Article Text

Download PDFPDF
Is greater patient involvement associated with higher satisfaction? Experimental evidence from a vignette survey
  1. Søren Birkeland1,2,
  2. Marie Bismark3,
  3. Michael John Barry4,
  4. Sören Möller1,2
  1. 1Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
  2. 2Open Patient data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
  3. 3Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
  4. 4Informed Medical Decisions Program, Division of General Internal Medicine, Department of Medicine, and The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
  1. Correspondence to Søren Birkeland, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark; sbirkeland{at}


Background Patient-centredness is an essential quality parameter of modern healthcare. Accordingly, involving patients in decisions about care is required by international laws and an increasing number of medical codes and standards. These directives are based on ethical principles of autonomy. Still, there is limited empirical knowledge about the influence of patient involvement on satisfaction with care.

Objective In a large national vignette survey, we aimed to empirically test healthcare users’ satisfaction with healthcare given different degrees of patient involvement, choices made and outcomes.

Methods A web-based cross-sectional survey distributed to a randomised sample of men in Denmark aged 45–70 years. Case vignettes used prostate-specific antigen (PSA) screening for early detection of prostate cancer as a clinical model. Using a 5-point Likert scale, we measured respondents’ satisfaction with care in scenarios which differed in the amount of patient involvement (ranging from no involvement, through involvement with neutral or nudged information, to shared decision-making), the decision made (PSA test or no PSA test) and clinical outcomes (no cancer detected, detection of treatable cancer and detection of non-treatable cancer).

Results Participating healthcare users tended to be more satisfied with healthcare in scenarios illustrating greater levels of patient involvement. Participants were positive towards nudging in favour of the intervention but patient involvement through shared decision-making obtained the highest satisfaction ratings (Likert rating 3.81 without any involvement vs 4.07 for shared decision-making, p<0.001). Greater involvement also had an ameliorating effect on satisfaction if a non-treatable cancer was later diagnosed.

Conclusion Our study provides empirical support for the hypothesis that greater patient involvement in healthcare decision-making improves satisfaction with care irrespective of decisions made and clinical outcomes. Overall satisfaction with the care illustrated was highest when decisions were reached through shared decision-making.

  • decision making
  • decision support
  • clinical
  • health policy
  • patient satisfaction
  • healthcare quality improvement

Data availability statement

Data may be obtained from a third party and are not publicly available.

Statistics from

Data availability statement

Data may be obtained from a third party and are not publicly available.

View Full Text


  • Twitter @mbismark

  • Contributors SB collected, analysed and interpreted the data used in this study and was a major contributor in writing the manuscript. SM assisted in analysing the data and writing the manuscript. MJB and BM assisted in interpreting the data and writing the manuscript. SB and SM verified the underlying data. All authors read, commented and approved the final manuscript.

  • Funding The project was funded by a grant of €40 000 from the Danish Health Insurance Foundation and €5700 from the Lilly & Herbert Hansen’s Foundation.

  • Disclaimer The funding bodies had no influence on the design of the study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles