Association of Shared Decision Making with Inpatient Satisfaction: A Cross-Sectional Study

Abstract Background: We assess inpatient perceived shared decision making (SDM) and test the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.Methods: A cross-sectional survey was conducted with 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018. We assessed SDM overall and 4 aspects of SDM and tested the factors that influenced SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and inpatient care overall), adopting multilevel mixed linear regression models.Results: The positive response rate (PRR) for SDM overall among the inpatients of public tertiary hospitals in Shanghai was high (95.30%), while the PRR for “My physician informed me of different treatment alternatives” was relatively low (88.63%). In addition, inpatients who underwent surgery during admission had higher PRRs and adjusted PRRs for SDM overall than those who did not undergo surgery (96.01% vs. 95.00% and 94.15% vs. 92.99%, respectively). Based on three-level mixed regression models, the study showed that inpatients with positive responses for SDM overall had higher adjusted satisfaction rates (SRs) for physician services, medical expenses, outcomes and inpatient care overall (98.89%, 91.73%, 98.44% and 97.34%, respectively) than those without positive responses (88.91%, 72.44%, 88.66% and 87.86%, respectively). The greatest differences in adjusted SRs between inpatients with or without positive responses for SDM were found for inpatient satisfaction with medical expenses and informed consent in SDM.Conclusions: Inpatient PRRs for SDM in public tertiary hospitals in Shanghai are high overall but are lower for information about alternatives. SDM can be affected by the SDM preference of both patients and physicians, medical condition, physician workload and professional requirements. Patient satisfaction with physician services, medical expenses, treatment outcomes and inpatient care overall can be improved through good SDM.

Download Full-text

Association of shared decision making with inpatient satisfaction: a cross-sectional study

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01385-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Huiwen Luo ◽

Guohua Liu ◽

Jing Lu ◽

Di Xue

Keyword(s):

Patient Satisfaction ◽

Inpatient Care ◽

Response Rate ◽

Positive Response ◽

Physician Services ◽

Cross Sectional ◽

Medical Expenses ◽

Tertiary Hospitals ◽

Positive Response Rate ◽

High Level

Abstract Background We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China. Methods A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models. Results The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals). Conclusions Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.

Download Full-text

Association of shared decision making with inpatient satisfaction: A cross-sectional study

10.21203/rs.3.rs-37164/v3 ◽

2021 ◽

Author(s):

Huiwen Luo ◽

Guohua Liu ◽

Jing Lu ◽

Di Xue

Keyword(s):

Patient Satisfaction ◽

Inpatient Care ◽

Response Rate ◽

Positive Response ◽

Physician Services ◽

Cross Sectional ◽

Medical Expenses ◽

Tertiary Hospitals ◽

Positive Response Rate ◽

High Level

Abstract Background: We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China. Methods: A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models. Results: The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals). Conclusions: Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.

Download Full-text

Association of shared decision making with inpatient satisfaction: A cross-sectional study

10.21203/rs.3.rs-37164/v2 ◽

2020 ◽

Author(s):

Huiwen Luo ◽

Guohua Liu ◽

Jing Lu ◽

Di Xue

Keyword(s):

Patient Satisfaction ◽

Inpatient Care ◽

Response Rate ◽

Positive Response ◽

Physician Services ◽

Cross Sectional ◽

Medical Expenses ◽

Tertiary Hospitals ◽

Positive Response Rate ◽

High Level

Abstract Background: We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.Methods: A cross-sectional survey was of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models.Results: The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals).Conclusions: Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.

Download Full-text

The Association Between Patients' eHealth Literacy and Satisfaction With Shared Decision-making and Well-being: Multicenter Cross-sectional Study (Preprint)

10.2196/preprints.26721 ◽

2020 ◽

Author(s):

Richard Huan Xu ◽

Ling-Ming Zhou ◽

Eliza Lai-Yi Wong ◽

Dong Wang

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Regression Models ◽

Well Being ◽

Shared Decision ◽

Background Characteristics ◽

Cross Sectional ◽

Ehealth Literacy ◽

High Level ◽

The Relationship

BACKGROUND Although previous studies have shown that a high level of health literacy can improve patients’ ability to engage in health-related shared decision-making (SDM) and improve their quality of life, few studies have investigated the role of eHealth literacy in improving patient satisfaction with SDM (SSDM) and well-being. OBJECTIVE This study aims to assess the relationship between patients’ eHealth literacy and their socioeconomic determinants and to investigate the association between patients’ eHealth literacy and their SSDM and well-being. METHODS The data used in this study were obtained from a multicenter cross-sectional survey in China. The eHealth Literacy Scale (eHEALS) and Investigating Choice Experiments Capability Measure for Adults were used to measure patients’ eHealth literacy and capability well-being, respectively. The SSDM was assessed by using a self-administered questionnaire. The Kruskal-Wallis one-way analysis of variance and Wilcoxon signed-rank test were used to compare the differences in the eHEALS, SSDM, and Investigating Choice Experiments Capability Measure for Adults scores of patients with varying background characteristics. Ordinary least square regression models were used to assess the relationship among eHealth literacy, SSDM, and well-being adjusted by patients’ background characteristics. RESULTS A total of 569 patients completed the questionnaire. Patients who were male, were highly educated, were childless, were fully employed, were without chronic conditions, and indicated no depressive disorder reported a higher mean score on the eHEALS. Younger patients (SSDM≥61 years=88.6 vs SSDM16-30 years=84.2) tended to show higher SSDM. Patients who were rural residents and were well paid were more likely to report good capability well-being. Patients who had a higher SSDM and better capability well-being reported a significantly higher level of eHealth literacy than those who had lower SSDM and poorer capability well-being. The regression models showed a positive relationship between eHealth literacy and both SSDM (β=.22; P<.001) and well-being (β=.26; P<.001) after adjusting for patients’ demographic, socioeconomic status, lifestyle, and health status variables. CONCLUSIONS This study showed that patients with a high level of eHealth literacy are more likely to experience optimal SDM and improved capability well-being. However, patients’ depressive status may alter the relationship between eHealth literacy and SSDM. CLINICALTRIAL

Download Full-text

Shared decision making in radiation oncology: Implications for patient satisfaction.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6610 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6610-6610

Author(s):

Jacob Ezra Shabason ◽

Jun J Mao ◽

Eitan S. Frankel ◽

Neha Vapiwala

Keyword(s):

Decision Making ◽

Patient Satisfaction ◽

Shared Decision Making ◽

Radiation Oncology ◽

Treatment Decisions ◽

Cancer Center ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Targeted Interventions

6610 Background: Shared decision making (SDM) has been linked to healthcare quality outcomes, including patient satisfaction. However, the importance of SDM has not been evaluated in radiation oncology. This study aims to determine the association between patient-perceived SDM and patient satisfaction during radiation therapy (RT). We also explore patient desire for and perception of control during RT and its relationship to patient satisfaction. Methods: We conducted a cross-sectional survey of 305 patients undergoing RT at an urban academic cancer center. Patients self-reported measures of satisfaction and control during the last week of RT. SDM was measured using a 3-item validated instrument. The relationships between SDM, control over treatment decisions, and satisfaction were evaluated using chi-2 analyses. Results: The 305 participants had a mean age of 59.8 (range 18-87) and were 47.5% female. Ethnicities included white (75.7%), black (19.7%), Asian (2.6%), and Hispanic (0.7%). Tumor types represented were breast (19.7%), prostate (17.7%), head and neck (18%), gastrointestinal (15.1%), lung (13.4%), and other cancers (16.1%). Ninety (31.3%) patients reported experiencing SDM and 227 (76.2%) reported feeling very satisfied with their treatments. There were no significant differences in these outcomes based on demographic or clinical characteristics. Patients who experienced SDM were more likely to be satisfied with the care provided by their radiation oncologist (84.4% vs. 71.4%, p <0.02). Furthermore, the perception of having control in treatment decisions was associated with increased satisfaction regardless of whether the patient preferred control or not (Table). Conclusions: These findings emphasize the value of SDM in radiation oncology. Regardless of a patient's desire for control, it is important for physicians to engage patients in the decision making process. Both physician- and patient-targeted interventions may aid in improving SDM and, in turn, overall satisfaction among radiation oncology patients. [Table: see text]

Download Full-text

Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18042128 ◽

2021 ◽

Vol 18 (4) ◽

pp. 2128

Author(s):

Marta Maes-Carballo ◽

Manuel Martín-Díaz ◽

Luciano Mignini ◽

Khalid Saeed Khan ◽

Rubén Trigueros ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Health Professionals ◽

Cross Sectional Study ◽

Shared Decision ◽

Online Questionnaire ◽

Cross Sectional ◽

Professional Societies ◽

New Policies

Objectives: To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. Materials and Methods: A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. Results: The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36–4.55)) and were in favour of its implementation (mean 4.58 (4.51–4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37–3.55)) and agreed on policies that improved its implementation (3.96 (3.88–4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients’ paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). Conclusions: New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

Download Full-text

Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

Medical Decision Making ◽

10.1177/0272989x20977885 ◽

2020 ◽

Vol 41 (1) ◽

pp. 51-59

Author(s):

Gisèle Diendéré ◽

Imen Farhat ◽

Holly Witteman ◽

Ruth Ndjaboue

Keyword(s):

Decision Making ◽

Family Medicine ◽

Risk Communication ◽

Shared Decision Making ◽

Cross Sectional Study ◽

Clinical Encounter ◽

Values Clarification ◽

Shared Decision ◽

Cross Sectional ◽

Medical Consultations

Background Measuring shared decision making (SDM) in clinical practice is important to improve the quality of health care. Measurement can be done by trained observers and by people participating in the clinical encounter, namely, patients. This study aimed to describe the correlations between patients’ and observers’ ratings of SDM using 2 validated and 2 nonvalidated SDM measures in clinical consultations. Methods In this cross-sectional study, we recruited 238 complete dyads of health professionals and patients in 5 university-affiliated family medicine clinics in Canada. Participants completed self-administered questionnaires before and after audio-recorded medical consultations. Observers rated the occurrence of SDM during medical consultations using both the validated OPTION-5 (the 5-item “observing patient involvement” score) and binary questions on risk communication and values clarification (RCVC-observer). Patients rated SDM using both the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and binary questions on risk communication and values clarification (RCVC-patient). Results Agreement was low between observers’ and patients’ ratings of SDM using validated OPTION-5 and SDM-Q9, respectively (ρ = 0.07; P = 0.38). Observers’ ratings using RCVC-observer were correlated to patients’ ratings using either SDM-Q9 ( rpb = −0.16; P = 0.01) or RCVC-patients ( rpb = 0.24; P = 0.03). Observers’ OPTION-5 scores and patients’ ratings using RCVC-questions were moderately correlated ( rφ = 0.33; P = 0.04). Conclusion There was moderate to no alignment between observers’ and patients’ ratings of SDM using both validated and nonvalidated measures. This lack of strong correlation emphasizes that observer and patient perspectives are not interchangeable. When assessing the presence, absence, or extent of SDM, it is important to clearly state whose perspectives are reflected.

Download Full-text

US-based cross-sectional survey of clinicians’ knowledge and attitudes about shared decision-making across healthcare professions and specialties

BMJ Open ◽

10.1136/bmjopen-2018-022730 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022730 ◽

Cited By ~ 3

Author(s):

Rachel C Forcino ◽

Renata West Yen ◽

Maya Aboumrad ◽

Paul J Barr ◽

Danielle Schubbe ◽

...

Keyword(s):

Decision Making ◽

Family Medicine ◽

Shared Decision Making ◽

Nurse Practitioners ◽

Physician Assistants ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Knowledge And Attitudes ◽

Positive Attitudes

ObjectiveIn this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties.SettingWe administered a cross-sectional, web-based survey between 20 September 2017 and 1 November 2017.Participants272 US-based NPs, PA and physicians completed the survey. 250 physicians were sent a generic email invitation to participate, of whom 100 completed the survey. 3300 NPs and PAs were invited, among whom 172 completed the survey. Individuals who met the following exclusion criteria were excluded from participation: (1) lack of English proficiency; (2) area of practice other than family medicine or surgery; (3) licensure other than physician, PA or NP; (4) practicing in a country other than the US.ResultsWe found few substantial differences in SDM knowledge and attitudes across clinician types, revealing positive attitudes across the sample paired with low to moderate knowledge. Family medicine professionals (PAs) were most knowledgeable on several items. Very few respondents (3%; 95% CI 1.5% to 6.2%) favoured a paternalistic approach to decision-making.ConclusionsRecent policy-level promotion of SDM may have influenced positive clinician attitudes towards SDM. Positive attitudes despite limited knowledge warrant SDM training across occupations and specialties, while encouraging all clinicians to promote SDM. Given positive attitudes and similar knowledge across clinician types, we recommend that SDM is not confined to the patient-physician dyad but instead advocated among other health professionals.

Download Full-text

Relationship Between Parental Intolerance of Uncertainty and Decisional Conflict in Pediatric Otolaryngologic Surgery

Otolaryngology ◽

10.1177/0194599820973644 ◽

2020 ◽

pp. 019459982097364

Author(s):

Chelsea Cleveland ◽

Vijay A. Patel ◽

Shari A. Steinman ◽

Reena Razdan ◽

Michele M. Carr

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Sex Education ◽

Short Form ◽

Intolerance Of Uncertainty ◽

Decisional Conflict ◽

Shared Decision ◽

Cross Sectional ◽

Pediatric Otolaryngology ◽

State Worry

Objective To assess the relationship between depression, anxiety, stress, worry, intolerance of uncertainty (IU), and shared decision making (SDM) in parents of pediatric otolaryngology surgical patients with their perceptions of decisional conflict (DC). Study Design Cross-sectional. Setting Academic pediatric otolaryngology outpatient clinic. Methods Participants were legal guardians of pediatric patients who met criteria for otolaryngologic surgery. Participants completed a demographic survey as well as validated Decisional Conflict Scale (DCS); Shared Decision-Making Scale (SDMS); Depression, Anxiety and Stress Scale–21 (DASS-21); Penn State Worry Questionnaire (PSWQ); and short form of the Intolerance of Uncertainty Scale (IUS-12). Results A total of 114 participants were enrolled. Respondents were predominantly female (93.0%) and married (60.5%). Most guardians had not consented previously for otolaryngologic surgery for their child (69.3%). Participants reported low levels of DC and depression as well as moderate levels of anxiety and stress. DC scores were not significantly correlated to DASS-21, PSWQ, or SDM. IUS-12 Total and subscale IUS-12 prospective negatively correlated with Total DC. DC was not related to age, sex, education level, previous otolaryngologic surgery, or type of surgery recommended. Conclusion In this group, an association was found between IU and DC. Clinicians should be aware that DC is not modified by previous surgical experience. Interventions aimed at addressing parental IU related to surgery may reduce DC. Further research efforts could help us understand how mental health relates to surgical decision making.

Download Full-text

Can the current hypodontia care pathway promote shared decision-making?

Journal of Orthodontics ◽

10.1177/1465312519842743 ◽

2019 ◽

Vol 46 (2) ◽

pp. 126-136 ◽

Cited By ~ 1

Author(s):

Sophy Barber ◽

Sue Pavitt ◽

David Meads ◽

Balvinder Khambay ◽

Hilary Bekker

Keyword(s):

Decision Making ◽

Young People ◽

Shared Decision Making ◽

Information Exchange ◽

Care Pathway ◽

Information Provision ◽

Alternative Methods ◽

Teaching Hospitals ◽

Shared Decision ◽

Cross Sectional

Objective: To determine the extent to which the current care pathway in hypodontia promotes shared decision-making (SDM). Design: Exploratory cross-sectional study using qualitative methods. Setting: Orthodontic department of two NHS teaching hospitals in Yorkshire. Participants: Young people aged 12–16 years with hypodontia of any severity and at any stage of treatment, and their parents and guardians. Methods: (1) Observation and audio-recording of interdisciplinary consultation in hypodontia clinics (n = 5) without any researcher interference; (2) short, structured interviews with young people with hypodontia (n = 8) and their parent (n = 8) using a topic guide to explore themes around decision-making. Audio-recordings were transcribed and analysed using a thematic framework. Results: Consultations were used as an opportunity for interdisciplinary discussion, information provision and treatment planning. Evidence of good communication was observed but patient engagement was low. The decision to be made was usually stated and treatment options discussed, but time constraints limited the scope for adequate information exchange and assessment of understanding. No methods were used to establish patient and family preferences or values. Interviews suggested parents expect the dental team to make decisions and young people rely on parental advocacy. Despite little evidence of SDM, participants reported satisfaction with their treatment. Conclusions: The current care pathway for hypodontia does not support clinicians in the steps of SDM. Recommendations for improving SDM processes include support to identify preference-based decisions, greater access to comprehensive and accessible patient information to enable preparation for consultation, alternative methods for effective communication of complex information and use of preference elicitation tools to aid value-driven decision-making.

Download Full-text