Preferences for medical collaboration: patient–physician congruence and patient outcomes

https://doi.org/10.1016/j.pec.2004.08.006Get rights and content

Abstract

Patient participation in medical care and in decision-making is generally viewed as a precursor to positive health outcomes. Patient participation is not always possible or desirable, however, and not all patients want to take an active part in their own medical care. This study examines the degree to which physician–patient congruence in preference for patient involvement is related to self-reported satisfaction, adherence, and health. Results indicate that when patients and their doctors share similar beliefs about patient participation, patient outcomes tend to be more positive, with highest satisfaction found in cases in which both patient and physician desire more patient involvement.

Section snippets

Participants

Participants were drawn from two populations. The first group was comprised of 74 (58% female) patients who reported no serious health problems, ranging in age from 18 to 63 years with a mean of 29.5. Of these patients, 32% were Latino, 15% African American, 40% Caucasian, and 13% Asian; they were cared for by four Caucasian physicians (two female). The second group of participants was made up of 193 (60% female) patients with type II diabetes mellitus, of whom 70% reported only fair or poor

Results

The hypothesis that patient–physician congruence on preference for involvement would be more closely associated with the outcome variables than would similarity on age, gender, or ethnicity was first assessed correlationally (see Table 1). As predicted, congruence on preferences for patient involvement (measured continuously) correlated most strongly with each of the three outcome variables, followed by age, which demonstrated a significant association with general health. Gender and ethnicity

Discussion

The present study investigated patient–physician congruence in several domains (preference for involvement, ethnicity, age, and gender), in relation to patient outcomes of general health perceptions, satisfaction with medical care, and general adherence. The first hypothesis, that patient–physician congruence regarding preferences for patient involvement would have a greater association with patient outcome variables than concordance on age, gender, or ethnicity, was supported. As predicted,

References (51)

  • S. Greenfield et al.

    Expanding patient involvement in care: effects on patient outcomes

    Ann Intern Med

    (1985)
  • S.H. Kaplan et al.

    Characteristics of physicians with participatory decision-making styles

    Ann Intern Med

    (1996)
  • D.L. Roter et al.

    Relations between physicians’ behaviors and analogue patients’ satisfaction, recall, and impressions

    Med Care

    (1987)
  • M.R. DiMatteo et al.

    Enhancing medication adherence through communication and informed collaborative choice

    Health Commun

    (1994)
  • S.H. Kaplan et al.

    Assessing the effects of physician–patient interactions on the outcomes of chronic disease

    Med Care

    (1989)
  • M.A. Stewart

    Effective physician–patient communication and health outcomes: a review

    Can Med Assoc J

    (1995)
  • M.R. DiMatteo

    The physician–patient relationship: effects on the quality of health care

    Clin Obstet Gynecol

    (1994)
  • H.B. Beckman et al.

    The doctor–patient relationship and malpractice: lessons from plaintiff depositions

    Arch Intern Med

    (1994)
  • G.B. Hickson et al.

    Obstetricians’ prior malpractice experience and patients’ satisfaction with care

    J Am Med Assoc

    (1999)
  • W. Levinson

    Physician–patient communication: a key to malpractice prevention

    J Am Med Assoc

    (1994)
  • N.K. Arora et al.

    Patient preferences for medical decision making: who really wants to participate?

    Med Care

    (2000)
  • C.E. Golin et al.

    The role of patient participation in the doctor visit: impact on adherence to diabetes care

    Diabetes Care

    (1996)
  • D. Mansell et al.

    Clinical factors that influence patients’ desire for participation in decisions about illness

    Arch Intern Med

    (2000)
  • W.M. Strull et al.

    Do patients want to participate in decision making?

    J Am Med Assoc

    (1984)
  • J. Benbassat et al.

    Patients’ preferences for participation in clinical decision making: a review of published surveys

    Behav Med

    (1998)
  • Cited by (173)

    View all citing articles on Scopus
    View full text