• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jmedethJournal of Medical EthicsVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Med Ethics. Apr 2003; 29(2): 103–108.
PMCID: PMC1733711

What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics


Objective: Contemporary ethical accounts of the patient-provider relationship emphasise respect for patient autonomy and shared decision making. We sought to examine the relative influence of involvement in decisions, confidence and trust in providers, and treatment with respect and dignity on patients' evaluations of their hospital care.

Design: Cross-sectional survey.

Setting: Fifty one hospitals in Massachusetts.

Participants: Stratified random sample of adults (N=27 414) discharged from a medical, surgical, or maternity hospitalisation between January and March, 1998. Twelve thousand six hundred and eighty survey recipients responded.

Main outcome measure: Respondent would definitely be willing to recommend the hospital to family and friends.

Results: In a logistic regression analysis, treatment with respect and dignity (odds ratio (OR) 3.4, 99% confidence interval (CI) 2.8 to 4.2) and confidence and trust in providers (OR 2.5, CI 2.1 to 3.0) were more strongly associated with willingness to recommend than having enough involvement in decisions (OR 1.4, CI 1.1 to 1.6). Courtesy and availability of staff (OR 2.5, CI 2.1 to 3.1), continuity and transition (OR 1.9, CI 1.5 to 2.2), attention to physical comfort (OR 1.8, CI 1.5 to 2.2), and coordination of care (OR 1.5, CI 1.3 to 1.8) were also significantly associated with willingness to recommend.

Conclusions: Confidence and trust in providers and treatment with respect and dignity are more closely associated with patients' overall evaluations of their hospitals than adequate involvement in decisions. These findings challenge a narrow emphasis on patient autonomy and shared decision making, while arguing for increased attention to trust and respect in ethical models of health care.

Full Text

The Full Text of this article is available as a PDF (136K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Cassell EJ. The principles of the Belmont report revisited. How have respect for persons, beneficence, and justice been applied to clinical medicine? Hastings Cent Rep. 2000 Jul-Aug;30(4):12–21. [PubMed]
  • Callahan Daniel. The social sciences and the task of bioethics. Daedalus. 1999 Fall;128(4):275–294. [PubMed]
  • Childress JF. The place of autonomy in bioethics. Hastings Cent Rep. 1990 Jan-Feb;20(1):12–17. [PubMed]
  • Lazare A. Shame and humiliation in the medical encounter. Arch Intern Med. 1987 Sep;147(9):1653–1658. [PubMed]
  • Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect. Attending physicians' responses to problematic behaviors. J Gen Intern Med. 1999 Jan;14(1):49–55. [PMC free article] [PubMed]
  • Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med. 1994 Jun 27;154(12):1365–1370. [PubMed]
  • Kass LR. Practicing ethics: where's the action? Hastings Cent Rep. 1990 Jan-Feb;20(1):5–12. [PubMed]
  • Eddy DM. Clinical decision making: from theory to practice. Anatomy of a decision. JAMA. 1990 Jan 19;263(3):441–443. [PubMed]
  • Coulter Angela. After Bristol: putting patients at the centre. BMJ. 2002 Mar 16;324(7338):648–651. [PMC free article] [PubMed]
  • Ende J, Kazis L, Ash A, Moskowitz MA. Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med. 1989 Jan-Feb;4(1):23–30. [PubMed]
  • Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making? Arch Intern Med. 1996 Jul 8;156(13):1414–1420. [PubMed]
  • Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984 Dec 7;252(21):2990–2994. [PubMed]
  • Arora NK, McHorney CA. Patient preferences for medical decision making: who really wants to participate? Med Care. 2000 Mar;38(3):335–341. [PubMed]
  • McKinstry B. Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes. BMJ. 2000 Oct 7;321(7265):867–871. [PMC free article] [PubMed]
  • Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere KC, O'Neil J, Bilodeau B, Watson P, Mueller B. Information needs and decisional preferences in women with breast cancer. JAMA. 1997 May 14;277(18):1485–1492. [PubMed]
  • Parsons T. The sick role and the role of the physician reconsidered. Milbank Mem Fund Q Health Soc. 1975 Summer;53(3):257–278. [PubMed]
  • Pescosolido BA, Tuch SA, Martin JK. The profession of medicine and the public: examining Americans' changing confidence in physician authority from the beginning of the 'health care crisis' to the era of health care reform. J Health Soc Behav. 2001 Mar;42(1):1–16. [PubMed]
  • Cleary PD. The increasing importance of patient surveys. Now that sound methods exist, patient surveys can facilitate improvement. BMJ. 1999 Sep 18;319(7212):720–721. [PMC free article] [PubMed]
  • Cleary PD, Edgman-Levitan S. Health care quality. Incorporating consumer perspectives. JAMA. 1997 Nov 19;278(19):1608–1612. [PubMed]
  • Cleary PD, Edgman-Levitan S, Walker JD, Gerteis M, Delbanco TL. Using patient reports to improve medical care: a preliminary report from 10 hospitals. Qual Manag Health Care. 1993 Fall;2(1):31–38. [PubMed]
  • Cleary PD, Edgman-Levitan S, McMullen W, Delbanco TL. The relationship between reported problems and patient summary evaluations of hospital care. QRB Qual Rev Bull. 1992 Feb;18(2):53–59. [PubMed]
  • Burroughs TE, Davies AR, Cira JC, Dunagan WC. Understanding patient willingness to recommend and return: a strategy for prioritizing improvement opportunities. Jt Comm J Qual Improv. 1999 Jun;25(6):271–287. [PubMed]
  • Charles C, Whelan T, Gafni A. What do we mean by partnership in making decisions about treatment? BMJ. 1999 Sep 18;319(7212):780–782. [PMC free article] [PubMed]
  • Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999 Sep;49(5):651–661. [PubMed]
  • Morris NM. Respect: its meaning and measurement as an element of patient care. J Public Health Policy. 1997;18(2):133–154. [PubMed]
  • Pearson SD, Raeke LH. Patients' trust in physicians: many theories, few measures, and little data. J Gen Intern Med. 2000 Jul;15(7):509–513. [PMC free article] [PubMed]
  • Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000 Nov-Dec;9(10):1156–1163. [PubMed]
  • Kao AC, Green DC, Davis NA, Koplan JP, Cleary PD. Patients' trust in their physicians: effects of choice, continuity, and payment method. J Gen Intern Med. 1998 Oct;13(10):681–686. [PMC free article] [PubMed]
  • Kao AC, Green DC, Zaslavsky AM, Koplan JP, Cleary PD. The relationship between method of physician payment and patient trust. JAMA. 1998 Nov 18;280(19):1708–1714. [PubMed]
  • Mechanic D, Meyer S. Concepts of trust among patients with serious illness. Soc Sci Med. 2000 Sep;51(5):657–668. [PubMed]
  • Pereira AG, Pearson SD. Patient attitudes toward physician financial incentives. Arch Intern Med. 2001 May 28;161(10):1313–1317. [PubMed]
  • Thom DH. Physician behaviors that predict patient trust. J Fam Pract. 2001 Apr;50(4):323–328. [PubMed]
  • Callahan D. Autonomy: a moral good, not a moral obsession. Hastings Cent Rep. 1984 Oct;14(5):40–42. [PubMed]
  • Zussman R. The contributions of sociology to medical ethics. Hastings Cent Rep. 2000 Jan-Feb;30(1):7–11. [PubMed]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...