Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
Open Patient data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark.
BMJ Qual Saf. 2022 Feb;31(2):86-93. doi: 10.1136/bmjqs-2020-012786. Epub 2021 Apr 22.
Patient-centredness is an essential quality parameter of modern healthcare. Accordingly, involving patients in decisions about care is required by international laws and an increasing number of medical codes and standards. These directives are based on ethical principles of autonomy. Still, there is limited empirical knowledge about the influence of patient involvement on satisfaction with care.
In a large national vignette survey, we aimed to empirically test healthcare users' satisfaction with healthcare given different degrees of patient involvement, choices made and outcomes.
A web-based cross-sectional survey distributed to a randomised sample of men in Denmark aged 45-70 years. Case vignettes used prostate-specific antigen (PSA) screening for early detection of prostate cancer as a clinical model. Using a 5-point Likert scale, we measured respondents' satisfaction with care in scenarios which differed in the amount of patient involvement (ranging from no involvement, through involvement with neutral or nudged information, to shared decision-making), the decision made (PSA test or no PSA test) and clinical outcomes (no cancer detected, detection of treatable cancer and detection of non-treatable cancer).
Participating healthcare users tended to be more satisfied with healthcare in scenarios illustrating greater levels of patient involvement. Participants were positive towards nudging in favour of the intervention but patient involvement through shared decision-making obtained the highest satisfaction ratings (Likert rating 3.81 without any involvement vs 4.07 for shared decision-making, p<0.001). Greater involvement also had an ameliorating effect on satisfaction if a non-treatable cancer was later diagnosed.
Our study provides empirical support for the hypothesis that greater patient involvement in healthcare decision-making improves satisfaction with care irrespective of decisions made and clinical outcomes. Overall satisfaction with the care illustrated was highest when decisions were reached through shared decision-making.
以患者为中心是现代医疗保健的一个基本质量参数。因此，国际法律以及越来越多的医疗法规和标准都要求让患者参与医疗决策。这些指令基于自主的伦理原则。尽管如此，关于患者参与对护理满意度的影响，仍缺乏实证知识。
在一项大型全国情景模拟调查中，我们旨在通过实证检验不同程度的患者参与、所做决策和结果对医疗保健用户满意度的影响。
我们对丹麦随机抽取的 45-70 岁男性进行了一项基于网络的横断面调查。使用前列腺特异性抗原（PSA）筛查作为早期发现前列腺癌的临床模型来制作病例情景模拟。我们使用 5 点 Likert 量表，根据患者参与度（从无参与到提供中立或提示性信息的参与，再到共同决策）、所做决策（PSA 测试或不进行 PSA 测试）和临床结果（未发现癌症、发现可治疗的癌症和发现不可治疗的癌症）的不同，来测量受访者对护理的满意度。
参与的医疗保健用户往往对说明患者参与度更高的医疗保健方案更满意。参与者对有利于干预的提示持积极态度，但通过共同决策进行患者参与获得了最高的满意度评分（无任何参与的 Likert 评分 3.81 与共同决策的 4.07 相比，p<0.001）。如果后来诊断出不可治疗的癌症，更大程度的参与也会改善满意度。
我们的研究为假设提供了实证支持，即患者在医疗保健决策中的更大参与度可以提高护理满意度，而与所做决策和临床结果无关。通过共同决策达成的护理方案整体满意度最高。
