Patient Perception, Preference and Participation
Determinants of patients’ attitudes toward patient-centered care: A cross-sectional study in Greece

https://doi.org/10.1016/j.pec.2014.08.007Get rights and content

Highlights

  • Inpatients expect to be informed, but not equally involved in the decision-making process.

  • Weaker spiritual faith in healing was negatively associated with patient-centered attitudes.

  • Inpatients’ higher desire for information was associated with worse subjective health status.

  • Higher expectations for caring physicians were correlated with higher perceived social support.

Abstract

Objective

The aim of this study was to investigate – for the first time in Greece – patients’ attitudes toward patient-centered care, by identifying the impact of socio-demographic factors, health condition, social support and religious beliefs.

Methods

454 Hospitalized patients were interviewed on the first day of their scheduled admission, answering demographic questions and the following questionnaires: Patient–Practitioner Orientation Scale (PPOS), Autonomy Preference Index (API), Short Form SF-12v2 Health Survey, God Locus of Health Control (GLHC) and Perceived Available Support (PAS).

Results

Mean PPOS and API scores were: PPOS Sharing 3.4 (sd = 0.69), Caring 3.99 (sd = 0.76), API Information-Seeking 88.32 (sd = 9.35) and Decision-Making 51.19 (sd = 9.27). Higher desire for information was associated with younger age, more years of education, weaker spiritual faith in healing and worse subjective health status. Higher expectations for caring physicians were correlated with older age, more years of education, higher perceived social support and weaker spiritual faith in healing.

Conclusion

Age, years of education, health status, social support and religious beliefs are determinants of patient-centered attitudes.

Practice implications

Patients expect to be informed, although they do not equally want to be involved in decision-making. Religious faith and perceived social support should be taken into consideration to further understand patients’ needs.

Introduction

Patient-centeredness has been recognized as an indispensable element of quality in health care [1]. It refers to health care that establishes a partnership among physicians, patients and their families (when appropriate), in order to enhance respect for patients’ needs and preferences and provide the necessary information and support, so that patients also get involved in decision-making and actively participate in their own care [2]. Patient-centered medicine has been associated with numerous favorable health outcomes [3]. It has been suggested that effective physician–patient communication can significantly improve patients’ health status, for enhanced communication involves increased access to care, greater patient knowledge and shared understanding, higher-quality medical decisions, strong therapeutic alliances, enhanced support, patient agency and empowerment and better management of emotions [4]. Patients vary considerably in their preferences for information-seeking, engagement in decision-making and the level of support they need from their physicians [5]. However, this variation has received little research attention in hospitalized patients [6].

Although there are very few data on hospitalized patients, determinants of patient-centered attitudes have been previously studied in outpatients visiting mainly primary care settings, as well as in general population [5], [7], [8], [9], [10], [11]. Female gender [5], [6], [7], [9], younger age [5], [6], [7], [8], [9], higher education [5], [6], [7], [8], [10] and higher income [9] have been previously associated with more patient-centered attitudes. Although better health status has been associated in outpatients with increased need for sharing information and power with the physician [5], [7], [11], an American study in hospitalized patients demonstrated that better health was associated with their preference to have the physician make their treatment decisions [6], possibly reflecting the influence of different health care contexts and type of decisions that have to be made. Moreover, although an association between the strength of religious beliefs and patient-centered attitudes has been previously described in Greek medical students and physicians, the effect of religious beliefs is an understudied parameter in patients’ attitudes [6]; more specifically, there has been described a negative influence on students’ attitudes toward sharing information and a positive influence on physicians’ psychosocial orientation [12], [13]. Furthermore, in primary care settings, psychological co-morbidity was found to have an impact on patients’ preferences for shared decision-making [8], while low perceived social support was associated with problematic resident–patient relationships [14]. Perceived social support has not been tested before as a variable associated with patient-centered attitudes in hospitalized patients, although it is expected to explain part of their variation. There are indications to support that patients’ coping strategies when dealing with a health problem during hospitalization, may differ to those utilized when the health problems do not require acute medical attention, as shown in a recent Greek study [15]. To our knowledge, no other study has previously examined determinants of hospitalized patients’ attitudes with the use of multifactor models including patients’ sharing information and power, as well as to their need for caring physicians.

Identifying factors associated with hospitalized patients’ attitudes is expected to provide an insight into the reasons why patients vary in their expectations for patient-centered care. Since no relevant study has been previously conducted in Greece, we wanted to investigate hospitalized patients’ preferences with regard to their information-seeking, involvement in decision-making and the level of support they need from their physicians, as well as potential determinants of their attitudes. Based on published literature, we hypothesized that parameters previously associated with the attitudes of outpatients and of Greek medical students and physicians would be also associated with patient-centered attitudes in hospitalized patients, although the strength of association might be different in this population. Therefore, the aim of our study was to explore hospitalized patients’ attitudes with reference to different aspects of patient-centered care and identify correlations among specific parameters, such as socio-demographic factors, subjective health status, perceived social support and religious faith in healing.

Section snippets

Study design

The study was conducted at the Papageorgiou General Hospital, that is seated in Thessaloniki and receives referrals from an area of 2,000,000 people in Northern Greece. This academic hospital provides both outpatient and inpatient services. For our research purpose though, only hospitalized patients from 13 clinics were included in our study: Internal medicine (two clinics), Cardiology, Neurology, Nephrology, Oncology, General surgery (two clinics), Gynecology, Ophthalmology, Orthopedics,

Sample characteristics

454 Patients accepted to participate in the study out of a total of 762 that had been initially approached (response rate 59.6%). The most frequently reported reasons for not wanting to participate in the study were that: (a) they were expecting visitors, (b) they preferred to rest, or (c) they preferred to take a walk around the hospital yard. Table 1 presents participants’ age and gender distribution (18–40, 41–60 and 61–80 years old). Mean duration of patients’ education was 10.2 years (sd = 

Discussion

This is the first study that reports on the attitudes of patients in Greece toward patient-centered care. Hospitalized patients declared high desire for caring physicians and receiving information about their health status, although desire to get involved in the decision-making process was not equally high. Younger age, more years of education, weaker belief that God determines health outcomes and worse subjective health status were among the variables that were associated with higher desire

Conflict of interest statement

None of the authors report having a conflict of interest.

Funding

No funding was received for this study.

Acknowledgements

We would like to thank all the patients who participated in our study.

References (24)

  • J. Ende et al.

    Measuring patients’ desire for autonomy: decision making and information-seeking preferences among medical patients

    J Gen Intern Med

    (1989)
  • Z. Tsimtsiou et al.

    Medical student attitudes toward patient-centred care: a longitudinal survey

    Med Educ

    (2007)
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