Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making

Abstract

Objective Patient‐centered care and shared decision making (SDM) are generally recognized as the gold standard for medical consultations, especially for preference‐sensitive decisions. However, little is known about psychological patient characteristics that influence patient‐reported preferences. We set out to explore the role of personality and anxiety for a preference‐sensitive decision in bladder cancer patients (choice of urinary diversion, UD) and to determine if anxiety predicts patients' participation preferences. Methods We recruited a sample of bladder cancer patients (N = 180, primarily male, retired) who awaited a medical consultation on radical cystectomy and their choice of UD. We asked patients to fill in a set of self‐report questionnaires before this consultation, including measures of treatment preference, personality (BFI‐10), anxiety (STAI), and participation preference (API and API‐Uro), as well as sociodemographic characteristics. Results Most patients (79%) indicated a clear preference for one of the treatment options (44% continent UD, 34% incontinent UD). Patients who reported more conscientiousness were more likely to prefer more complex methods (continent UD). The majority (62%) preferred to delegate decision making to healthcare professionals. A substantial number of patients reported elevated anxiety (32%), and more anxiety was predictive of higher participation preference, specifically for uro‐oncological decisions (β = 0.207, p < 0.01). Conclusions Our findings provide insight into the role of psychological patient characteristics for SDM. Aspects of personality such as conscientiousness influence treatment preferences. Anxiety contributes to patients' motivation to be involved in pertinent decisions. Thus, personality and negative affect should be considered to improve SDM.

Choosing between Orthotopic Neobladder and Ileal Conduit after Radical Cystectomy: Tools for Assessing Patient-Specific Characteristics and Enhancing the Decision-Making Process—A Review of Current Studies

“…Design. Prospective, multicenter observational study from Germany described the role of personality and anxiety in patient preference in the context of choosing UD [ 16 ]. Patients.…”

“…In the second group, we found four studies focusing on shared decision-making and a more personalized approach to the patient while choosing UD, involving studies describing personality [ 16 ], patients’ values and goals [ 17 , 18 ], and role of patient–physician dialogue in the context of choosing UD [ 19 ]. The main drawbacks of all four studies are small sample sizes, but most of all, the correlations between all assessed features and their impact on choice of UD were not evaluated.…”

Getting specific: participation preference in urooncological decision-making

“…In order to establish the context specificity of the API-Uro, and highlight the relevance of assessing patients’ preference for active participation in the specific decision contexts, we compared the participation preference for treatment decisions vs. diagnostic decisions in both studies. Patients were categorized based on a taxonomy from the literature [ 30 , 50 , 62 ] into either delegators (participation preference ≤ 40) or participators (participation preference > 40). Table 5 illustrates the differences in participation preference depending on the decision context and the respective diagnoses of the patients.…”

“…A study nurse approached patients, and after giving informed consent, they completed a set of self-report measures, including the German API [ 45 ], the original case vignettes API-OV [ 23 ], and the urooncological case vignettes API-Uro [ 46 ]. More details on the study procedure and additional measured constructs can be found in Köther et al [ 50 ]. The study was approved by the ethics committee of the Medical Faculty of Mannheim of the University of Heidelberg (MA-2019-727N).…”

“…In order to analyze the difference between the desire to participate in different decision-making contexts obtained during factor analysis (API-Uro factors), we categorized patients as participators and delegators based on an established convention from the literature [ 30 , 50 , 62 ]: a score of ≤ 40 indicates the desire to delegate the decision (delegators), while a score > 40 indicates a preference for autonomy and participation in decision-making (participators). Differences in the proportion of participators between the two decision contexts (API-Uro factors) were analyzed with the McNemar χ 2 test.…”