title: Communication behaviors and patient autonomy in hospital care: A qualitative study.
abstract: BACKGROUND
  Little is known about how hospitalized patients share decisions with physicians.
  
  
  METHODS
  We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis.
  
  
  RESULTS
  Most patients were white (61%) and half were female. Most physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed.
  
  
  CONCLUSIONS
  Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict.
  
  
  CONCLUSIONS
  Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA. Electronic address: zberger1@jhmi.edu.
authors.forename: Zackary D
authors.initials: ZD
authors.lastname: Berger
authors.affiliation: Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Boss
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D005260:Female; D020445:Hospitalists; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D036301:Qualitative Research
keywords: Autonomy; Doctor-patient communication; Hospitalists; Hospitals; Patients; Shared decision making