Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland.
Emergency Department, University Hospital Basel, Basel, Switzerland.
J Gen Intern Med. 2023 Apr;38(5):1180-1189. doi: 10.1007/s11606-022-07775-z. Epub 2022 Sep 9.
Patients may prefer different levels of involvement in decision-making regarding their medical care which may influence their medical knowledge.
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).
This is a secondary analysis of a randomized controlled multicenter trial conducted between 2017 and 2019 at 3 Swiss teaching hospitals.
Adult patients that were hospitalized for inpatient care.
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.
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).
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.
ClinicalTrials.gov (NCT03210987).
患者可能对其医疗护理的决策参与程度有不同的偏好，这可能会影响他们的医疗知识。
我们调查了患者决策控制偏好（DCP）与他们的医疗知识、查房表现测量指标（如持续时间、敏感话题的出现）以及感知的护理质量测量指标（如对医疗团队的信任、对住院的满意度）之间的关联。
这是 2017 年至 2019 年在瑞士 3 家教学医院进行的一项随机对照多中心试验的二次分析。
因住院接受住院治疗的成年患者。
主要结局是患者对其医疗护理的主观平均知识（0 到 100 的视觉模拟评分）。我们根据控制偏好量表将患者分类为积极、协作和被动。数据收集在查房前后进行。
在纳入的 761 名患者中，具有被动 DCP 的患者的主观平均（均值 ± 标准差）知识（81.3 ± 19.4 分）与具有协作 DCP（78.7 ± 20.3 分）和主动 DCP（81.3 ± 21.5 分）的患者相似，p = 0.25。关于患者对医生和护士的信任，我们发现与具有被动 DCP 的患者相比，具有主动 DCP 的患者对医生的信任明显降低（调整差异，-5.08 [95%CI，-8.69 至-1.48 分]，p = 0.006）和对护士的信任（调整差异，-3.41 [95%CI，-6.51 至-0.31 分]，p = 0.031）。此外，具有主动 DCP 的患者对住院治疗的满意度明显低于具有被动 DCP 的患者（调整差异，-7.17 [95%CI，-11.01 至-3.34 分]，p <0.001）。
尽管感知的医疗知识相似，但具有主动 DCP 的患者对医疗保健团队的信任度较低，整体满意度也较低。患者 DCP 的知识可能有助于个性化以患者为中心的护理。个性化方法可能会改善医患关系并提高患者对医疗护理的满意度。
ClinicalTrials.gov（NCT03210987）。
