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.

Download full-text


Available from: Rebecca Say, Sep 15, 2015
    • "Likewise, feelings of empowerment – including perceptions of competence and control [32] – are thought to be related to patient participation in the doctor-patient consultation [33] [34] [35]. Eventually, trust in one's doctor is said to be linked to patient involvement during the medical consultation [36] [37] [38]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To explore micro-cultural differences in patients' need for information provision, perceived participation in decision making, and related concepts during the doctor-patient consultation between French- and Italian-speaking patients in Switzerland. Methods: In 2012, 153 French- and 120 Italian-speaking patients with chronic low back pain (cLBP) were surveyed on their need for information provision, perceived participation in decision making, cLBP knowledge, psychological empowerment, and trust in their doctor. T-tests and regression analyses with interaction terms were performed. Results: Results show that French- and Italian-speaking patients significantly differed in their participation in decision making, with French-speaking patients reporting higher involvement. Need for information provision was related to empowerment among French- and to trust among Italian-speaking patients. For participation in decision making, trust was the only related concept among French-, and cLBP knowledge among Italian-speaking patients. Significant interaction terms indicate a moderation of micro-cultural background. Conclusion: Findings point towards differences in the relationships between individual patient characteristics (i.e. knowledge, empowerment) and relational doctor-patient characteristics (i.e. trust) and patients' need for information provision and participation in decision making between French- and Italian-speaking patients in Switzerland. Practice implications: Doctors should be aware of these differences when dealing with patients of different micro-cultural backgrounds.
    Patient Education and Counseling 11/2015; DOI:10.1016/j.pec.2015.10.018 · 2.20 Impact Factor
    • "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). "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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
Show more