Value discrepancies between nurses and patients: A survey study

Abstract

Background

Patient-centeredness, respect for patient autonomy, and shared decision-making have now made it to center stage in discussions on quality of care. Knowing what actually counts in care and how it should be accomplished from the patients’ and nurses’ perspective seems crucial.

Aim

To explore how patients and their nurses perceive the importance and enactment of values in their healthcare.

Research design

An observational, cross-sectional study using a self-developed questionnaire, consisting of 15 items related to seven values (e.g. uniqueness, autonomy, professionalism, compassion, responsiveness, partnership, and empowerment) as described in the taxonomy of Bastemeijer et al.

Participants and research context

The survey was completed by 384 patients and 81 nurses. Participants were recruited on eight internal medicine wards of a 1000-bed university hospital in Belgium.

Ethical considerations

This study was approved by the ethical committee of the Ghent University Hospital (B670201836799).

Findings

(1) Patients and nurses prioritize values of care differently; (2) nurses report not being able to enact the values they prioritize in actual practice as much as one would like to; and (3) there is a gap in experienced delivery of a comprehensible explanation of all treatment options, a conversation based on equality, making shared decisions, and being non-judgmental between nurses and patients.

Discussion

Our findings challenge nurses’ overemphasis on professional compassion and uniqueness while arguing for increased attention on authentic shared decision-making and empowerment. The first step to a patient-centered culture truly involving patients in their healthcare is communication and information provision, rather than focusing on tangible and normative constructs.

Conclusion

Our findings revealed differences in prioritization and actual enactment of values in care between patients and nurses. This was especially so for values related to communication, provision of complete unbiased information, and shared decision-making. Nurses should prioritize providing comprehensible information and using conversations based on equality to make decision together with patients.

Keywords

Hospital nurses patient-centered care patients prioritization quantitative survey values

Introduction

Over the last decades, the face of healthcare has changed profoundly in many ways. First, the bulk of provided healthcare has changed scope from curing acute conditions (e.g. infections and trauma) toward caring for more chronic and complex conditions. Second, advanced technology led to more treatment possibilities and therefore more choices and decisions. Third, the rising number of medical innovations place substantial strain on healthcare costs.¹ This resulted in a surge of health economic evaluations, and more recently the concept of value-based healthcare.² Last, in times of increased access to health-related information through the Internet of things, a growing inclination toward individual responsibility and promotion of personalized medicine has risen. These evolutions coincided with a call for more patient-centered care, patient participation, and patient empowerment,³ which the Institute of Medicine (IOM) considers as essential for the future of high-quality care.⁴ It is indeed argued that the current paternalistic approach to patient care ignores patient preferences and creates dependency, whereas more patient empowerment would result in patients gaining more control over their life and integrate better in society and workforce.⁵ Such patient-oriented care respects the preferences, needs, and values of patients and has interaction based on terms of equality.⁶ This equality results in shared decision-making, a key concept in patient empowerment, the culmination of patient-centered care, and patient participation.^7,8 Shared decision-making presumes that patients are informed about therapeutic options and their potential consequences on patient-preferred outcomes. This should allow patients to participate (e.g. partnership) in the discussion with their healthcare provider and ensure treatment decisions are aligned with their personal expectations and values (e.g. uniqueness, autonomy). When focusing on values, a recent review⁹ explored what patients actually value as an individual, resulting in expectations about the behavior of healthcare providers and the interaction between themselves and healthcare providers. Seven themes were identified: uniqueness, autonomy, compassion, professionalism, responsiveness, partnership, and empowerment. These values related to (1) the individual patient, (2) the expected behavior of professionals, and (3) the interaction between patients and healthcare providers. However, patients with chronic diseases still remain highly exposed to and dependent on technical medical expertise. Ignorance for and lack of insight by the healthcare providers into the patient’s illness experience (e.g. compassion, responsiveness) could engender a sense of mistrust, abandonment, isolation, and/or alienation.¹⁰ Moreover, these patients often have existential struggles, trying to make sense of their illness, sometimes resulting in self-blame. This experience of being a “bad patient” and the personal responsibility for lifestyle choices and its consequences may negatively impact their quality of life.¹¹ Good communication and understanding between both patients and their healthcare providers is important to tackle this negative impact.¹² It is therefore essential to identify possible discrepancies between what patients really value in their healthcare and what they actually receive. Such disparities might be caused by the divergence in prioritization of values between healthcare providers and patients, as making good treatment decisions does not only depend upon scientific evidence and facts (professionalism), but also includes value judgments.^13,14 By researching what patients value in healthcare, we hope to provide an input on quality improvement in clinical guidelines, policy, and the daily practice of healthcare.¹⁵ The values of another person are difficult to anticipate and can be influenced by clinicians’ views.¹⁶ Embracing the statement of the IOM and the Picker Institute that patients’ values should guide clinical decisions, this study wanted to explore the degree to which themes valued by patients with chronic conditions were also valued by their nurses and whether prioritization of these values would be comparable between them.

Materials and methods

Questionnaire

Based on the taxonomy of Bastemeijer et al.,⁹ a questionnaire was developed. Themes and subthemes from this study were translated to Dutch by two independent, professional translators using forward–backward translation to ensure consistency. Next, a purposive sample of healthcare providers (n = 75) and patients (n = 40) were asked to indicate which subthemes represented the main themes best, using a Q-sort technique.¹⁷ These persons were excluded for further participation in the survey.

Based on these selected themes, a survey with statements representing the seven original values was constructed. Each value was questioned for both the importance the person attached to the value and how much they have experienced this value during providing/receiving care. Therefore, each theme had two statements. For each of the statements, respondents could indicate how much they agreed with the statement on a 6-point Likert-type scale. Thereafter, this survey was validated using a Delphi procedure in combination with cognitive interviewing (i.e. Thinking Aloud Method).¹⁸ The test panel consisted of eight experts with both academic and clinical expertise in qualitative research and patient-centered care, and 10 patients and 10 professionals from another hospital, who were representative of our study population. Doing so, the content, comprehension, unambiguity, and equivalence of the survey were tested. The group of experts was asked to evaluate each statement and the possible answer categories on relevance, clarity, and simplicity as 1 (not relevant), 2 (somewhat relevant), 3 (quite relevant), or 4 (highly relevant). The Content Validity Index (CVI) was calculated for each statement to evaluate the experts’ agreement.¹⁹ CVI was computed as the number of experts who gave a rating of either 3 or 4, divided by the total number of experts. The item CVI ranged from 0.78 to 1.0, and the total CVI was 0.93 in the final version. A two-round Delphi procedure was conducted. Reliability analyses showed good internal consistency for the instrument. The patient version had a standardized alpha coefficient of 0.847 and the nurse version an alpha coefficient of 0.847. An overview of the included values and their translations is given in Table 1. The full questionnaire can be found in Supplements 1–4.

Table 1.

Overview of included values.

Value^a	Translation in the study^b	Abbreviation in the study
Patient uniqueness (three items)	The patient is recognized as a person with a personal history and life story	Unique individual
	The patients is seen and respected as a person rather than as a patient with a health problem	Person
	The patient’s beliefs and views on spirituality and religion are respected	Religion and spirituality
Patient autonomy (three items)	The patient has the final say	Having the final say
	Healthcare providers give information tailored to my needs	Tailored information
	Healthcare providers involve family members and significant others if needed	Involvement of family
Professional compassion (two items)	Healthcare providers are able to reassure the patient	Reassuring
Professional compassion (two items)	Healthcare providers are sincerely involved and engaged	Sincerely involved
Professionalism (one item)	Healthcare providers explain what is possible and what is not	Explaining possibilities and options
Professional responsiveness (three items)	Healthcare providers are honest with patients	Honesty
	Healthcare providers do not judge the patient’s situation	Being non-judgmental
	Healthcare providers respect the patient’s privacy	Privacy
Interaction partnership (one item)	Patients and healthcare providers interact with each other based on equality	Equality
Interaction empowerment (two items)	The patient is enabled to keep control of his or her own situation	Control
Interaction empowerment (two items)	The patient has authority in the decision-making process	Shared decision-making

^a As defined in the study of Bastemeijer et al.⁹

^b As translated in our study.

Sample

The study was conducted in a 1000-bed university hospital in Belgium. The patients and nurses of four hospital wards and four ambulatory care units (dialysis, outpatient clinic, and day hospital) belonging to a cluster of chronic internal medicine departments (nephrology, geriatrics, cardiology, infectiology, endocrinology) were included. Patients were recruited consecutively. Inclusion criteria were (1) being 18 years or older, (2) being able to speak and understand Dutch, and (3) capacity to consent. Patients needed to stay for longer than 1 day on the participating hospital ward to be included in the study. New patients attending the ambulatory care units were excluded. Patients were asked to complete the survey by a team of students who were not involved in the care of the patients. Nurses had to be working on the ward/unit for more than 6 months. Student nurses were excluded, as well as nurses who did not have any contact with the patients. Nurses involved in the direct clinical care received a hard copy or an email with the survey in electronic format. Data collection took place between July and October 2018.

Data analysis

Data were analyzed using SPSS 25.0 (IBM, Armonk, NY). First, all questionnaires with more than 10% of the answers missing were deleted. Next, the data were checked on response patterns to exclude acquiescence response bias. Third, the answer categories of the 6-point Likert-type scale were dichotomized: the lower four categories and the upper two categories were merged into two categories, labeling values as either more important or less important (“importance”) and either more frequent or less frequent (“experience”). The prioritization of the values (“importance”) was calculated using descriptive statistics. To analyze the difference in responses between patients and nurses, and between experience and importance within both groups, Pearson’s chi-square analyses were used.

Ethical approval

The study project was approved by the ethical committee of the Ghent University Hospital (B670201836799), and all participants in the different stages of the study provided written informed consent. Data management and analysis was in line with protection of personal information (European Union General Data Protection Regulation).

Results

The survey was completed by 384 patients and 81 nurses. Their demographic characteristics are reported in Table 2. Statistical analyses showed no trends concerning the influence of socio-demographic characteristics of nurses and patients on the importance and actual experience of values.

Table 2.

Socio-demographic characteristics of patients and nurses.

Patients (n = 384)		Nurses (n = 81)
Age (years)		Age (years)
18–24	2.1%	18–24	9.9%
25–34	5.7%	25–34	24.7%
35–44	7.6%	35–44	30.9%
45–54	11.7%	45–54	18.5%
55–64	14.6%	55–64	16.0%
65–74	25.8%	Gender
75–84	20.1%	Male	16.3%
85+	12.5%	Female	83.8%
Gender		Education
Male	60.4%	Undergraduate	21.8%
Female	39.6%	Non-university education	66.7%
Education		University education	11.5%
Secondary school	20.1%	Employment (FTE)
Non-university education	70.8%	<½ FTE	2.4%
University education	8.9%	>½ FTE <1 FTE	39.5%
University education	8.9%	1 FTE	58.0%
Living situation		Working experience (years)
Alone	25.6%	<1	13.6%
With family	72.1%	1–5	29.6%
Specialized care	2.3%	6–10	21.0%
		11–5	11.1%
		15–20	14.8%
		>21	9.9%

FTE: full-time equivalent.

The importance and experience of values between nurses and patients

As shown in Table 3, prioritization of the values was different between patients and nurses. While patients prioritized honesty, and comprehensible and tailored information, nurses expressed the importance of treating the patient as a unique individual and person, and putting the patient in control. Moreover, patients valued explaining all possibilities and options higher than nurses. Nurses valued safeguarding religion and spirituality, treating the patient as a unique individual and person, and being reassuring higher than patients. Table 3 also indicates that patients experience 4 of 15 values more than nurses report to provide them.

Table 3.

Comparison of the scores for importance and experience of rated values between patients and nurses.

Value	Importance[prioritization]				Experience
Value	Patient	Nurses	χ²	p value	Patient	Nurses	χ²	p value
Honesty	95.6% [1]	91.1% [6]	2.408	.121	92.7%	86.4%	3.356	.067
Explaining possibilities and options	93.2% [2]	68.4% [15]	41.050	<.001*	88.9%	72.5%	14.839	<.001*
Tailored information	92.2% [3]	90.1% [7]	0.371	.542	86.0%	81.0%	1.272	.259
Privacy	88.5% [4]	95.1% [4/5]	3.093	.079	93.9%	78.8%	19.225	<.001
Sincerely involved	88.0% [5]	95.1% [9]	3.478	.062	88.1%	92.5%	1.279	.258
Equality	88.3% [6]	87.5% [4/5]	0.036	.850	89.2%	79.0%	6.364	.012*
Reassuring	87.2% [7]	96.3% [10]	5.552	.018*	86.1%	93.8%	3.669	.055
Control	87.7% [8]	86.4% [2/3]	0.099	.753	82.0%	74.1%	2.688	.101
Person	87.2% [9]	96.3% [2/3]	5.552	.018*	82.0%	84.0%	0.173	.678
Shared decision-making	86.9% [10]	87.7% [8]	0.036	.850	81.8%	68.8%	6.902	.009*
Being non-judgmental	83.1% [11]	80.0% [12]	0.445	.505	85.5%	58.0%	32.203	<.001*
Unique individual	80.5% [12]	98.8% [1]	16.305	<.001*	82.0%	86.4%	0.910	.340
Involvement of family	72.5% [13]	81.3% [11]	2.626	.105	72.6%	65.4%	1.677	.195
Having the final say	57.9% [14]	53.8% [14]	0.455	.500	59.1%	51.2%	1.669	.196
Religion and spirituality	50.3% [15]	77.8% [13]	20.431	<.001*	62.1%	72.8%	3.315	.069

*p < 0.05.

The importance and experience of values within nurses and patients

Table 4 shows that patients experienced the discussion of treatment options, tailored information, being in control, and being treated as a person less than they valued them, while safeguarding their religion was offered more than needed or liked. Nurses in their turn reported putting the patient in control, treating the patient as a person, conducting shared decision-making, being non-judgmental, seeing the patient as a unique individual, and involving family more than actually provided by them.

Table 4.

Comparison of scores for importance and experience within patients and nurses.

Value	Patient				Nurses
Value	Importance	Experience	χ²	p value	Importance	Experience	χ²	p value
Honesty	95.6%	92.7%	2.919	.088	91.4%	86.4%	1.000	.317
Explaining possibilities and options	93.2%	88.9%	4.274	.039*	68.4%	72.5%	0.328	.567
Tailored information	92.2%	86.0%	7.497	.006*	90.1%	81.0%	2.697	.101
Privacy	88.5%	93.9%	7.036	.008*	95.1%	78.8%	9.442	.002*
Sincerely involved	88.0%	88.1%	0.003	.953	95.1%	92.5%	0.453	.501
Equality	88.3%	89.2%	0.187	.666	87.5%	79.0%	2.077	.150
Reassuring	87.2%	86.1%	0.219	.640	96.3%	93.8%	0.526	.468
Control	87.7%	82.0%	4.783	.029*	86.4%	74.1%	3.894	.048*
Person	87.2%	82.0%	3.947	.047*	96.3%	90.1%	6.935	.008*
Shared decision-making	86.9%	81.8%	3.716	.054	87.7%	68.8%	8.454	.004*
Being non-judgmental	83.1%	84.3%	0.825	.364	80.0%	58.0%	9.078	.003*
Unique individual	80.5%	82.0%	0.274	.601	98.8%	86.4%	9.000	.003*
Involvement of family	72.5%	72.6%	0.001	.977	81.3%	73.3%	5.145	.023*
Having the final say	57.9%	59.1%	0.122	.727	53.8%	51.2%	0.100	.752
Religion and spirituality	50.3%	62.1%	10.801	.001*	77.8%	72.8%	0.531	.466

*p < 0.05.

The importance of values for patient and the actual delivery by nurses

When comparing the expectations of patients (“patient importance”) with the actual deliverance as reported by nurses (nurses’ experience), Table 5 shows that eight values were insufficiently provided by the healthcare providers. Only one value, safeguarding religion and spirituality, was overrepresented. The other six values were sufficiently provided in accordance with the patients’ expectations.

Table 5.

Comparison of the scores for importance and experience within patients and nurses.

Value	Patient importance	Nurses’ experience	Difference	χ²	P value
Honesty	95.6%	86.4%	–9.2%	9.854	.002*
Explaining possibilities and options	93.2%	72.5%	–20.7%	30.425	<.001*
Tailored information	92.2%	81.0%	–11.2%	9.263	.002*
Privacy	88.5%	78.8%	–9.7%	5.513	.019*
Sincerely involved	88.0%	92.5%	4.5%	1.350	.245
Equality	88.3%	79.0%	–9.3%	4.929	.026*
Reassuring	87.2%	93.8%	6.6%	2.850	.091
Control	87.7%	74.1%	–13.6%	9.897	.002*
Person	87.4%	84.0%	–3.4%	0.612	.434
Shared decision-making	86.9%	68.8%	–18.1%	15.948	<.001*
Being non-judgmental	83.1%	58.0%	–25.1%	25.056	<.001*
Unique individual	80.5%	86.4%	5.9%	1.542	.214
Involvement of family	72.5%	65.4%	–7.1%	1.637	.201
Having the final say	57.9%	51.2%	–6.7%	1.175	.278
Religion and spirituality	50.3%	72.8%	22.5%	13.711	<.001*

*p < 0.05.

Discussion

This study investigated prioritized and experienced values of care and the differences between nurses and patients concerning these. Three assumptions can be drawn from these results: (1) patients and nurses prioritize values of care differently; (2) the experience of actual delivery of comprehensible explanation of options, conversations based on equality, making shared decisions, and being non-judgmental was lower in patients than in nurses; and (3) nurses experience the actual delivery of the values they prioritize as being lower than they expect, and patients’ experiences partially confirm this. These assumptions show that especially values with regard to provision of sufficient and comprehensible information and equivalent, non-judgmental decision-making while putting the patient in control are actually underprovided and were in fact also a lower priority for nurses. These elements can all be considered as essential for enabling patient participation or involvement.^3,20,21 In contrast, more tangible or normative constructs like professional compassion and seeing the patient as a unique individual are well or sufficiently represented in actually delivered care and were mostly prioritized by nurses. However, these elements focus on the formal requirements of patient-centeredness, but are—on their own—insufficient for actually achieving true patient participation.²² Three points of discussion can be made.

First, it seems that patients mostly valued the constructs that enable their opportunity to be truly involved in the decision-making process, possibly reflecting a wish for empowerment and autonomy. This is in line with literature quoting that patients want to be informed and involved in the decision-making.¹⁹ Yet, these aspects of care are seemingly of less importance for nurses who tend to focus on more tangible or normative components of patient-centered care. Focusing only on these tangible and normative dimensions while neglecting the content dimensions of patient-centeredness may reduce the efficiency of patient-centered care.²³ As shown by Castro et al.,³ patient involvement and participation is the first step toward a patient-centered culture. Without the involvement of patients, patient-centered care is oversimplified and reduced to acknowledgment of choices and preferences and compassion, leading to tokenism.²²

Second, nurses perceived they underachieved compared to their own expectations for a substantial number of themes. However, for the themes provision of information and shared decision-making, they considered they performed up to their own expectation, but performance was still lower than what patients expected of them. This remarkable discrepancy requires some consideration. On one hand, this seems to suggest that nurses still consider that a certain degree of paternalism (i.e. not providing all information or by ignoring some options they consider not suitable for this particular patient) can be defended or is even indicated in some circumstances.²⁴ On the other hand, research indicates that nurses find patient involvement difficult²⁵ and therefore even actively try to avoid it in practice.²⁶ Consciously or unconsciously, values influence the selection of priorities that are then acted on in our personal and professional lives. Value indicates what is important, worthwhile, and worth striving for. The “behaviors” exhibited by nurses are seen as a tangible demonstration of the values they hold.²⁷ Nevertheless, there is skepticism as to whether attitudes can be considered a valid predictor of an individual’s behavior, as attitudes are often not translated into action.²⁸ This phenomenon has been referred to as the attitude–behavior gap^28,29 which may underpin the discrepancies found in our study. In both cases, nursing education and curricula should be targeted and further investigated and improved. Nursing students should be trained in order to achieve true shared decision-making, and flexibility in the decision-making process (situational-determined) should be emphasized instead of a blanket approach so that individual differences in patient preferences are respected.³⁰ This concern rests on the misconception that being patient-centered means sharing all information and all decisions. Being patient-centered actually means taking into account the patient’s desire for information and shared decision-making and responding appropriately.

Third, this research made it clear that care is still organized by the choices of healthcare professionals, and not those of patients. In order to make a change in culture, it takes more than asking the patient “what matters to you”²² and to provide a “quick fix” solution.³¹ A meaningful and authentic answer should be provided. In all levels of healthcare, patients should be included in the development and evaluation of initiatives. A method that has been proven successful to achieve this is co-design.³² The method does not only design interventions in accordance with both the wishes of patients and nurses, it also makes nurses introspect on how they organize care. Good nursing is defined by its values. The “values” held and displayed by nurses were seen to be an important base on which the nurse–patient relationship develops.²⁷ It is therefore important for nurses to understand the values with which they practice so that good nursing practice can be achieved.³³ Similarly, perceptions of the nursing role must be explored as these may differ substantially between nurses and patients.^34,35

In conclusion, although the idea that providing correct and complete information to patients is crucial to shared decision-making and patient-centeredness is well established in the literature, it is apparently less adapted in clinical reality.^7,36 In contrast, nurses attributed high priority to formal requirements of patient-centeredness such as respect for spiritual and religious needs, for treating patients as an individual, and for privacy, whereas these were far less valued by the patients. All these result in a substantial disparity between patients and nurses on essential determinants of patient information, patient involvement, and patient-centeredness.

Limitations

As this study has a cross-sectional design within one hospital, it is difficult to make firm and generalized conclusions. A cross-sectional design is merely a single point measurement, which means that results may differ depending on the time frame. Also, this study was performed in one hospital. As we have argued in the “Discussion” section, patient involvement is an initial step toward a patient-centered culture. Because only one hospital was included, with its own culture, this may have influenced the results. Both elements limit the transferability of the results. Among others, the danger of social desirability bias in answering the survey exists.³⁷ Furthermore, as authors we acknowledge that it is difficult to measure abstract concepts like values. Therefore, these results should primarily be seen as trigger for introspection and critical thinking. However, we are confident that these results have meaning, due to the similarities with previous theoretical reviews.^20,32

Implications for practice and research

First, patients should be informed without bias or prejudice about the different options and their expected outcomes to be able to enact their autonomy at all time. As such, a broader conception of autonomy is captured by the idea that patients must be able to make decisions that reflect their most important values and commitments.^38,39 Instead of adhering to a rigid style of communication, a nurse must adapt his or her participatory style to the autonomy preferences of the patient, thereby providing patient-centered care. This is a complex process for nurses.²⁵ Therefore, training should start as early as possible. As said before, nursing education and curricula should be scrutinized in detail and improved.

Second, given the importance attributed to patient-centered care, it is essential that values—how abstract they might be—are included in patient experience surveys, indicators of quality of care, and the training and education of healthcare workers overall. Patients’ understandings of these values are crucial for healthcare communication, and therefore the provision of patient-centered care. However, as some values can conflict with some preferences or other values, healthcare providers should be able to elicit these values and preferences. The patient perspective in concept development would provide for a better understanding and may enhance the potentials for mutual understanding of organizational core values. The mutual clarification of values can be a rewarding exercise, as it not only ensures the best possible decision but also demonstrates to patients a genuine interest in incorporating their views.^40,41 Given the growing social, legislative, and policy imperatives to help people make health-related decisions which reflect what is important to them, more research is needed into the design of these values clarification methods.^42,43

Third, most healthcare providers focus on normative thinking regarding decision-making as a means of respecting autonomy In this setting, it is often framed as the right of the patient for self-determination. This implies that patients who decide to defer decision-making do not necessarily fail to exercise autonomy.^44,45 A shared decision-making model is probably most appropriate and, if performed adequately, may result in the best patient-centered outcomes.²² It requests that healthcare providers take the effort and time to listen to what the patients really expect.⁴⁶ Only when provided information is in line with the patient’s questions and concerns and is also reflecting the personal condition of the patient, it will be effectively educating and empowering the patient.⁴⁷

Last, future research should focus on how the results of this study can be used in ways that stimulate reflexivity and that help actors to make dissensus over patient-centered practices productive. It could, for instance, explore how reflexive workshops can help different stakeholders (e.g. healthcare providers, patients, managers, policymakers and researchers) to reflect on different discourses and the challenge of dissensus, thereby developing ways to deal with discrepancies of values within local working contexts.⁴⁸

Finally, the wider community needs to be engaged in conversations about the sort of healthcare experiences they want and value. There is growing disconnect between the rhetoric of patient-centered care and people’s actual experiences of hospitalization. However, this requires a concerted and continuous effort to create the sorts of health systems in which we would wish to be cared for, and this should be what drives us to achieve it.⁴⁹

Conclusion

This study showed that there are discrepancies in what is valued as good healthcare between patients and nurses. While patients’ preferences focus on information provision and shared decision-making, healthcare workers tend to focus on normative and/or tangible elements of patient-centered care, which are less important to patients. This can result in suboptimal performance and disadvantages in patients. There is room for improvement as far as values in care are concerned. According to patients, more attention needs to be paid to honest and tailored communication and the complete, unbiased, and non-prejudiced explanation of possibilities and options. Future research is necessary to further the development of value clarification methods and ways of easily detecting discrepancies of values in care practice. Furthermore, completing the exercise above calls for introspection and critical thinking.

Supplemental material

Supplemental Material, Supp._1_Dutch_questionnaire_patient - Value discrepancies between nurses and patients: A survey study

Supplemental Material, Supp._1_Dutch_questionnaire_patient for Value discrepancies between nurses and patients: A survey study by Liesbeth Van Humbeeck, Simon Malfait, Els Holvoet, Dirk Vogelaers, Michel De Pauw, Nele Van Den Noortgate and Wim Van Biesen in Nursing Ethics

Supplemental material

Supplemental Material, Supp._2_English_questionnaire_patient - Value discrepancies between nurses and patients: A survey study

Supplemental Material, Supp._2_English_questionnaire_patient for Value discrepancies between nurses and patients: A survey study by Liesbeth Van Humbeeck, Simon Malfait, Els Holvoet, Dirk Vogelaers, Michel De Pauw, Nele Van Den Noortgate and Wim Van Biesen in Nursing Ethics

Supplemental material

Supplemental Material, Supp._3_Dutch_questionnaire_healthcareprovider - Value discrepancies between nurses and patients: A survey study

Supplemental Material, Supp._3_Dutch_questionnaire_healthcareprovider for Value discrepancies between nurses and patients: A survey study by Liesbeth Van Humbeeck, Simon Malfait, Els Holvoet, Dirk Vogelaers, Michel De Pauw, Nele Van Den Noortgate and Wim Van Biesen in Nursing Ethics

Supplemental material

Supplemental Material, Supp._4_English_questionnaire_healthcareprovider - Value discrepancies between nurses and patients: A survey study

Supplemental Material, Supp._4_English_questionnaire_healthcareprovider for Value discrepancies between nurses and patients: A survey study by Liesbeth Van Humbeeck, Simon Malfait, Els Holvoet, Dirk Vogelaers, Michel De Pauw, Nele Van Den Noortgate and Wim Van Biesen in Nursing Ethics

Footnotes

Acknowledgements

The authors would like to thank all the respondents for their contribution to this study. The authors would like to thank Annalin Van Biesen, Friedel Crombez, Jolyn Geens, Jolien De Graeve, and Setara Mathab for their help in recruiting and questioning respondents. The authors would like to thank the members of the steering committee for their advice and support. Special thanks go to Prof. Dr Ann Van Hecke for her insights on patient-centeredness and individualized care.

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Liesbeth Van Humbeeck

Simon Malfait

Supplemental material

Supplemental material for this article is available online.

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