Patient perception of involvement in medical care
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Objective:The purpose of this study was to explore the relationships among patients’ perceptions about the roles they played during medical visits, their subsequent attitudes about their illnesses and treatments, and their self-rated improvement.
Design:Questionnaires were completed by patients before, one day after, and one week after their medical visits, and by their physicians following the visits.
Setting:The study was conducted in a general internal medicine faculty practice that provided adult primary care to a largely HMO population.
Participants:Adult patients with new or increased symptoms who were capable of reading and understanding the study questionnaire.
Main results:Fifty-five patients (47%) reported playing an active role; 62 patients (53%) reported playing a passive role. After adjusting for age, sex, baseline illness ratings, and physician-rated prognosis, “active” patients reported less discomfort (p=0.04), greater alleviation of symptoms (p=0.008), and more improvement in their general medical condition (p=0.04) one week after the visits than did “passive” patients. These differences were not influenced by the roles patients desired to play. Active patients also reported less concern with their illnesses (p=0.04), a greater sense of control of their illnesses (p=0.04), and more satisfaction with their physicians (p=0.02) one day after the visit. Post-visit dysfunction ratings were not related to patients’ role perceptions.
Conclusions:Patients’ perceptions about their involvement in care appeared to be related to their attitudes about their illnesses as well as to recovery. Further research is needed, however, to determine the factors that influence these role perceptions and to define the types of patients, illnesses, and settings in which the benefits of active-role perceptions are most likely to be realized.
- Lazare, A, Eisenthal, S, Wasserman, L (1975) The customer approach to patienthood. Arch Gen Psychiatry 32: pp. 553-8
- Brody, D (1980) The patient’s role in clinical decision-making. Ann Intern Med. 93: pp. 718-22
- Lidz, C, Meisel, A (1982) Informed consent and the structure of medical care. U.S. Government Printing Office 2: pp. 317-410
- Strull, WM, Lo, B, Charles, G (1984) Do patients want to participate in medical decision making?. JAMA 252: pp. 2990-4 CrossRef
- Ende, J, Kazis, L, Ash, A, Moskowitz, MA (1989) Measuring patients’ desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med 4: pp. 23-30 CrossRef
- Cassileth, B, Zupkis, RV, Sutton-Smith, K, March, V (1980) Information and participation preferences among cancer patients. Ann Intern Med. 92: pp. 832-6
- Greenfield, S, Kaplan, S, Ware, J (1985) Expanding patient involvement in care. Ann Intern Med. 102: pp. 520-8
- Greenfield, S, Kaplan, S, Ware, J, Yano, E, Frank, H (1988) Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 3: pp. 448-57 CrossRef
- Roter, DL (1977) Patient participation in the patient provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Education Monograph 5: pp. 281-315
- Ware, JE, Snyder, MK, Wright, WR (1976) Development and validation of scales to measure patient satisfaction with health care services. National Technical Information Service, Springfield, VA
- Schulman, B (1979) Active patient orientation and outcomes in hypertensive treatment. Med Care 17: pp. 267-80 CrossRef
- Brody, D, Miller, S (1986) Illness concerns and recovery from a URI. Med Care 24: pp. 742-8 CrossRef
- Miller SM, Combs C, Stoddard E. Information, coping and control in patients undergoing surgery and stressful medical procedures. In: Steptoe A, Appels GA, eds. Stress, personal control and health. Chichester, England: Wiley; in press.
- Bowers, KS (1968) Pain, anxiety, and perceived control. J Consult Clin Psychol 32: pp. 596-602 CrossRef
- Pennebaker, JW, Burnam, A, Schaeffer, MA, Harper, DC (1977) Lack of control as a determinant of perceived physical symptoms. J Pers Soc Psychol 35: pp. 167-74 CrossRef
- Imboden, JB (1972) Psychosocial determinants of recovery. Adv Psychosom Med 8: pp. 142-55
- Bandura, A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 84: pp. 191-215 CrossRef
- Bandura, A (1982) The assessment and predictive generality of self-percepts of efficacy. J Behav Ther Exp Psychiatry 13: pp. 195-9 CrossRef
- Szasz, TS, Hollender, MFH (1956) A contribution to the philosophy of medicine: the basic models of the doctor-patient relationship. Arch Intern Med. 97: pp. 585-92
- Patient perception of involvement in medical care
Journal of General Internal Medicine
Volume 4, Issue 6 , pp 506-511
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- patient role
- clinical decision making
- doctor-patient communication
- doctor-patient relationship
- patient satisfaction
- Industry Sectors
- Author Affiliations
- 1. the Section of General Internal Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
- 3. the Department of Psychology, Temple University, Philadelphia, Pennsylvania
- 4. the Division of Cancer Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania