Physicians underestimate the importance of patient-centredness to patients: a discrete choice experiment in fertility care

Abstract

BACKGROUND: High-quality healthcare should be effective, safe and patient-centred. How important patient-centredness is in relation to effectiveness of fertility care has never been investigated. This study aimed to determine and compare the importance of patient-centredness, relative to pregnancy rates, to patients and physicians. METHODS: A discrete choice experiment (DCE) was designed. Participants had to choose between hypothetical fertility clinics differing in following attributes: travel time; pregnancy rate (effectiveness); physicians' attitude; information on treatment; and continuity of physicians (the latter three represent patient-centredness). A total of 1378 patients and 268 physicians from eight Dutch and Belgian fertility clinics received the DCE-questionnaire. The attributes' relative importance was analysed using multinomial logistic regression. Additionally, patients' actual choice behaviour was investigated. RESULTS: In total, 925 patients and 227 physicians participated. Pregnancy rates were relatively more important to physicians. Patients assigned more value to patient-centredness (P < 0.001) and were willing to trade-off a higher pregnancy rate for patient-centredness than physicians recommended them to do (P < 0.05). For example, patients considered pregnancy rates 1.5 times as important as an interested physician's attitude, whereas physicians considered this 2.4 times as important (P < 0.001). The willingness to trade-off pregnancy rate for this attitude was 9.8% for patients and 6.3% for physicians (P < 0.001). A lack of patient-centredness was the most cited non-medical reason for changing fertility clinics. CONCLUSIONS: Patients and physicians put considerable value on pregnancy rates. However, physicians significantly undervalue the importance of patient-centredness to patients. Clinics aiming to optimize the quality of their services should be aware of the substantial importance their patients assign to patient-centredness.