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Patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with physician: a
Lars P Hölzel1, Levente Kriston, Martin Härter
1Division of Psychiatry and Psychotherapy, Clinical Epidemiology and Health Services Research, University Medical Center Freiburg, Freiburg, Germany. lars.hoelzel@uniklinik-freiburg.de
BMC Health Services Research
|June 27, 2013
Summary
This study developed a model showing that increased patient involvement in medical decisions reduces decisional conflict, leading to higher patient satisfaction. However, patient preference for involvement did not correlate as expected with experienced involvement.
Area of Science:
- Health Services Research
- Medical Decision Making
- Patient-Centered Care
Background:
- A comprehensive model linking shared decision-making (SDM) constructs to patient outcomes is lacking.
- This study aimed to develop and test a model of medical decision-making in primary care.
- Key hypotheses focused on patient involvement, decisional conflict, and physician satisfaction.
Purpose of the Study:
- To develop a model that connects decision-making processes in medical encounters to intermediate and long-term patient outcomes.
- To test the hypotheses that physician-led patient involvement is influenced by patient preferences, that increased involvement reduces decisional conflict, and that reduced conflict enhances patient satisfaction.
Main Methods:
- A structural equation modeling approach was used with a large German primary care sample (N=1,913).
- Validated instruments measured patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with the primary care provider.
- The model was developed and cross-validated, accounting for demographic and clinical confounders.
Main Results:
- The theoretical model demonstrated an acceptable fit with the empirical data.
- Increased patient involvement significantly decreased decisional conflict (β = -.73).
- Higher experienced involvement (β = .34) and lower decisional conflict (β = -.28) predicted greater physician satisfaction. Patient preference for involvement was negatively associated with experienced involvement (β = -.24).
Conclusions:
- The developed model was largely supported by the data, with the exception of the unexpected negative association between preference for and experienced involvement.
- Findings suggest a strong link between patient involvement, decisional conflict, and satisfaction.
- Future research should employ longitudinal designs to confirm causal relationships among SDM constructs.
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