Decision-making preferences of hospitalized patients linked to care satisfaction, trust

In a survey study of hospitalized patients, most of them African American, those who disagreed with leaving medical decisions to their physicians were more likely to be dissatisfied with their care and lack confidence and trust in their physicians compared with those who agreed.


Hospitalized patients' willingness to leave medical decisions to their physicians was associated with care satisfaction and trust in their physicians in a recent study.

Researchers conducted a survey study in an academic research setting to investigate the association of hospitalized patients' desire to delegate decisions to their physician with care dissatisfaction. As part of the University of Chicago Hospitalist Study, they collected data on hospitalized patients admitted to the general internal medicine service of the University of Chicago Medical Center between July 1, 2004, and Sept. 30, 2012, who answered surveys soon after admission and at 30-day follow-up. The survey measured patients' preferences to leave medical decisions to their physician (definitely agree or somewhat agree vs. somewhat disagree or definitely disagree). 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. Results were published on Oct. 2 by JAMA Network Open.

The sample population included 13,902 patients (mean age, 56.7 years; 60.4% women; 74.2% African American) who completed both surveys. Overall, 53.2% had no higher educational attainment, 22.7% were insured by Medicaid, and 51.1% self-assessed their health status as fair or poor. When asked whether they preferred to delegate decisions to their physician, 71.1% agreed and 28.9% disagreed. A 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%; P<0.001). In addition, a higher proportion of those who agreed were extremely satisfied with the physician care received (67.8% vs. 62.5%; P<0.001). 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 to 2.24) and the physician care received (OR, 1.78; 95% CI, 1.42 to 2.22) and to lack confidence and trust in the physicians providing treatment (OR, 2.05; 95% CI, 1.62 to 2.59).

Limitations of the study include the fact that the results may not be generalizable outside of its urban, largely African American population, the authors noted. They added that about 29% of admitted patients did not participate in the survey.

“Within certain patient populations, expectations of care and communication that accompany a desire to participate in health care decisions may deleteriously alter satisfaction,” they concluded. “Clinicians should individualize their encouragement of patient participation, which can have consequences on satisfaction and trust.”