Patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with physician - a structural equation model test

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Patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with physician - a structural equation model test. / Hölzel, Lars P; Kriston, Levente; Härter, Martin.

in: BMC HEALTH SERV RES, Jahrgang 13, 01.01.2013, S. 231.

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@article{c211aa2f21bc4a93a4530303d262edbf,
title = "Patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with physician - a structural equation model test",
abstract = "BACKGROUND: A comprehensive model of the relationships among different shared decision-making related constructs and their effects on patient-relevant outcomes is largely missing. Objective of our study was the development of a model linking decision-making in medical encounters to an intermediate and a long-term endpoint. The following hypotheses were tested: physicians are more likely to involve patients who have a preference for participation and are willing to take responsibility in the medical decision-making process, increased patient involvement decreases decisional conflict, and lower decisional conflict favourably influences patient satisfaction with the physician.METHODS: This model was tested in a German primary care sample (N = 1,913). Psychometrically tested instruments were administered to assess the following: patients' preference for being involved in medical decision-making, patients' experienced involvement in medical decision-making, decisional conflict, and satisfaction with the primary care provider. Structural equation modelling was used to explore multiple associations. The model was tested and adjusted in a development sub-sample and cross-validated in a confirmatory sample. Demographic and clinical characteristics were accounted for as possible confounders.RESULTS: Local and global indexes suggested an acceptable fit between the theoretical model and the data. Increased patient involvement was strongly associated with decreased decisional conflict (standardised regression coefficient Β = -.73). Both high experienced involvement (Β = .34) and low decisional conflict (B = -.28) predicted higher satisfaction with the physician. Patients' preference for involvement was negatively associated with the experienced involvement (B = -.24).CONCLUSION: Altogether, our model could be largely corroborated by the collected empirical data except the unexpected negative association between preference for involvement and experienced involvement. Future research on the associations among different SDM-related constructs should incorporate longitudinal studies in order to strengthen the hypothesis of causal associations.",
keywords = "Aged, Aged, 80 and over, Conflict (Psychology), Cross-Sectional Studies, Decision Making, Family Characteristics, Female, Germany, Humans, Male, Middle Aged, Models, Structural, Patient Participation, Patient Preference, Patient Satisfaction, Personal Autonomy, Physician-Patient Relations, Physicians, Family, Psychometrics, Quality of Life, Questionnaires, Socioeconomic Factors",
author = "H{\"o}lzel, {Lars P} and Levente Kriston and Martin H{\"a}rter",
year = "2013",
month = jan,
day = "1",
doi = "10.1186/1472-6963-13-231",
language = "English",
volume = "13",
pages = "231",
journal = "BMC HEALTH SERV RES",
issn = "1472-6963",
publisher = "BioMed Central Ltd.",

}

RIS

TY - JOUR

T1 - Patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with physician - a structural equation model test

AU - Hölzel, Lars P

AU - Kriston, Levente

AU - Härter, Martin

PY - 2013/1/1

Y1 - 2013/1/1

N2 - BACKGROUND: A comprehensive model of the relationships among different shared decision-making related constructs and their effects on patient-relevant outcomes is largely missing. Objective of our study was the development of a model linking decision-making in medical encounters to an intermediate and a long-term endpoint. The following hypotheses were tested: physicians are more likely to involve patients who have a preference for participation and are willing to take responsibility in the medical decision-making process, increased patient involvement decreases decisional conflict, and lower decisional conflict favourably influences patient satisfaction with the physician.METHODS: This model was tested in a German primary care sample (N = 1,913). Psychometrically tested instruments were administered to assess the following: patients' preference for being involved in medical decision-making, patients' experienced involvement in medical decision-making, decisional conflict, and satisfaction with the primary care provider. Structural equation modelling was used to explore multiple associations. The model was tested and adjusted in a development sub-sample and cross-validated in a confirmatory sample. Demographic and clinical characteristics were accounted for as possible confounders.RESULTS: Local and global indexes suggested an acceptable fit between the theoretical model and the data. Increased patient involvement was strongly associated with decreased decisional conflict (standardised regression coefficient Β = -.73). Both high experienced involvement (Β = .34) and low decisional conflict (B = -.28) predicted higher satisfaction with the physician. Patients' preference for involvement was negatively associated with the experienced involvement (B = -.24).CONCLUSION: Altogether, our model could be largely corroborated by the collected empirical data except the unexpected negative association between preference for involvement and experienced involvement. Future research on the associations among different SDM-related constructs should incorporate longitudinal studies in order to strengthen the hypothesis of causal associations.

AB - BACKGROUND: A comprehensive model of the relationships among different shared decision-making related constructs and their effects on patient-relevant outcomes is largely missing. Objective of our study was the development of a model linking decision-making in medical encounters to an intermediate and a long-term endpoint. The following hypotheses were tested: physicians are more likely to involve patients who have a preference for participation and are willing to take responsibility in the medical decision-making process, increased patient involvement decreases decisional conflict, and lower decisional conflict favourably influences patient satisfaction with the physician.METHODS: This model was tested in a German primary care sample (N = 1,913). Psychometrically tested instruments were administered to assess the following: patients' preference for being involved in medical decision-making, patients' experienced involvement in medical decision-making, decisional conflict, and satisfaction with the primary care provider. Structural equation modelling was used to explore multiple associations. The model was tested and adjusted in a development sub-sample and cross-validated in a confirmatory sample. Demographic and clinical characteristics were accounted for as possible confounders.RESULTS: Local and global indexes suggested an acceptable fit between the theoretical model and the data. Increased patient involvement was strongly associated with decreased decisional conflict (standardised regression coefficient Β = -.73). Both high experienced involvement (Β = .34) and low decisional conflict (B = -.28) predicted higher satisfaction with the physician. Patients' preference for involvement was negatively associated with the experienced involvement (B = -.24).CONCLUSION: Altogether, our model could be largely corroborated by the collected empirical data except the unexpected negative association between preference for involvement and experienced involvement. Future research on the associations among different SDM-related constructs should incorporate longitudinal studies in order to strengthen the hypothesis of causal associations.

KW - Aged

KW - Aged, 80 and over

KW - Conflict (Psychology)

KW - Cross-Sectional Studies

KW - Decision Making

KW - Family Characteristics

KW - Female

KW - Germany

KW - Humans

KW - Male

KW - Middle Aged

KW - Models, Structural

KW - Patient Participation

KW - Patient Preference

KW - Patient Satisfaction

KW - Personal Autonomy

KW - Physician-Patient Relations

KW - Physicians, Family

KW - Psychometrics

KW - Quality of Life

KW - Questionnaires

KW - Socioeconomic Factors

U2 - 10.1186/1472-6963-13-231

DO - 10.1186/1472-6963-13-231

M3 - SCORING: Journal article

C2 - 23800366

VL - 13

SP - 231

JO - BMC HEALTH SERV RES

JF - BMC HEALTH SERV RES

SN - 1472-6963

ER -