Preferences of acutely ill patients for participation in medical decision-making

Wilkinson, Catherine; Khanji, Mohammed Y; Cotter, Paul; Dunne, O; O'Keeffe, Shaun T

doi:10.1136/qshc.2006.021378

Cited by 31 publications

(21 citation statements)

References 27 publications

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“…About half of the patients did not feel they were well informed, and some (15%) admitted they were afraid to ask about their health care. The present study emphasizes the wish for information and thus communication, and supports a recent study on acutely admitted elderly patients [31]. …”

Section: Discussionsupporting

confidence: 91%

Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey

et al. 2011

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BackgroundMedical decision making has long been in focus, but little is known of the preferences and conditions for elderly people with co-morbidities to participate in medical decision making. The main objective of the present study was to investigate the preferred and the actual degree of control, i.e. the role elderly people with co-morbidities wish to assume and actually had with regard to information and participation in medical decision making during their last stay in hospital.This study was a cross-sectional survey including three Swedish hospitals with acute admittance. The participants were patients aged 75 years and above with three or more diagnoses according to the International Classification of Diseases (ICD-10) and three or more hospitalisations during the last year.MethodsWe used a questionnaire combined with a telephone interview, using the Control Preference Scale to measure each participant's preferred and actual role in medical decision making during their last stay in hospital. Additional questions were asked about barriers to participation in decision making and preferred information seeking role. The results are presented with descriptive statistics with kappa weights.ResultsOf the 297 elderly patients identified, 52.5% responded (n = 156, 46.5% male). Mean age was 83.1 years. Of the respondents, 42 of 153 patients said that they were not asked for their opinion (i.e. no shared decision making). Among the other 111 patients, 49 had their exact preferred level of participation, 37 had less participation than they would have preferred, and 23 had more responsibility than they would have preferred. Kappa statistics showed a moderate agreement between preferred and actual role (κw = 0.57; 95% CI: 0.45-0.69). Most patients wanted to be given more information without having to ask. There was no correlation between age, gender, or education and preferred role. 35% of the patients agreed that they experienced some of the various barriers to decision making that they were asked about: 1) the severity of their illness, 2) doctors with different treatment strategies, 3) difficulty understanding the medical information, and 4) difficulty understanding doctors who did not speak the patient's own language.ConclusionsPhysicians are not fully responsive to patient preferences regarding either the degree of communication or the patient's participation in decision making. Barriers to participation can be a problem, and should be taken into account more often when dealing with hospitalised elderly people.

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Section: Discussionsupporting

confidence: 91%

Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey

et al. 2011

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“…This finding is similar to that of prior studies of hospitalised patients,29 30 suggesting that patients prefer to relinquish decision control during periods of acute illness. Torke et al 31 recently published a study showing that nearly half of older hospitalised adults required at least some involvement of a surrogate for decision-making.…”

Section: Discussionsupporting

confidence: 89%

Effect of patient-centred bedside rounds on hospitalised patients’ decision control, activation and satisfaction with care

et al. 2015

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“…Many eventually felt they were able to explain to the clinicians what they could and could not tolerate. Although the literature suggests that patients take a passive role [18][19][20] in healthcare decision-making, this study reaffirms their wishes to more actively contribute to care decisions [6,21]. Most of the participants offered suggestions for improving the experience of cannulation.…”

Section: Discussionsupporting

confidence: 69%

Venous access: the patient experience

Robinson-Reilly

Paliadelis

Cruickshank

2015

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Preferences of acutely ill patients for participation in medical decision-making

Abstract: Acute medical inpatients want to receive a lot of information about their illness, but most prefer a relatively passive role in decision-making. The only way to determine individual patient preferences is to ask them; preferences cannot be predicted from clinical or sociodemographic data.

Cited by 31 publications

References 27 publications

Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey

Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey

Effect of patient-centred bedside rounds on hospitalised patients’ decision control, activation and satisfaction with care

Venous access: the patient experience

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