Association of decision-making with patients' perceptions of care and knowledge during longitudinal pulmonary nodule surveillance

Donald R. Sullivan, Sara E. Golden, Linda Ganzini, Renda Soylemez Wiener, Karen B. Eden, Christopher Slatore

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Rationale: Patient participation in medical decision-making is widely advocated, but outcomes are inconsistent. Objectives: We examined the associations between medical decision-making roles, and patients' perceptions of their care and knowledge while undergoing pulmonary nodule surveillance. Methods: The study setting was an academically affiliated Veterans Affairs hospital network in which 121 participants had 319 decision-making encounters. The Control Preferences Scale was used to assess patients' decision-making roles. Associations between decision-making, including role concordance (i.e., agreement between patients' preferred and actual roles), shared decisionmaking (SDM), and perceptions of care and knowledge, were assessed using logistic regression and generalized estimating equations. Results: Participants had a preferred role in 98% of encounters, and most desired an active role (shared or patient controlled). For some encounters (36%), patients did not report their actual decisionmaking role, because they did not know what their role was. Role concordance and SDM occurred in 56% and 26% of encounters, respectively. Role concordance was associated with greater satisfaction with medical care (adjusted odds ratio [Adj-OR], 5.39; 95% confidence interval [CI], 1.68-17.26), higher quality of patientreported care (Adj-OR, 2.86; 95% CI, 1.31-6.27), and more disagreement that care could be better (Adj-OR, 2.16; 95% CI, 1.12-4.16). Role concordance was not associated with improved pulmonary nodule knowledge with respect to lung cancer risk (Adj-OR, 1.12; 95% CI, 0.63-2.00) or nodule information received (Adj-OR, 1.13; 95% CI, 0.31-4.13). SDM was not associated with perceptions of care or knowledge. Conclusions: Among patients undergoing longitudinal nodule surveillance, a majority had a preference for having active roles in decision-making. Interestingly, during some encounters, patients did not know what their role was or that a decision was being made. Role concordance was associated with greater patient-reported satisfaction and quality of medical care, but not with improved knowledge. Patient participation in decision-making may influence perceptions of care; however, clinicians may need to focus on other communication strategies or domains to improve patient knowledge and health outcomes.

Original languageEnglish (US)
Pages (from-to)1690-1696
Number of pages7
JournalAnnals of the American Thoracic Society
Volume14
Issue number11
DOIs
StatePublished - Nov 2017

Keywords

  • Communication
  • Decision-making
  • Lung cancer
  • Patient outcome assessment
  • Pulmonary nodule

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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