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
    • "Others may feel unsettled or uncertain about the several options and what might be the best one for them (Politi et al, 2011). Some patients may initially decline the responsibility of making the decision, and ask for the treating clinician to choose for them (Say et al, 2006). The third phase is the 'decision-support intervention', which recaps the information in tables or figures. "

    No preview · Article · Jan 2016 · British journal of nursing (Mark Allen Publishing)
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    • "Studies indicate that self-management is significantly influenced by health-and disease-related information people acquire. Moreover, information seems to improve patients' active involvement in the disease-related decision-making process [3]. It is therefore not surprising that diabetes mellitus was identified as the chronic condition with the highest desire for information in comparison to cancer and gastrointestinal or respiratory diseases [4]. "
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    ABSTRACT: Aim: To develop a questionnaire suitable for assessing the information needs of individuals with diabetes mellitus types 1 and 2 in diverse healthcare settings (e.g. primary care or long-term care) and at different time points during the course of the disease. Methods: The initial questionnaire was developed on the basis of literature search and analysis, reviewed by clinical experts, and evaluated in two focus groups. The revised version was pilot-tested on 39 individuals with diabetes type 2, type 1 and gestational diabetes. Results: The final questionnaire reveals the most important information needs in diabetes. A choice task, a rating task and open-ended questions are combined. First, participants have to choose three topics that interest them out of a list with 12 general topics and specify in their own words their particular information needs for the chosen topics. They are then asked how informed they feel with regard to all topics (4-point Likert-scale), and whether information is currently desired (yes/no). The questionnaire ends with an open-ended question asking for additional topics of interest. Conclusions: Careful selection of topics and inclusion of open-ended questions seem to be essential prerequisites for the unbiased assessment of information needs. The questionnaire can be applied in surveys in order to examine patterns of information needs across various groups and changes during the course of the disease. Such knowledge would contribute to more patient-guided information, counselling and support.
    Full-text · Article · Jan 2016
    • "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]. "
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    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.
    No preview · Article · Nov 2015 · Patient Education and Counseling
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