OBJECTIVE: Greater participation in medical decision making is generally advocated for patients, and often advocated for those with
diabetes. Although some studies suggest that diabetic patients prefer to participate less in decision making than do healthy
patients, the empirical relationship between such participation and diabetic patients’ satisfaction with their care is currently
unknown. We sought to characterize the relationship between aspects of diabetic patients’ participation in medical decision
making and their satisfaction with care.
DESIGN: Cross-sectional observational study.
SETTING: A general medical county hospital-affiliated clinic.
PARTICIPANTS: One hundred ninety-eight patients with type 2 diabetes.
MAIN MEASURES: Interviews conducted prior to the doctor visit assessed patients’ desire to participate in medical decision making, baseline
satisfaction (using a standardized measure), and sociodemographic and clinical characteristics. Postvisit interviews of those
patients assessed their visit satisfaction and perception of their doctor’s facilitation of patient involvement in care. A
discrepancy score was computed for each subject to reflect the difference between the previsit stated desire regarding participation
and the postvisit report of their experience of participation.
RESULTS: Overall, patients reported low postvisit satisfaction relative to national standards (mean of 70 on a 98-point scale). Patients
perceived a high level of facilitation of participation (mean 88 on a 100-point scale). Facilitation of participation and
the discrepancy score both independently predicted greater visit satisfaction. In particular, a 13-point (1 SD) increase in
the perceived facilitation score resulted in a 12-point (0.87 SD) increase in patient satisfaction, and a 1.22 point increase
(1 SD) in the discrepancy score (the extent to which the patient was allowed more participation than, at previsit, he or she
desired) resulted in a 6-point (0.5 SD) increase in the satisfaction score, even after controlling for initial desire to participate.
For women, but not for men, physician facilitation of participation was a positive predictor of satisfaction; for men, but
not women, desire to participate was a significant positive predictor of visit satisfaction.
CONCLUSION: Clinicians may feel reassured that encouraging even initially reluctant patients with diabetes to participate in medical
decision making may be associated with increased patient satisfaction. Greater patient participation has the potential to
improve diabetic self-care because of the likely positive effect of patient satisfaction on adherence to treatment. Further
research to assess the prospective effects of enhancing physician facilitation of patient participation is likely to yield
important information for the effective treatment of chronically ill patients.
Key words patient participation - patient satisfaction - doctor-patient communication - diabetes
Dr. Golin was supported by the UCLA Robert Wood Johnson Clinical Scholars program and the NRSA postdoctoral training program.
Dr. Gelberg is a Robert Wood Johnson Generalist Physician Faculty Scholar and the George F. Kneller Professor of Family Medicine.