MedicalResearch.com Interview with:
Sosena Kebede, MD, MPH
Assistant Professor of Medicine, Department of Medicine
Associate Faculty, the Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine
Faculty, Department of Health Policy and Management and
Baltimore, MD 21287
Medical Research: What are the main findings of the study?
Dr. Kebede: There were 3 main findings in this study:
1. Patients’ understanding of aspects of their hospital care is suboptimal on the domains of knowledge of diagnoses, indications for the medications they take and the types of procedures/tests they get. Some forms of poor shared understanding could have potentially serious implications for their health and for future care such as identifying a prescribed antidepressant as a blood thinner or mistaking an echocardiogram a left heart catheterization or thinking a liver cyst is a liver cancer. Other forms of poor shared understanding such as not accurately identifying why a procedure is done or what the results of the procedure show (a finding not discussed in the research letter) may seem less consequential but raise the issue of informed consent, patient empowerment and may alsoraise questions about patient and physician behavior towards appropriate use of in-patient procedures. Some of the questions we could ask here include: would patients demand more or less procedures if they had better understanding of what the procedures entail, and why they are beingordered? Conversely, would physicians recommend more or less of in-patient procedures, when they encounter patients whose understanding of procedure indications are optimal?
2. Patients across the spectrum of age, race and other looked at demographics rated their understanding better than the observed shared understanding. This fairly high perceived understanding raised the question if our patients have very limited or selective expectation/need/desire to know about aspects of their care than we think is appropriate? What is the right amount and type of knowledge the patient should have about his/her in-patient care? Should patients want to know more? Would patients’ expectation for knowledge on aspects of their care change if they knew they were in fact entitled to or should have more than we have traditionally provided? If perceived understanding is not predictive of observed shared understanding, then what is and should we look for it?
3. The higher the patients’ perception of good understanding the higher their level of satisfaction. This suggests that whatever drives the perception of good shared understanding can drive better satisfaction. Knowing what patients expectations and even values are for their care would be important if we want to find out what makes them satisfied with the care we provide. We used measured shared understanding as a surrogate marker for effective communication. Despite some difficulty in objectifying the degree of shared understanding between patients and their physicians the overwhelming majority of patients’ high level of satisfaction that tracks their perceived understanding rather than their measured understanding raises doubt if quality of care correlates with satisfaction at all. It is possible that our patients tend to be satisfied in spite of our suboptimal quality of care delivery- in this case they seem to be satisfied despite suboptimal effective communication as evidenced by their suboptimal shared understanding.
Medical Research: Were any of the findings unexpected?
Dr. Kebede: That perception of shared understanding consistently predicted shared understanding at all levels, while nothing else we measured seemed to be associated with satisfaction.
Medical Research: What should clinicians and patients take away from your report?
Dr. Kebede: Patients satisfaction and quality of care delivery may not be directly associated. Patient perception is likely important for satisfaction.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Kebede: We should ask some of the questions asked in the answer listed for the first question.
Kebede S, Shihab HM, Berger ZD, Shah NG, Yeh H, Brotman DJ. Patients’ Understanding of Their Hospitalizations and Association With Satisfaction. JAMA Intern Med. Published online August 18, 2014. doi:10.1001/jamainternmed.2014.3765.