title: What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics.
abstract: 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.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. steven_joffe@dfci.harvard.edu
authors.forename: S
authors.initials: S
authors.lastname: Joffe
authors.forename: M
authors.initials: M
authors.lastname: Manocchia
authors.forename: J C
authors.initials: JC
authors.lastname: Weeks
authors.forename: P D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: 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