Patients' Preference for Involvement in Medical Decision Making: A Narrative Review

School of Population and Health Sciences, Medical School, University of Newcastle, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.
Patient Education and Counseling (Impact Factor: 2.2). 03/2006; 60(2):102-14. DOI: 10.1016/j.pec.2005.02.003
Source: PubMed


This review aimed to clarify present knowledge about the factors which influence patients' preference for involvement in medical decision making.
A thorough search of the literature was carried out to identify quantitative and qualitative studies investigating the factors which influence patients' preference for involvement in decision making. All studies were rigorously critically appraised.
Patients' preferences are influenced by: demographic variables (with younger, better educated patients and women being quite consistently found to prefer a more active role in decision making), their experience of illness and medical care, their diagnosis and health status, the type of decision they need to make, the amount of knowledge they have acquired about their condition, their attitude towards involvement, and the interactions and relationships they experience with health professionals. Their preferences are likely to develop over time as they gain experience and may change at different stages of their illness.
While patients' preferences for involvement in decision making are variable and the process of developing them likely to be highly complex, this review has identified a number of influences on patients' preference for involvement in medical decision making, some of which are consistent across studies.
By identifying the factors which might influence patients' preference for involvement, health professionals may be more sensitive to individual patients' preferences and provide better patient-centred care.

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Available from: Rebecca Say, Sep 15, 2015
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    • "For example, one study found that consumers wanted a passive role in primary care encounters, a more collaborative role when making choices about psychiatric medications, and greater autonomy regarding psychosocial treatment decisions (O'Neal et al., 2008). This is consistent with findings in general medical care, showing that autonomy preferences vary based on a number of factors, such as health status and type of decision (Say et al., 2006). The growing use of the API indicates increased attention to patient preferences and rights in medical settings, but some studies have raised questions about the psychometric properties of the measure when used with persons with severe mental illness (Hamann et al., 2007a; Puschner et al., 2013). "
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    ABSTRACT: People vary in the amount of control they want to exercise over decisions about their healthcare. Given the importance of patient-centered care, accurate measurement of these autonomy preferences is critical. This study aimed to assess the factor structure of the Autonomy Preference Index (API), used widely in general healthcare, in individuals with severe mental illness. Data came from two studies of people with severe mental illness (N=293) who were receiving mental health and/or primary care/integrated care services. Autonomy preferences were assessed with the API regarding both psychiatric and primary care services. Confirmatory factor analysis was used to evaluate fit of the hypothesized two-factor structure of the API (decision-making autonomy and information-seeking autonomy). Results indicated the hypothesized structure for the API did not adequately fit the data for either psychiatric or primary care services. Three problematic items were dropped, resulting in adequate fit for both types of treatment. These results suggest that with relatively minor modifications the API has an acceptable factor structure when asking people with severe mental illness about their preferences to be involved in decision-making. The modified API has clinical and research utility for this population in the burgeoning field of autonomy in patient-centered healthcare. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    06/2015; 228(3). DOI:10.1016/j.psychres.2015.06.004
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    • "874). In treatments for chronic conditions, moreover, participation in decision making may more fruitfully viewed as a process which may unfold over the course of an encounter, or even multiple encounters (Say et al., 2006) and, in the case of psychiatric disorders, is inextricably tied to the context of an ongoing therapeutic relationship (Matthias et al., 2013). In this sense, everyday psychiatric practice may inhabit a middle ground between the egalitarian process idealized in SDM and the starkly authoritarian model of medicine to which SDM was designed to respond. "
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    ABSTRACT: Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients' concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists' orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship. Copyright © 2015. Published by Elsevier Ltd.
    Social Science & Medicine 04/2015; 138:44-56. DOI:10.1016/j.socscimed.2015.04.029 · 2.89 Impact Factor
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    • "Eldh et al. found that if the discussion emanated from a patient perspective, patients were more likely to participate [25]. Furthermore, Say et al. concluded that health professionals should be more sensitive to patients as people to provide person-centred care [26]. In some cases, the respondents expressed uncertainty about openly talking about their situation and felt that their personal experiences were of no relevance to their medical situation. "
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    ABSTRACT: Background Patient care models have been implemented and documented worldwide. Many studies have focused on features that hinder and facilitate the shift to such models, including the implementation process, staff involvement, resistance to new models and cultural dimensions. However, few studies have identified the potential effects of such new care models from a patient perspective. The aim of the present study was to investigate whether patients did in fact perceive the intentions of partnership in the new care model 1 year after its implementation. Methods Sixteen participants were interviewed, selected from two wards in a medical department where a new care model had been implemented 1 year earlier. A directed deductive content analysis was selected. The aim of the directed approach to content analysis was to investigate to what extent the new care model had been implemented, using patients’ perspectives to describe the level of implementation. A coding framework was developed based on a theoretical paper that described the key features of the new care model. Results The implementation of person-centred care had clearly occurred to a large degree, even if some patients appeared not to have been exposed to the model at all. Aspects of the newly implemented care model were obvious; however, it was also clear that implementation was not complete. The analysis showed that patients felt listened to and that their own perception of the situation had been noted. Patients spontaneously expressed that they felt that the staff saw them as persons and did not solely focus on their disease. It was also stated that not every ailment or aspect of a patient’s illness needed to be addressed or resolved for open listening to be perceived as a positive experience. Conclusions The findings indicate that even though some patients were not interested in participating and playing an active role in their own care, this might relate to a lack of understanding on how to invite them to do so and to increase their confidence. To change healthcare from a paternalistic system to care where patients are seen as partners may require pedagogical skills.
    BMC Nursing 10/2014; 13(1):28. DOI:10.1186/1472-6955-13-28
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