Am Fam Physician. 2003 Feb 15;67(4):877-878.
Active participation in treatment decisions by patients with type 2 diabetes is increasingly advocated. Golin and associates investigated the question of whether active participation in medical decision-making influences patient satisfaction. Specifically, the authors focused on patients with diabetes to determine whether there were positive correlations between patients' satisfaction and their perception that their physician facilitated their participation and allowed them to participate to the extent that they wanted. These issues are particularly important because, compared with healthy adults or patients with other illnesses, patients with diabetes typically have a lower interest in participating in their own care.
The authors studied a cross-sectional sample of patients with type 2 diabetes in a large clinic in southern California. Interviews with these patients were conducted before and after physician visits. Of 312 eligible patients, 198 completed interviews before and after physician visits.
For the study's outcome variable, the authors administered a patient satisfaction questionnaire. Before the visit, patients completed the Desire to Participate in Medical Decision-making Scale. After the visit, they completed the Facilitation of Patient Involvement in Care Scale to determine the extent to which the physician had facilitated or encouraged their involvement in medical decision-making.
The authors also constructed a discrepancy score between the Desire to Participate in Medical Decision-making and the Facilitation of Patient Involvement in Care scales to evaluate the relationship between the patients' desire for involvement before the visit and their perceived actual involvement by the end of the visit. The more positive the discrepancy score, the higher the impact of the visit on perceived participation relative to the degree of participation desired before the visit. Participant characteristics also were obtained, and factors affecting visit satisfaction were controlled for by before-visit assessment.
Both bivariate and multivariate analyses showed a significant correlation between active participation in disease management and patient satisfaction. A consistent finding was that in men, satisfaction correlated with before-visit desire for participation; in women, satisfaction correlated with after-visit perception of physician facilitation. The discrepancy score correlated positively in women but not in men. In a prediction model for the average patient, the authors calculated that for each 1 standard deviation (SD) along the facilitation of participation scale, an average woman's satisfaction increased 15 points; for each 1 SD along the discrepancy scale, her satisfaction increased 8.4 points. An average man's satisfaction increased 16 points for each 1 SD increment along the desire for participation scale.
The authors conclude that the more patients perceive their physician to have facilitated their participation in diabetes care decision-making, the greater their satisfaction. This finding contradicts previous findings that patients with severe, chronic diabetes prefer less active involvement in the management of the disease. The authors note that further studies are needed to determine the impact of patients' participation and satisfaction on their adherence to diabetes treatment regimens.
Golin C, et al. Impoverished diabetic patients whose doctors facilitate their participation in medical decision making are more satisfied with their care. J Gen Intern Med. November 2002;17:857–66.
editor's note: The authors' conclusion is based on their findings in a combined sample of men and women. The gender-distinct analysis suggests that in men, desire for participation, not perception of physician facilitation, is correlated with satisfaction. A common-sense interpretation is that while women need to be persuaded to assume an active role in self-care, men have already made up their minds before the visit about how much they want to participate in their care. These gender differences may determine a physician's strategy for the most efficient use of office time.—C.W.
Copyright © 2003 by the American Academy of Family Physicians.
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