Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools

Abstract

While there is an increasing emphasis on patient empowerment and shared decision making, evidence suggests that many patients do not wish to be involved in decisions about their own care. Previous research has found patient preferences for involvement in decision making to vary with age, socioeconomic status, illness experience, and the gravity of the decision. Furthermore, there is evidence that certain patients may experience disutility from being involved in decision making about the treatment of their health problems. We discuss the implications of these findings for the use of decision support tools and the diYculties of targeting their use towards those patients most likely to benefit. We argue that patients may be ill informed about what participation in decision making actually entails and unaware of the benefits they stand to gain by articulating their preferences to their clinician. Furthermore, clinicians are not good at accurately assessing patients' preferences, while patients may have unrealistic expectations about their clinician's ability to "know what is best" for them. Further research is required to understand variations in patients' preferences for information and involvement in decision making, and the factors that influence them. (Quality in Health Care 2001;10(Suppl I):i34-i38)

Treatment choices, preferences and decision‐making by patients with rheumatoid arthritis

“…That only a minority of RA patients wished to choose their medication is similar to fi ndings for other chronic conditions (Deber et al, 1996;Doherty and Doherty, 2005;Ende et al, 1989) and is consistent with previous reports from general practice (Robinson and Thomson, 2001;Say and Thompson, 2003). The requirement for considerable reassurance and support is also consistent with the fi ndings of Deber et al (1996), who suggested that patients are more likely to participate in decision-making when they understand alternatives and trade-offs.…”

A typology of preferences for participation in healthcare decision making

“…It is well established that patients want to receive information from their physicians almost universally (Deber, Kraetschmer, & Irvine, 1996;Ende, Kazis, Ash et al, 1989;Nease & Brooks, 1995), but less is known about information transmission, that is, patient preferences for providing information to their physicians. Preferences for deliberation (i.e., formal discussion about options) and preferences for decisional control (i.e., power over the final selection of treatment) are known to differ substantially among patients (Robinson & Thomson, 2001), although it is unclear whether patients who prefer discussing treatment options also prefer making the final decision about treatment. Where one study suggests that patients do not want to be involved in problemsolving tasks while retaining control over decisions (Deber, Kraetschmer, & Irvine, 1996), others advise patient involvement in both stages (Quill & Brody, 1996).…”

A new measure of consensus with reciprocal preference relations: The correlation consensus degree

“…Among others, age, sex, and type of clinical problem have been described as factors that can influence patients' choice. Due to these fats, it could be interesting to understand better patients' preferences in Clinical decision-making and the factors that could influence them (see e.g., De las Cuevas, Peñate and de Rivera [20], Robison and Thomson [54], Rodriguez et al [56] and Tang et al [59] among others). Most studies about patients' decision making preferences have been carried out by means of the use of the Control Preference Scale (CPS) introduced by Degner [21].…”