title: Physicians underestimate the importance of patient-centredness to patients: a discrete choice experiment in fertility care.
abstract: BACKGROUND
  High-quality healthcare should be effective, safe and patient-centred. How important patient-centredness is in relation to effectiveness of fertility care has never been investigated. This study aimed to determine and compare the importance of patient-centredness, relative to pregnancy rates, to patients and physicians.
  
  
  METHODS
  A discrete choice experiment (DCE) was designed. Participants had to choose between hypothetical fertility clinics differing in following attributes: travel time; pregnancy rate (effectiveness); physicians' attitude; information on treatment; and continuity of physicians (the latter three represent patient-centredness). A total of 1378 patients and 268 physicians from eight Dutch and Belgian fertility clinics received the DCE-questionnaire. The attributes' relative importance was analysed using multinomial logistic regression. Additionally, patients' actual choice behaviour was investigated.
  
  
  RESULTS
  In total, 925 patients and 227 physicians participated. Pregnancy rates were relatively more important to physicians. Patients assigned more value to patient-centredness (P < 0.001) and were willing to trade-off a higher pregnancy rate for patient-centredness than physicians recommended them to do (P < 0.05). For example, patients considered pregnancy rates 1.5 times as important as an interested physician's attitude, whereas physicians considered this 2.4 times as important (P < 0.001). The willingness to trade-off pregnancy rate for this attitude was 9.8% for patients and 6.3% for physicians (P < 0.001). A lack of patient-centredness was the most cited non-medical reason for changing fertility clinics.
  
  
  CONCLUSIONS
  Patients and physicians put considerable value on pregnancy rates. However, physicians significantly undervalue the importance of patient-centredness to patients. Clinics aiming to optimize the quality of their services should be aware of the substantial importance their patients assign to patient-centredness.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. i.vanempel@obgyn.umcn.nl
authors.forename: Inge W H
authors.initials: IW
authors.lastname: van Empel
authors.forename: Eline A F
authors.initials: EA
authors.lastname: Dancet
authors.forename: Xander H E
authors.initials: XH
authors.lastname: Koolman
authors.forename: Willianne L D M
authors.initials: WL
authors.lastname: Nelen
authors.forename: Elly A
authors.initials: EA
authors.lastname: Stolk
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
authors.forename: Thomas M
authors.initials: TM
authors.lastname: D'Hooghe
authors.forename: Jan A M
authors.initials: JA
authors.lastname: Kremer
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001530:Belgium; D002755:Choice Behavior; D005260:Female; D017144:Focus Groups; D006801:Humans; D007246:Infertility / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018802:Patient-Centered Care; D010820:Physicians / Q000523:psychology*; D011247:Pregnancy; D018873:Pregnancy Rate; D034121:Reproductive Health Services; D027724:Reproductive Techniques, Assisted / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult