What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics.
OBJECTIVE
Contemporary ethical accounts of the patient-provider relationship emphasise respect for patient autonomy and shared decision making. We sought to examine the relative influence of involvement in decisions, confidence and trust in providers, and treatment with respect and dignity on patients' evaluations of their hospital care.


METHODS
Cross-sectional survey.


METHODS
Fifty one hospitals in Massachusetts.


METHODS
Stratified random sample of adults (N=27 414) discharged from a medical, surgical, or maternity hospitalisation between January and March, 1998. Twelve thousand six hundred and eighty survey recipients responded.


METHODS
Respondent would definitely be willing to recommend the hospital to family and friends.


RESULTS
In a logistic regression analysis, treatment with respect and dignity (odds ratio (OR) 3.4, 99% confidence interval (CI) 2.8 to 4.2) and confidence and trust in providers (OR 2.5, CI 2.1 to 3.0) were more strongly associated with willingness to recommend than having enough involvement in decisions (OR 1.4, CI 1.1 to 1.6). Courtesy and availability of staff (OR 2.5, CI 2.1 to 3.1), continuity and transition (OR 1.9, CI 1.5 to 2.2), attention to physical comfort (OR 1.8, CI 1.5 to 2.2), and coordination of care (OR 1.5, CI 1.3 to 1.8) were also significantly associated with willingness to recommend.


CONCLUSIONS
Confidence and trust in providers and treatment with respect and dignity are more closely associated with patients' overall evaluations of their hospitals than adequate involvement in decisions. These findings challenge a narrow emphasis on patient autonomy and shared decision making, while arguing for increased attention to trust and respect in ethical models of health care.
Joffe
S
S
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. steven_joffe@dfci.harvard.edu
Manocchia
M
M
Weeks
J C
JC
Cleary
P D
PD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010358:Patient Participation / Q000523:psychology; D010361:Patients / Q000523:psychology*; D026684:Personal Autonomy; D011369:Professional-Patient Relations; D011787:Quality of Health Care