Do Patients Treated With Dignity Report Higher Satisfaction, Adherence, and Receipt of Preventive Care?

Mary Catherine Beach; Jeremy Sugarman; Rachel L. Johnson; Jose J. Arbelaez; Patrick S. Duggan; Lisa A. Cooper

doi:10.1370/afm.328

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Figure 1.
Theoretical association between respect for autonomy and respect for persons.

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Table 1.

Percentage of Respondents Reporting Different Types of Respect

		Treated with Dignity*		Involved in Decisions^†
Characteristic	Number (% of total)	%	PValue	%	PValue
* Percentage of selected demographic category compared with not being treated with dignity.
† Percentage of selected demographic category compared with not being involved in decisions.
Age, years
18–39	2,394 (44)	70		74
40–64	2,236 (41)	79	<.0001	77	.0002
>65	815 (15)	85		84
Sex
Male	1,936 (35)	75	.2266	76	.4005
Female	3,578 (65)	77		78
Race/ethnicity
White	3,150 (57)	77	<.0001	77	<.0001
African American	926 (17)	75		75
Hispanic, Latino	947 (17)	76		67
Asian	491 (9)	59		59
Primary language
English	5,118 (93)	76	.0006	78	.0042
Non-English	396 (7)	86		68
Income
Below poverty	592 (13)	75	.0032	71	.0347
100%–200% poverty	936 (21)	70		76
>200% poverty	3,032 (66)	78		78
Education
High-school incomplete	660 (12)	76	.4485	74	.1878
High-school complete	1,410 (26)	74		79
Some college	1,480 (27)	77		78
College +	1,940 (35)	78		76
Insurance
Uninsured	695 (13)	67	<.0001	67	<.0001
Insured	4,803 (87)	77		79

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Table 2.

Probabilities of Positive Patient Outcomes

	Satisfaction		Adherence		Optimal Preventive Care
Involvement With Health Care	AP (95% CI)	PValue	AP (95% CI)	PValue	AP (95% CI)	PValue
AP = adjusted probability; CI = confidence interval.
* Demographics included respondant age, sex, race/ethnicity, income, insurance, and primary language.
Treated with dignity
Unadjusted
A great deal	0.73 (0.71–0.75)	<.001	0.78 (0.76–0.80)	<.001	0.66 (0.64–0.68)	.009
Less than a great deal	0.33 (0.29–0.37)		0.69 (0.65–0.72)		0.60 (0.57–0.64)
Adjusted for involvement in decisions
A great deal	0.71 (0.69–0.73)	<.001	0.77 (0.75–0.79	.008	0.66 (0.64–0.68)	.019
Less than a great deal	0.38 (0.34–0.42)		0.71 (0.69–0.75)		0.61 (0.56–0.65)
Adjusted for demographics* and involvement in decisions
A great deal	0.70 (0.68–0.72)	<.001	0.77 (0.75–0.79	.096	0.68 (0.66–0.70)	.054
Less than a great deal	0.38 (0.34–0.43)		0.73 (0.69–0.77)		0.63 (0.58–0.67
Involved in decisions
Unadjusted
As much as desired	0.72 (0.70–0.74)	<.001	0.78 (0.76–0.80)	<.001	0.66 (0.63–0.68)	.235
Less than desired	0.34 (0.30–0.38)		0.67 (90.63–0.71)		0.63 (0.59–0.67)
Adjusted for treatment with dignity
As much as desired	0.70 (0.68–0.72)	<.001	0.78 (0.76–0.79)	<.001	0.65 (0.63–0.67)	.841
Less than desired	0.41 (0.36–0.45)		0.69 (0.65–0.72)		0.64 (0.60–0.68)
Adjustment for demographics* and treatment with dignity
As much as desired	0.70 (0.68–0.72)	<.001	0.78 (0.76–0.80)	<.001	0.67 (0.66–0.70)	.953
Less than desired	0.39 (0.35–0.44)		0.69 (0.65–0.73)		0.67 (0.62–0.71)

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Table 3.

Adjusted Probabilities of Positive Patient Outcomes Across Race/Ethnicity

	Satisfaction		Adherence		Optimal Preventive Care
Involvement With Health Care	AP (95% CI)	PValue	AP (95% CI)	PValue	AP (95% CI)	PValue
AP = Adjusted probability; CI = confidence interval.
* Probability adjusted for respondent age, sex, incomve, insurance, primary language, and being involved in decisions.
† Probability adjusted for respondent age, sex, incomve, insurance, primary language, and being treated with dignity.
Treated with dignity*
Whites (n = 3,488)
A great deal	0.71 (0.68–0.74)	<.001	0.74 (0.71–0.77)	.388	0.66 (0.61–0.71)	.367
Less than a great deal	0.40 (0.34–0.47)		0.71 (0.66–0.76)		0.75 (0.56–0.70)
African Americans (n = 1,037)
A great deal	0.73 (0.67–0.79)	<.001	0.79 (0.73–0.83)	.124	0.75 (0.69–0.80)	.406
Less than a great deal	0.35 (0.25–0.46)		0.71 (0.61–0.79)		0.70 (0.59–0.79)
Latinos (n = 1,153)
A great deal	0.73 (0.65–08.80	.001	0.83 (0.77–0.87)	.456	0.73 (0.66–0.79)	.039
Less than a great deal	0.52 (0.40–0.63)		0.79 (0.68–0.87)		0.59 (0.47–0.71)
Asians (n = 621)
A great deal	0.56 (0.45–0.66)	<.001	0.80 (0.70–0.87)	.202	0.62 (0.51–0.71)	.231
Less than a great deal	0.18 (0.10–0.28)		0.71 (0.58–0.81)		0.52 (0.38–0.66)
Involved in decision^†
Whites (n = 3,488)
As much as desired	0.71 (0.68–0.74)	<.001	0.76 (0.73–0.79)	<.001	0.65 (0.60–0.70)	.481
Less than desired	0.39 (0.33–0.46)		0.64 (0.68–0.69)		0.67 (0.60–0.73)
African Americans (n = 1,037)
As much as desired	0.70 (0.6400.76)	<.001	0.78 (0.72–0.83)	.433	0.74 (0.68–0.80)	.585
Less than desired	0.44 (0.33–0.55)		0.74 (0.64–0.82)		0.71 (0.60–0.80)
Latinos (n = 1,153)
As much as desired	0.74 (0.67–0.81)	<.001	0.82 (0.76–0.87)	.711	0.72 (0.66–0.78)	.051
Less than desired	0.46 (0.35–0.58)		0.80 (0.70–0.88)		0.61 (0.48–0.72
Asians (n = 621)
As much as desired	0.50 (0.39–0.61)	.018	0.78 (0.68–0.85)	.876	0.57 (0.46–0.67)	.336
Less than desired	0.28 (0.17–0.42)		0.77 (0.64–0.86)		0.65 (0.51–0.77)

The Article in Brief

Background: This study looked at whether patients who felt that they were treated with dignity were more satisfied with their medical care, more likely to follow medical advice, and whether they received appropriate preventive medical tests (such as mammograms and cholesterol tests).
What This Study Found: Patients who were treated with dignity and who were involved in decisions about their health care treatment were more satisfied with their care, more likely to follow medical advice, and more likely to receive preventive medical services. White patients who were involved in decisions were more likely to follow medical advice. Racial and ethnic minorities were more likely to follow medical advice if they were treated with dignity.
Implications:
� It is important for doctors to not only involve their patients in decisions but also to treat them with dignity.
� Involving patients in decision making is not necessarily the same as treating them with dignity and respect. Both are important to patients.