How culture influences patient preferences for patient-centered care with their doctors

ABSTRACT

Background:

Patient-centered care (PCC) is the prevailing model of care globally. However, most research on PCC has been conducted in Westernized countries or has focused on only two facets of PCC: decision-making and information exchange. Our study examined how culture influences patients’ preferences for five facets of PCC, including communication, decision-making, empathy, individualized focus, and relationship.

Methods:

Participants (N = 2071) from Hong Kong, the Philippines, Australia, and the U.S.A. completed an online survey assessing their preferences for exchange of information, autonomy in decision-making, expression and validation of their emotions, focus on them as an individual, and the doctor-patient relationship.

Results:

Participants from all four countries had similar preferences for empathy and shared decision-making. For other facets of PCC, participants in the Philippines and Australia expressed somewhat similar preferences, as did those in the U.S.A. and Hong Kong, challenging East–West stereotypes. Participants in the Philippines placed greater value on relationships, whereas Australians valued more autonomy. Participants in Hong Kong more commonly preferred doctor-directed care, with less importance placed on the relationship. Responses from U.S.A. participants were surprising, as they ranked the need for individualized care and two-way flow of information as least important.

Conclusions:

Empathy, information exchange, and shared decision-making are values shared across countries, while preferences for how the information is shared, and the importance of the doctor-patient relationship differ.

KEYWORDS:

• Patient preference
• empathy
• decision-making
• communication
• emotions

Data availability statement for basic data sharing policy

Data and accompanying syntax is available from the authors upon request.

Consent to publish statement

Participants were informed that data would be published and ethical approval was granted.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Acknowledgements

The authors would like to acknowledge the International Association for Language and Social Psychology (IALSP) and Asian Association of Social Psychology for their support of the2019 small group meeting ‘Narratives of Identity: Bridging the Divides’ in Hong Kong 2019 that brought the research team together.

Notes

1 Countries included reflect the outcomes from the joint Asian Association of Social Psychology and International Association of Language and Social Psychology small group meeting that sought to bring together researchers from different countries to design studies to explore how communication dynamics influence healthcare across cultures.

2 We did not include direct measures of coordinated care as our context was general health and not specific illnesses, where coordination would likely be important.

3 Adapted from original scale which assesses frequency, quality, amount, or presence.

4 Education is not reported due to issues in the way the question was interpreted across countries.

5 This should be a sub-heading as per the PCC- Self management sub-heading under the heading of Individualised focus. Please use same level of heading as PCC-self management

Additional information

Funding

This research project was supported by a grant from Santa Barbara Cottage Hospital, Santa Barbara, California, and funding by Griffith University, Brisbane, Australia. These funders had no involvement in the design or analysis of the study, or in submission for publication.

Notes on contributors

Nicola Sheeran

Nicola Sheeran research interests include communication in health contexts, the role of culture in patient preferences for health communication, and interpreter use.

Liz Jones

Liz Jones research interests are an intergroup approach to health and organizational communication, and its impact on the quality of patient care, including health practitioner-patient communication.

Rachyl Pines

Rachyl Pines conducts research in behavioral health, population health, and intergroup communication to improve patient-provider interactions and patient education.

Blair Jin

Blair Jin research interests include health communication, workplace discourse, conversation analysis, and pragmatics.

Aron Pamoso

Aron Pamoso is interested in culture and social identities in shaping stigma and discrimination and its effects on mental health and well-being.

Jessica Eigeland

Jessica Eigeland research interests are in health communication, with a specific focus on the working relationship between health practitioners and patients and its impact on patient outcomes.

Maria Benedetti

Maria Benedettiti is an Emergency Department nurse with over 10 years’ experience and a master’s in nursing leadership and education. Maria is interested in the role of culture in understanding why patients do not advocate for themselves or ask questions regarding medical care.