Communication behaviors and patient autonomy in hospital care: A qualitative study

Research output: Contribution to journalArticle

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. Practice implications Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy.

Original languageEnglish (US)
Pages (from-to)1473-1481
Number of pages9
JournalPatient Education and Counseling
Volume100
Issue number8
DOIs
StatePublished - Aug 1 2017

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Communication
Physicians
Teaching Rounds
Research
Observational Studies
Inpatients
Decision Making
Patient Care
Medicine

Keywords

  • Autonomy
  • Doctor-patient communication
  • Hospitalists
  • Hospitals
  • Patients
  • Shared decision making

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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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. Practice implications Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy.",
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