Impoverished diabetic patients whose doctors facilitate their participation in medical decision making are more satisfied with their care

Abstract

OBJECTIVE: Greater participation in medical decision making is generally advocated for patients, and often advocated for those with diabetes. Although some studies suggest that diabetic patients prefer to participate less in decision making than do healthy patients, the empirical relationship between such participation and diabetic patients' satisfaction with their care is currently unknown. We sought to characterize the relationship between aspects of diabetic patients' participation in medical decision making and their satisfaction with care. DESIGN: Cross‐sectional observational study. SETTING: A general medical county hospital–affiliated clinic. PARTICIPANTS: One hundred ninety‐eight patients with type 2 diabetes. MAIN MEASURES: Interviews conducted prior to the doctor visit assessed patients' desire to participate in medical decision making, baseline satisfaction (using a standardized measure), and sociodemographic and clinical characteristics. Postvisit interviews of those patients assessed their visit satisfaction and perception of their doctor's facilitation of patient involvement in care. A discrepancy score was computed for each subject to reflect the difference between the previsit stated desire regarding participation and the postvisit report of their experience of participation. RESULTS: Overall, patients reported low postvisit satisfaction relative to national standards (mean of 70 on a 98‐point scale). Patients perceived a high level of facilitation of participation (mean 88 on a 100‐point scale). Facilitation of participation and the discrepancy score both independently predicted greater visit satisfaction. In particular, a 13‐point (1 SD) increase in the perceived facilitation score resulted in a 12‐point (0.87 SD) increase in patient satisfaction, and a 1.22 point increase (1 SD) in the discrepancy score (the extent to which the patient was allowed more participation than, at previsit, he or she desired) resulted in a 6‐point (0.5 SD) increase in the satisfaction score, even after controlling for initial desire to participate. For women, but not for men, physician facilitation of participation was a positive predictor of satisfaction; for men, but not women, desire to participate was a significant positive predictor of visit satisfaction. CONCLUSION: Clinicians may feel reassured that encouraging even initially reluctant patients with diabetes to participate in medical decision making may be associated with increased patient satisfaction. Greater patient participation has the potential to improve diabetic self‐care because of the likely positive effect of patient satisfaction on adherence to treatment. Further research to assess the prospective effects of enhancing physician facilitation of patient participation is likely to yield important information for the effective treatment of chronically ill patients.

Satisfaction with the outpatient encounter

“…Patients’ previsit preference for participation in medical decision making in our study was also not associated with patients’ satisfaction ratings. This is in line with findings of Gattellari et al, 43 whereas Golin et al 44 found that diabetic patients who desired greater participation in medical decision making were more satisfied with the visit.…”

Satisfaction with the outpatient encounter

“…Patients’ previsit preference for participation in medical decision making in our study was also not associated with patients’ satisfaction ratings. This is in line with findings of Gattellari et al, 43 whereas Golin et al 44 found that diabetic patients who desired greater participation in medical decision making were more satisfied with the visit.…”

Satisfaction with the outpatient encounter: A comparison of patients' and physicians' views

“…Patients' previsit preference for participation in medical decision making in our study was also not associated with patients' satisfaction ratings. This is in line with findings of Gattellari et al, 43 whereas Golin et al 44 found that diabetic patients who desired greater participation in medical decision making were more satisfied with the visit. Physicians seemed to be more comfortable seeing an "easy patient": a person who is well-educated, whose primary language is Dutch, who does not want to be fully informed, and has good mental health.…”

Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes

“…Most of the studies were either a cross-sectional or prospective survey in which data were collected either before and after, or only after, a consultation with a clinician. Only nine of the studies utilized a pre-test, post-test design (24, 27, 39, 40, 42, 44, 60–62) and 19 studies measured SDM at the same time as measuring the outcome of interest (25, 26, 28, 29, 31–34, 37, 41, 45–47, 49–53) Nine of the 39 studies were conducted in the context of a clinical trial. (27, 32, 38, 39, 42, 44, 46, 51, 56) Eight of these were a secondary analysis of a previous RCT.…”

“…Forty-one publications 24–64 representing 39 unique studies met the inclusion criteria (Figure 3, Table 1). Thirty-four of the 41 articles meeting inclusion criteria were published in the last 10 years, and the earliest study meeting the inclusion criteria was published in 1989 (Brody and others 24 ).…”

Satisfaction with the outpatient encounter

“…Patients’ previsit preference for participation in medical decision making in our study was also not associated with patients’ satisfaction ratings. This is in line with findings of Gattellari et al, 43 whereas Golin et al 44 found that diabetic patients who desired greater participation in medical decision making were more satisfied with the visit.…”

Satisfaction with the outpatient encounter: A comparison of patients' and physicians' views

“…Patients' previsit preference for participation in medical decision making in our study was also not associated with patients' satisfaction ratings. This is in line with findings of Gattellari et al, 43 whereas Golin et al 44 found that diabetic patients who desired greater participation in medical decision making were more satisfied with the visit. Physicians seemed to be more comfortable seeing an "easy patient": a person who is well-educated, whose primary language is Dutch, who does not want to be fully informed, and has good mental health.…”

Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes

“…Most of the studies were either a cross-sectional or prospective survey in which data were collected either before and after, or only after, a consultation with a clinician. Only nine of the studies utilized a pre-test, post-test design (24, 27, 39, 40, 42, 44, 60–62) and 19 studies measured SDM at the same time as measuring the outcome of interest (25, 26, 28, 29, 31–34, 37, 41, 45–47, 49–53) Nine of the 39 studies were conducted in the context of a clinical trial. (27, 32, 38, 39, 42, 44, 46, 51, 56) Eight of these were a secondary analysis of a previous RCT.…”

“…Forty-one publications 24–64 representing 39 unique studies met the inclusion criteria (Figure 3, Table 1). Thirty-four of the 41 articles meeting inclusion criteria were published in the last 10 years, and the earliest study meeting the inclusion criteria was published in 1989 (Brody and others 24 ).…”

Satisfaction with the outpatient encounter

“…Patients’ previsit preference for participation in medical decision making in our study was also not associated with patients’ satisfaction ratings. This is in line with findings of Gattellari et al, 43 whereas Golin et al 44 found that diabetic patients who desired greater participation in medical decision making were more satisfied with the visit.…”

Satisfaction with the outpatient encounter: A comparison of patients' and physicians' views

“…Patients' previsit preference for participation in medical decision making in our study was also not associated with patients' satisfaction ratings. This is in line with findings of Gattellari et al, 43 whereas Golin et al 44 found that diabetic patients who desired greater participation in medical decision making were more satisfied with the visit. Physicians seemed to be more comfortable seeing an "easy patient": a person who is well-educated, whose primary language is Dutch, who does not want to be fully informed, and has good mental health.…”

Where Is the Evidence? A Systematic Review of Shared Decision Making and Patient Outcomes

“…Most of the studies were either a cross-sectional or prospective survey in which data were collected either before and after, or only after, a consultation with a clinician. Only nine of the studies utilized a pre-test, post-test design (24, 27, 39, 40, 42, 44, 60–62) and 19 studies measured SDM at the same time as measuring the outcome of interest (25, 26, 28, 29, 31–34, 37, 41, 45–47, 49–53) Nine of the 39 studies were conducted in the context of a clinical trial. (27, 32, 38, 39, 42, 44, 46, 51, 56) Eight of these were a secondary analysis of a previous RCT.…”

“…Forty-one publications 24–64 representing 39 unique studies met the inclusion criteria (Figure 3, Table 1). Thirty-four of the 41 articles meeting inclusion criteria were published in the last 10 years, and the earliest study meeting the inclusion criteria was published in 1989 (Brody and others 24 ).…”