Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Apr;38(5):1180-1189.
doi: 10.1007/s11606-022-07775-z. Epub 2022 Sep 9.

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

Christoph Becker  1   2 , Sebastian Gross  1 , Martina Gamp  1 , Katharina Beck  1 , Simon A Amacher  1   3 , Jonas Mueller  1 , Chantal Bohren  1 , René Blatter  1 , Rainer Schaefert  1   4 , Philipp Schuetz  4   5 , Joerg Leuppi  4   6 , Stefano Bassetti  4   7 , Sabina Hunziker  8   9
Affiliations
Randomized Controlled Trial

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

Christoph Becker et al. J Gen Intern Med. 2023 Apr.

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.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
a Patients’ subjective knowledge regarding their medical care according to patients’ DCP stratified for study intervention. Legend: DCP, decisional control preference; SD, standard deviation; CI, confidence interval. b Occurrence of sensitive topics according to patients’ DCP stratified for study intervention. Legend: DCP, decisional control preference; OR, odds ratio; CI, confidence interval. c Duration of ward round according to patients’ DCP stratified for study intervention. Legend: DCP, decisional control preference; SD, standard deviation; CI, confidence interval
See this image and copyright information in PMC

References

    1. O'Hare JA. Anatomy of the ward round. Eur J Intern Med. 2008;19(5):309–13. doi: 10.1016/j.ejim.2007.09.016. - DOI - PubMed
    1. Royal College of Physicians RCoN. Ward rounds in medicine: principles for best practice. 2015 (London: RCP, 2012.).
    1. O'Mahony S, Mazur E, Charney P, Wang Y, Fine J. Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. J Gen Intern Med. 2007;22(8):1073–9. doi: 10.1007/s11606-007-0225-1. - DOI - PMC - PubMed
    1. Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2009;3:CD000072. doi: 10.1002/14651858.CD000072.pub2. - DOI - PubMed
    1. Pucher PH, Aggarwal R, Darzi A. Surgical ward round quality and impact on variable patient outcomes. Ann Surg. 2014;259(2):222–6. doi: 10.1097/SLA.0000000000000376. - DOI - PubMed

Publication types

Associated data