Abstract
BackgroundWe assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.MethodsA 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.ResultsThe 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).ConclusionsInpatient 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.
Highlights
We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China
The inpatients admitted to internal medicine, surgery, obstetrics and gynecology, pediatrics and other departments accounted for 34.31%, Table 2 Comparison of high positive response rate (HPRR) to SDM between different groups of inpatients (%)
When analyzing the variances using the method described by Snijders and Bosker, the results showed that 46.22% of the variances in the high satisfaction rate (HSR) with overall inpatient care across the hospitals were attributed to the hospital type, while 30.80% of the variances in the HSRs with overall inpatient care across individuals were attributed to the Level-1 model
Summary
We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China. Shared decision making (SDM) involves the participation of both physicians and patients in medical decision making by weighing the available medical evidence and the values and preferences of patients [1, 2]. The core of SDM is that physicians and patients develop the best treatment plan for the patients through discussion with the aim to maximize patients’ benefits [6, 7]. Informed consent, which reflects respect for patient autonomy in special medical care (such as high-risk, costly or considerable out-of-pocket medical care), is not included in current SDM studies. In an era during which new technology is developed very rapidly, informed consent should not be neglected when some new technologies introduce higher risks and financial burden to patients
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