Hospitalized Patients' Understanding of Their Plan of Care

doi:10.4065/mcp.2009.0232

Mayo Clinic Proceedings

Volume 85, Issue 1, January 2010, Pages 47-52

https://doi.org/10.4065/mcp.2009.0232 Get rights and content

OBJECTIVE

To evaluate hospitalized patients' understanding of their plan of care.

PATIENTS AND METHODS

Interviews of a cross-sectional sample of hospitalized patients and their physicians were conducted from June 6 through June 26, 2008. Patients were asked whether they knew the name of the physician and nurse responsible for their care and specific questions about 6 aspects of the plan of care for the day (primary diagnosis, planned tests, planned procedures, medication changes, physician services consulted, and the expected length of stay). Physicians were interviewed and asked about the plan of care in the same fashion as for the patients. Two board-certified internists reviewed responses and rated patient-physician agreement on each aspect of the plan of care as none, partial, or complete agreement.

RESULTS

Of 250 eligible patients, 241 (96%) agreed to be interviewed. A total of 233 (97%) of 241 physicians completed the interview, although sample sizes vary because of missing data elements. Of 239 patients, 77 (32%) correctly named at least 1 of their hospital physicians, and 143 patients (60%) correctly named their nurses. For each aspect of care, patients and physicians lacked agreement on the plan of care in a large number of instances. Specifically, there was no agreement between patients and physicians on planned tests or procedures for the day in 87 (38%) of 229 instances and in 22 (10%) of 220 instances. Complete agreement on the anticipated length of stay occurred in only 85 (39%) of 218 instances.

CONCLUSION

A substantial portion of hospitalized patients do not understand their plan of care. Patients' limited understanding of their plan of care may adversely affect their ability to provide informed consent for hospital treatments and to assume their own care after discharge.

Section snippets

PATIENTS AND METHODS

We conducted interviews of a cross-sectional sample of patients and their physicians from June 6 through June 26, 2008. Each weekday during the study period, patients admitted to general medical services and their physicians were interviewed in the afternoon of the patient's second hospital day. Patients were randomly selected from daily hospital census reports for inclusion in the study using a random number generator.

The study was conducted at an 897-bed, academic, not-for-profit, urban

RESULTS

We identified 294 patients to participate in the study. Twenty-two patients were discharged before we approached them for interview. Sixteen were ineligible to participate because of cognitive impairment or inability to speak English. Six patients were unavailable to be interviewed because they were undergoing testing or procedures. Of the 250 eligible patients, 241 (96%) agreed to be interviewed. Of the 241 physicians, 233 (97%) completed the interview. Individual physicians may have been

DISCUSSION

We found that a substantial portion of hospitalized patients do not understand their plan of care. Several potential explanations exist for patients' incomplete understanding of the plan of care. Physicians in our study may not have adequately engaged patients in discussions about the plan because of time constraints or perceptions about patients' level of understanding or capacity to understand the plan. Physicians also may not have tested their patients' understanding of the care plan. A

CONCLUSION

Physicians should be aware that hospitalized patients frequently do not understand aspects of their plan of care. Improvement of patients' understanding is essential for patients to provide informed consent for hospital treatments and may better prepare patients to assume their own care after discharge. Efforts should be made to improve hospitalized patients' understanding of their care plan by using a shared decision-making model and health education activities throughout their hospitalization.

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Citation Excerpt :
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: Funding for this study was received from the Department of Medicine, Northwestern University, Chicago, IL.

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ORIGINAL ARTICLEHospitalized Patients' Understanding of Their Plan of Care

OBJECTIVE

PATIENTS AND METHODS

RESULTS

CONCLUSION

Section snippets

PATIENTS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

Mayo Clin Proc

Mayo Clin Proc

Mayo Clin Proc

The physician's actions and the outcome of illness in family practice

J Fam Pract

Physician-patient relationship and medication compliance: a primary care investigation

Ann Fam Med

Brief report: patient-physician agreement as a predictor of outcomes in patients with back pain

J Gen Intern Med

The influence of patient-practitioner agreement on outcome of care

Am J Public Health

Does your patient know your name? An approach to enhancing patients' awareness of their caretaker's name

J Healthc Qual

Patients do not know the level of training of their doctors because doctors do not tell them

J Gen Intern Med

Ability of hospitalized patients to identify their in-hospital physicians [letter]

Arch Intern Med

Patients' understanding of the roles of interns, residents, and attending physicians in the emergency department

Acad Emerg Med

Do patients understand their physician's level of training? a survey of emergency department patients

Acad Med

Patient-physician communication at hospital discharge and patients' understanding of the postdischarge treatment plan

Arch Intern Med

ORIGINAL ARTICLE
Hospitalized Patients' Understanding of Their Plan of Care