Patients' Attitudes Towards Integrating Environmental Sustainability Into Healthcare Decision-Making: An Interview Study

Abstract

Introduction: The ethical obligation to reduce the environmental impact of healthcare systems prompts an exploration of if and when environmental concerns should be integrated into clinical decision-making. In this study, we aimed to elucidate patients' attitudes regarding the provision of environmental information in healthcare decision-making and to identify preferred approaches for integrating these considerations into patient-provider consultations.

Methods: This interview study served as an in-depth follow-up of a survey study on gynaecological patients' perspectives on environmental sustainability within healthcare settings. We conducted semistructured interviews with 14 patients from two Dutch outpatient clinics between February and May 2024. We employed reflexive thematic analysis to analyse the data.

Results: Five main themes were developed from the data: (1) Patients are an integral part of the transition to sustainable healthcare, (2) Patients are open to information on environmental impact of healthcare, (3) Information on environmental impact should be tailored to the individual patient and context, (4) Patients vary in preferences for involvement in decision-making related to environmental sustainability and (5) Patients prioritize individual health over environmental concerns in healthcare decision-making.

Conclusion: The findings of our study underscore the importance of integrating sustainability into clinical decision-making, aligning with bioethical principles and the expectations and goals of patients. By ensuring that environmental considerations are introduced in a personalized and context-appropriate manner within patient-provider interactions, healthcare can foster greater support for sustainable practices.

Patient or public contribution: Patients were involved in developing the pre-interview questionnaire. The preliminary results of the study were presented to healthcare professionals from various backgrounds during a meeting of the Dutch Green Care Alliance, after which the input was incorporated into the interpretation of the study results. Finally, the complete manuscript was presented to representatives from the Dutch Patient Federation to obtain their input on the interpretation and implications of our research. The interpretation of our results aligned with the findings from their recent national inquiries, which included data from over 9300 patients within their network. Consequently, no changes were made to the manuscript's discussion.

Keywords: climate change; environmental impact; environmental sustainability; green bioethics; green informed consent; shared decision‐making.