Decision-Making Role Preferences Among Patients with HIV: Associations with Patient and Provider Characteristics and Communication Behaviors

Abstract

BACKGROUND: A preference for shared decision-making among patients with HIV has been associated with better health outcomes. One possible explanation for this association is that patients who prefer a more active role in decision-making are more engaged in the communication process during encounters with their providers. Little is known, however, about patient and provider characteristics or communication behaviors associated with patient decision-making preferences in HIV settings. OBJECTIVE:We examined patient and provider characteristics and patient-provider communication behaviors associated with the decision-making role preferences of patients with HIV. DESIGN:Cross-sectional analysis of patient and provider questionnaires and audio recorded clinical encounters from four sites.PARTICIPANTS: A total of 45 providers and 434 of their patients with HIV. MEASURES:Patients were asked how they prefer to be involved in the decision-making process (doctor makes all/most decisions, patients and doctors share decisions, or patients make decisions alone). Measures of provider and patient communication behaviors were coded from audio recordings using the Roter Interaction Analysis System. MAIN RESULTS:Overall, 72% of patients preferred to share decisions with their provider, 23% wanted their provider to make decisions, and 5% wanted to make decisions themselves. Compared to patients who preferred to share decisions with their provider, patients who preferred their provider make decisions were less likely to be above the age of 60 (ARR 0.09, 95% CI 0.01-0.89) and perceive high quality provider communication about decision-making (ARR 0.41, 95% CI 0.23-0.73), and more likely to have depressive symptoms (ARR 1.92, 95% CI 1.07-3.44). There was no significant association between patient preferences and measures of provider or patient communication behavior. CONCLUSION:Observed measures of patient and provider communication behavior were similar across all patient decision-making role preferences, indicating that it may be difficult for providers to determine these preferences based solely on communication behavior.Engaging patients in open discussion about decisionmaking preferences may be a more effective approach.

Communication between health professionals and patients: review of studies using the RIAS (Roter Interaction Analysis System) method

“…Examples of these causal models are the relationships between some RIAS codes and satisfaction, adherence to treatment, level of control and patient knowledge about their pathologies. 3,26,32,34,35 As could be expected, the instrumental codes showed to be most important in the evaluation of technical aspects of the consultation, 7,29,30 and the af-reveal that in addition to characterizing communication RIAS investigators also studied other factors, such as:…”

“…12,36,43 Indeed, one of the most common uses of the RIAS has been to study the association between communication and patient satisfaction, where a cause-effect relationship has been confirmed. 8,13,32,42 With regard to the aspects relating to verbal communication, there are RIAS studies that have identified the verbal dominance of the physician in relation to the patient, with a predominance of technical and biomedical dialogs. 7,10,28,37 One study identified that communication for anesthetists was almost biomedical in nature, 38 while another demonstrated that this communication pattern is more evident in medical interns than specialists.…”

“…• The perception of respect by the participants in the consultations; 8,13 • The changes of the communication characteristics over time (longitudinal studies); 14,15 • The impact of training actions on patients and physicians; 9,11,22,23,28,33 • The reaction of simulated patients; 3,27,[29][30][31] • Burnout, 16,17 overwork, 18 tiredness 24 or clinical malpractice; 10 • The identification of conflicts 12,36 • The primary results (e.g satisfaction and the intention to adhere to treatment by the patient), secondary results (e.g changes in the way the patient approaches their health problems) 26 and treatment decisions; 32,35 • The use of technical terms 7 and informed consent (in clinical trials); 25,34,44 • The approach to matters of a psychosocial nature; 19,45 • Intercultural differences. 20 The involvement of various countries and continents 2,20,15,38 in the studies selected confirm the relevance of this methodology, but potential generalization of the conclusions is limited, given the differences in professional practice and context, from the training of the professionals up to the sociocultural characteristics of the populations.…”

Internet Health Information Seeking Behavior and Antiretroviral Adherence in Persons Living with HIV/AIDS

“…The design of the ECHO study has been previously published. [23][24][25][26] Briefly, study subjects were HIV pro- …”

Variables Psicológicas y Adhesión en Personas con VIH: Evaluación en función del Tiempo de Infección

“…De ahí que sea entendible el hecho de que a medida que se tiene más tiempo viviendo con el VIH, las personas precisan de modos diferentes de interacción, en los que destaca por ejemplo la toma de decisiones (Beach, Duggan & Moore, 2007). Empero, sobre este fenómeno hay que aclarar que no nos referimos a una respuesta discreta y particular que ocurre en un momento del continuo de interacción, i.e., consumir o no los medicamentos, acudir o no a las citas programadas con el personal de salud, etcétera (Denburg et al, 2009;Kumar et al, 2010), sino a modos consistentes de interacción, esto es, a una diversidad de comportamientos que darían cuenta del perfil funcional del que se hizo mención antes (Ribes, 2009). Asimismo, es de llamar la atención de la influencia de los motivos y el desempeño competencial en el presente.…”