Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
PLoS One. 2021 Jul 2;16(7):e0254052. doi: 10.1371/journal.pone.0254052. eCollection 2021.
Although research findings consistently find poor communication about medical procedures to be a key predictor of patient complaints, compensation claims, and malpractice lawsuits ("complaints"), there is insufficient evidence to determine if greater patient involvement could actually affect the inclination to complain.
We conducted an experimental case vignette survey that explores whether greater patient involvement in decision-making is likely to influence the intention to complain given different decisions and consequences.
Randomized, national case vignette survey with various levels of patient involvement, decisions, and outcomes in a representative Danish sample of men. We used prostate specific antigen (PSA) screening in men aged 45 to 70 years as the intervention illustrated in 30 different versions of a mock clinical encounter. Versions differed in the amount of patient involvement, the decision made (PSA test or no PSA test), and the clinical outcomes (no cancer detected, detection of treatable cancer, and detection of non-treatable cancer). We measured respondents' inclination to complain about care in response to the scenarios on a 5-point Likert scale (from 1: very unlikely to 5: very likely).
The response rate was 30% (6,756 of 22,288). Across all scenarios, the likelihood of complaint increased if the clinical outcome was poor (untreatable cancer). Compared with scenarios that involved shared decision-making (SDM), neutral information, or nudging in favor of screening, the urge to complain increased if the patient was excluded from decision-making or if the doctor had nudged the patient to decline screening (mean Likert differences .12 to .16, p < .001). With neutral involvement or nudging in favor of intervention, the desire to complain depended highly on the decision reached and on the patient's course. This dependence was smaller with SDM.
Greater patient involvement in decision-making appears to be associated with less intention to complain about health care, with SDM resulting in the greatest reduction in complaint likelihood.
尽管研究结果一致表明，医疗程序沟通不畅是患者投诉、赔偿要求和医疗事故诉讼（“投诉”）的关键预测因素，但没有足够的证据表明患者更多的参与是否会真正影响投诉的倾向。
我们进行了一项实验性病例描述调查，探讨在不同的决策和结果下，患者更多的参与决策是否可能影响投诉的意愿。
这是一项在丹麦男性代表性样本中进行的随机、全国性病例描述调查，涉及不同程度的患者参与、决策和结果。我们使用前列腺特异性抗原（PSA）筛查作为干预措施，在 45 至 70 岁的男性中进行了 30 种不同版本的模拟临床接触。这些版本在患者参与程度、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）方面有所不同。我们使用 5 点 Likert 量表（从 1：极不可能到 5：极有可能）来衡量受访者对护理的投诉倾向。
回复率为 30%（6756 名中的 22288 名）。在所有情况下，如果临床结果不佳（不可治疗的癌症），投诉的可能性会增加。与涉及共享决策（SDM）、中性信息或倾向于筛查的情况相比，如果患者被排除在决策之外或医生倾向于让患者拒绝筛查，投诉的冲动会增加（平均 Likert 差异.12 到.16，p<0.001）。在中性参与或倾向于干预的情况下，投诉的愿望高度取决于所做出的决策和患者的病情。这种依赖性在 SDM 中较小。
患者更多的参与决策似乎与对医疗保健投诉的意愿降低有关，SDM 导致投诉可能性降低的幅度最大。
