K. Heinze3, P. A. Suwanabol2,6, K. Gibson1, B. Lansing1, C. A. Vitous6, P. Abrahamse5, L. Mody1,4 1University of Michigan,Internal Medicine,Ann Arbor, MI, USA 2University Of Michigan,Surgery,Ann Arbor, MI, USA 3St. Joseph’s Mercy Hospital,Ann Arbor, MI, USA 4Veterans Affairs Ann Arbor Healthcare System,Ann Arbor, MI, USA 5University of Michigan,Biostatistics,Ann Arbor, MI, USA 6University of Michigan,Center For Healthcare Outcomes And Policy,Ann Arbor, MI, USA
Introduction: Focus has turned to the importance and often lack of compassion in providing high-quality healthcare. Patients routinely rank intrinsic physician characteristics higher than technical skills when caring for patients with cancer and in end-of-life care. However, the preferences of patients in other scenarios such as during surgical interventions, chronic disease management, and pediatric conditions are not well studied. To address this, we sought to identify whether clinical or demographic characteristics influence patient preferences for a compassionate or a competent surgeon or physician.
Methods: We sent 800 surveys to patients identified through the University of Michigan (U-M) Geriatrics Center and the U-M Research volunteer registries in July 2017. Surveys comprised 7 clinical vignettes followed by a 5-point Likert scale assessing the relative importance of surgeon or physician compassion or competence, and an open-ended question to elaborate on their choice. Multivariable logistic regression was performed on quantitative data and thematic analysis on qualitative responses.
Results: Of the mailed surveys, 36 were returned due to address changes, and we received 651 completed surveys (85% response rate). Older age (p < 0.001), male sex (p = 0.016), and higher income levels (p = 0.039) were associated with a preference of competence over compassion in surgical vignettes. Competence was more often preferred in surgical and pediatric scenarios, and less often in chronic care and end-of-life care scenarios where female sex (p = 0.008) and increasing number of physician visits per year (p = 0.01) were associated with a preference of compassion.
Thematic analysis demonstrated that patient preferences were influenced by: 1) explicit beliefs regarding their value of competence versus compassion; 2) perceived role of the surgeon or physician in various clinical scenarios; 3) impact of emotional and mental health on medical experiences; and 4) type and frequency of healthcare exposure. Furthermore, although patients desired a competent approach from surgeons overall, a complex interplay of preferences exists suggesting that compassion is a priority once competence is established and vice-versa (Table 1).
Conclusion: Overall, patients ranked competency higher than compassion particularly in surgical scenarios where technical skill was critical to the patient’s perception of a good outcome. However, qualitative analyses suggest that competence is a priority as long as compassion is established. These novel findings can inform surgeons and surgical training programs on how best to elicit, navigate and prioritize patient communication and informational needs in diverse clinical settings.
