When is choice a good thing? An experimental study of the impact of choice on patient outcomes

Although policy emphasises the benefits of choice, an increasing body of work points to times when choice may not always have positive consequences. The present experimental study aimed to explore the impact of choice on a number of patient outcomes in the health care setting. The study also explored the extent to which the influence of choice was affected by patient uncertainty and anticipated regret. Choice was conceptualised as consisting of two dimensions: 'having choice' which reflects the availability of a number of options and 'making choice' reflecting resolution and a desire for a choice to be made. Consecutive patients (n = 427) from four General Practices in Surrey were asked to read one of 16 vignettes which varied in terms of four independent variables (having choice, making choice, uncertainty, anticipated regret) and to rate items relating to four outcome variables (patient satisfaction, perceived control, negative emotions, information seeking). The results showed that having more choice was consistently associated with more positive patient outcomes than having no choice. Having no choice was particularly detrimental for those experiencing anticipated regret and uncertainty. In contrast, whether or not a choice was made had no impact upon any of the outcome measures. In line with current policy having choice in the health care setting is related to improved patient outcomes. The results provide some insights into the factors which influence the direction of the impact of choice. They also indicate the importance of differentiating between 'having choice' and 'making choice'.