Among urological patients, higher levels of perceived power asymmetry predicted lower generic participation preference (β = - 0.98, p <.001, adjusted R2 = 0.14) and higher decisional conflict (β = 0.25, p <.01, adjusted R2 = 0.07). While, in patients, embarrassment was not linked to generic participation preference before the consultation (p ≥.5), it resulted in higher decisional conflict after the consultation (β = 0.39, p <.001, adjusted R2 = 0.14). Neither power asymmetry nor embarrassment were specifically associated with participation preference regarding urological care (p ≥.273).ConclusionsGiven their promising psychometric properties, the new instruments are recommended for routine assessment of power asymmetry and embarrassment among patients. Addressing these factors may be helpful to reduce decisional conflict and increase participation preferences. Both factors are prerequisites for a successful SDM-process and active patient engagement in health-related decisions.

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Dataset Information

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

Background

Objective

Design

Participants

Main measures

Key results

Conclusion

Trial registration

Publications

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

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