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Patients' preferences for participation in treatment decision making should be considered seriously by doctors during the encounter. Health providers should make a greater effort to improve doctor-patient communication and decrease the mismatch between patients' perceived and preferred decisional role.

Tourism eco-efficiency is an important indicator that has often been applied to measure the quality of green tourism development. This paper takes the 31 provinces of China as examples to analyze regional tourism eco-efficiency. By constructing multiple input and output indicator systems for regional tourism, we estimated the eco-efficiency of 31 provinces in 1997–2016 using an undesirable output model of a slack-based model (undesirable-SBM) for data envelopment analysis (DEA). Then, we analyzed the spatial–temporal evolutionary trends and patterns of the eco-efficiency over 20 years by using the Hot Spot Model and Spatial Center of Gravity Model. Finally, we explored the driving forces internal and external to the tourism eco-economic system using the Panel Tobit Regression Model and Geodetector Model, respectively. The results show that: In the last 20 years, the tourism eco-efficiency of provinces in China declined, though tourism has experienced rapid but extensive development. The western regions of China, which have better eco-environmental conditions, and the southeastern coastal regions, which have higher levels of economic development, have higher tourism eco-efficiency. Regions with lower tourism eco-efficiency show diffusion trends, while regions with higher tourism eco-efficiency are characterized by a lack of obvious space spillover effects. Technology is the core driving force of regional tourism eco-efficiency, while traffic conditions and social civilization levels are key external influence factors leading to improvement of tourism eco-efficiency. The research results reveal the great significance of laws for sustainable green tourism development with different economic levels in the different regions. Our work could provide a reference for similar countries and regions in the world with the rapid growth of tourism or obvious spatial differentiation in socioeconomic development.

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