What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics.

Full Abstract

OBJECTIVE:
Contemporary ethical accounts of the patient-provider relationship emphasise respect for patient autonomy and shared decision making. We sought to examine the relative influence of involvement in decisions, confidence and trust in providers, and treatment with respect and dignity on patients' evaluations of their hospital care.

DESIGN:
Cross-sectional survey.

SETTING:
Fifty one hospitals in Massachusetts.

PARTICIPANTS:
Stratified random sample of adults (N=27 414) discharged from a medical, surgical, or maternity hospitalisation between January and March, 1998. Twelve thousand six hundred and eighty survey recipients responded.

MAIN OUTCOME MEASURE:
Respondent would definitely be willing to recommend the hospital to family and friends.

RESULTS:
In a logistic regression analysis, treatment with respect and dignity (odds ratio (OR) 3.4, 99% confidence interval (CI) 2.8 to 4.2) and confidence and trust in providers (OR 2.5, CI 2.1 to 3.0) were more strongly associated with willingness to recommend than having enough involvement in decisions (OR 1.4, CI 1.1 to 1.6). Courtesy and availability of staff (OR 2.5, CI 2.1 to 3.1), continuity and transition (OR 1.9, CI 1.5 to 2.2), attention to physical comfort (OR 1.8, CI 1.5 to 2.2), and coordination of care (OR 1.5, CI 1.3 to 1.8) were also significantly associated with willingness to recommend.

CONCLUSIONS:
Confidence and trust in providers and treatment with respect and dignity are more closely associated with patients' overall evaluations of their hospitals than adequate involvement in decisions. These findings challenge a narrow emphasis on patient autonomy and shared decision making, while arguing for increased attention to trust and respect in ethical models of health care.

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Author information

Author/s: Joffe, S (S); Manocchia, M (M); Weeks, J C (JC); Cleary, P D (PD);

Affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. steven_joffe(-atsign-)dfci.harvard.edu

Grants: T32 HS00063 (Agency:AHRQ HHS)

Journal and publication information

Publication Type: Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S.

Journal: Journal of medical ethics (J Med Ethics), published in England. (Language: eng)

Reference: 2003-Apr; vol 29 (issue 2) : pp 103-8

Dates: Created 2003/04/03; Completed 2003/06/06; Revised 2008/11/20;

PMID: 12672891, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: J Med Ethics. 2004 Dec;30(6):610-2. (PMID: 15574458)

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