Qom University of Medical Sciences Journal

Introduction
Due to the significant effect of physicians’ behaviors on the improvement of health care and its outcomes for the patients, the access to essential, safe and quality services is needed for achieving universal health coverage. Therefore, it is necessary to adopt cost-effective measures to provide beneficial services. In the studies on health economics, the uncertainty and information asymmetry between patients and health care professionals have been reported, which can affect on physicians’ behaviors. Different initial health status of patients, uncertainty about treatment effects and unawareness of patient preferences are three factors causing uncertainty. Patient preferences are health priorities and goals that should be perceived by physicians and the related factors should be accurately identified. In fact, the patient preferences are formed by considering the balance between the patient’s needs, wants and demands. Therefore, to provide optimal health services, it is better for patients to be fully aware of their needs and how to satisfy them. Measuring the level of “uncertainty tolerance” plays a decisive role in the patient’s acceptance and cooperation in treatment. Therefore, this study aims to investigate the factors affecting patients’ preferences and uncertainty intolerance in private and public hospitals of Iran from the perspective of healthcare professionals.
Methods
This is a cross-sectional study that was conducted in 2024. Participants were 550 experts, including university professors, health system policymakers, and managers and physicians from private and public hospitals (320 from the governmental centers and 230 from the private centers). A stratified sampling method was used for sampling. According to Karni’s theory and other studies, effective factors of patient preferences were identified and a questionnaire was designed with 6 items rated from 0 to 5 and two domains of private centers and governmental centers. To measure the patient’s uncertainty tolerance, the intolerance of uncertainty scale (IUS) was used which measures emotional, cognitive and behavioral reactions to ambiguous situations.
Results
The results showed that 6 factors affected patient preferences in the governmental and private centers: Determining the treatment steps to achieve the desired result by the physician, explanation of all treatment steps and their strengths and weaknesses by the physician, allowing the patient to compare treatment options, information on how to pay for different treatment options, the patient’s right to make the final decision with full knowledge and insistence of patients and the type of patient insurance in choosing treatment options.
Regarding the factors affecting uncertainty tolerance, in the emotional dimension, the most important factor was “interest in making decisions in uncertain situations” in the governmental centers and “courage in making uncertain decisions” in the private centers. In the behavioral dimension, the most important factor was “search for making uncertain decisions” in the governmental centers and “attention to uncertain decisions” in the private centers. In the cognitive dimension, the most important factor was “certaintycertainty about the treatment procedures” in the governmental centers and “trust of the patient in the physician” in the private centers.
Conclusion
It is necessary to consider the patients’ preferences and uncertainty tolerance by paying attention to the effective factors identified in this study. We found six factors effective in patient preferences and three cognitive, behavioral, and emotional factors effective in measuring the uncertainty tolerance of patients in different governmental and private centers. Insistence of patients and the type of patient insurance in choosing treatment options is the most important factor in patient preferences, according to experts in both governmental and private centers in Iran, which should receive more attention
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the  Islamic Azad University, Science and Research Branch, Tehran, Iran (Code: IR.IAU.SRB.REC.1402.091). All necessary explanations about the study objectives were given to participants and their informed consent was obtained.
Funding
This study was taken from the PhD dissertation of Atiyeh Sadat Begdali, approved by the Department of Health Services Adminstration, Faculty of Medical Sciences and Technologies, Science and Research Branch, Islamic Azad University, Tehran, Iran. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.
Authors contributions
Supervision: Leila Riahi; Conceptualization, investigation, editing and review: Leila Riahi and Atieh Sadat Begdali; Methodology: Leila Riahi, Atieh Sadat Begdali and Aniseh Nik Ravan; Data collection and analysis: Fakhreddin Hejazi.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like to thanks Naser Sadr Mumtaz and all specialists and personnel of private and government hospitals for their cooperation in this study.