Survey of general population found concerns regarding physicians and hospital fundraising

A survey study of the general population found that about 83% felt that physicians speaking with their patients about donating to their hospital could interfere with the patient-physician relationship.


Participants in a recent survey study were not accepting of a number of legally allowable approaches for identifying, engaging, and thanking hospital patient-donors.

Researchers used the Ipsos KnowledgePanel, a probability-based sample representative of the U.S. population, to survey a primary cohort representing the general population as well as three supplemental cohorts of individuals with high income, with cancer, and with heart disease. The online questionnaire assessed respondents' attitudes regarding the acceptability of strategies hospitals may use to identify, solicit, and thank donors; perceptions of the effect of physicians discussing donations with their patients; and opinions regarding gift use and stewardship. Results were published online on July 21 by JAMA.

A total of 513 individuals (48.0% women; 67.3% non-Hispanic white) in the general population sample completed surveys. In the weighted sample, 47.0% (95% CI, 42.3% to 51.7%) responded that physicians giving patient names to hospital fundraising staff after asking patients' permission was definitely or probably acceptable, and 8.5% (95% CI, 5.7% to 11.2%) endorsed referring without asking permission. Overall, 79.5% (95% CI, 75.6% to 83.4%) said it would be acceptable for physicians to talk to patients about donating if patients have brought it up, and 14.2% (95% CI, 10.9% to 17.6%) thought it acceptable when patients have not brought it up. About 10% (95% CI, 7.1% to 12.8%) accepted hospital development staff performing wealth screening using publicly available data to identify patients capable of large donations. Of the participants, 83.2% (95% CI, 79.5% to 86.9%) felt that physicians talking with their patients about donating may interfere with the patient-physician relationship, and 90.7% (95% CI, 87.7% to 93.7%) felt that patients may feel pressure to donate if asked to do so by their physician. For a hypothetical patient who donated $1 million, 50.1% (95% CI, 45.4% to 54.7%) said it would be acceptable for the hospital to show thanks by providing nicer hospital rooms, 26.0% (95% CI, 21.9% to 30.1%) by providing expedited appointments, and 19.8% (95% CI, 16.1% to 23.5%) by providing physicians' cell phone numbers.

For the supplemental samples, there were 253 high-income respondents, 260 respondents with cancer, and 256 respondents with heart disease. Physicians giving hospital fundraising staff patient names after asking permission was acceptable to 58.6% (95% CI, 51.3% to 65.8%), 53.3% (95% CI, 46.7% to 59.8%), and 41.0% (95% CI, 33.8% to 48.3%) of these respective groups. The proportions who said it would be acceptable for physicians to talk to patients about donating if patients have brought it up were 87.6% (95% CI, 82.3% to 92.5%), 83.6% (95% CI, 78.8% to 88.3%), and 87.6% (95% CI, 83.3% to 92.0%), respectively. When asked about physicians sending letters to their wealthy patients asking if someone can contact them about making a donation to the hospital, 37.7% (95% CI, 33.2% to 42.3%) of the general population sample, 37.4% (95% CI, 30.1% to 44.7%) of the high-income sample, 31.7% (95% CI, 25.6% to 37.8%) of those with cancer, and 40.0% (95% CI, 32.8% to 47.2%) of those with heart disease considered this acceptable.

Among other limitations, the survey had a 62% completion rate, with potentially important differences between respondents and those who did not respond that might have biased the results, study authors noted. In addition, supplemental group assignment was based on self-report.

“The findings of the present study may provide insights into the expectations of the public regarding physicians' behavior in the context of philanthropy. … The inherent vulnerability of patients and the unique importance of trust in the patient-physician relationship suggest that great caution is necessary in this context and that ethical guidelines merit further specification,” the authors wrote.