Integrating environmental sustainability in clinical counselling: a randomised, double-blinded, experimental vignette study of satisfaction with care
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Objective
to explore whether advising environmentally sustainable treatment options in clinical counselling affects patients’ satisfaction with care compared to less sustainable (standard) options – accounting for differences in severity and types of medical problems.
Design
a randomised, double-blinded, experimental vignette study with a four (between-group, Type of Advice) x two (between-group, Severity) x five (within-group, Medical Problem) mixed design. Participants received short descriptions of hypothetical patient-physician interactions based on their group allocation and subsequently indicated their satisfaction with care.
Setting
a general practice or hospital visit.
Participants
a representative sample of the general Dutch adult population.
Interventions
four different types of medical advice, varying in level of environmental sustainability and whether sustainability is mentioned explicitly.
Main outcome measures
satisfaction with care, operationalised as: treatment acceptability, trust in the physician, trust in the treatment, and the feeling that the physician prioritised their health (Likert scales, 1=strongly disagree, 7=strongly agree).
Results
1,536 participants completed the study. Across vignettes, participants receiving the less sustainable advice (M=5.6, SD=1.2) were generally more satisfied than participants receiving the more sustainable types of advice (P’s<.001). Participants receiving the explicitly more sustainable advice (M=4.8, SD 1.6) were generally less satisfied than participants receiving the implicitly more sustainable types of advice (P’s<.001). Differences were larger for the high-severity conditions (mean differences 0.4 to 1.8, P’s<.001), non-significant for most low-severity conditions, and varied per medical problem.
Conclusions
advising more sustainable treatment options for high-severity conditions may negatively affect patients’ satisfaction with care, especially when sustainability is mentioned explicitly. However, the presence and size of the observed effect varied across medical problems and was generally non-significant or small for low-severity conditions. Clinicians’ situational awareness may differentiate whether sustainability should be discussed, or only guaranteed through institutional level decisions.
