Predicting the preferences for involvement in medical decision making among patients with mental disorders.

Svea Michaelis,Martin Härter,Hanne Melchior,Birgit Watzke,Holger Schulz,Levente Kriston,Sadaaki Fukui

doi:10.1371/journal.pone.0182203

Abstract

BackgroundThe involvement of patients in medical decision making has been investigated widely in somatic diseases. However, little is known about the preferences for involvement and variables that could predict these preferences in patients with mental disorders.ObjectiveThis study aims to determine what roles mentally ill patients actually want to assume when making medical decisions and to identify the variables that could predict this role, including patients’ self-efficacy.MethodDemographic and clinical data of 798 patients with mental disorders from three psychotherapeutic units in Germany were elicited using self-report questionnaires. Control preference was measured using the Control Preferences Scale, and patients’ perceived self-efficacy was assessed using the Self-Efficacy Scale. Bivariate and multivariate regression analyses were conducted to investigate the associations between patient variables and control preference.ResultsMost patients preferred a collaborative role (57.5%), followed by a semi passive (21.2%), a partly autonomous (16.2%), an autonomous (2.8%) and a fully passive (2.3%) role when making medical decisions. Age, sex, diagnosis, employment status, medical pretreatment and perceived self-efficacy were associated with the preference for involvement in the multivariate logistic model.ConclusionOur results confirm the preferences for involvement in medical decisions of mentally ill patients. We reconfirmed previous findings that older patients prefer a shared role over an autonomous role and that subjects with a high qualification prefer a more autonomous role over a shared role. The knowledge about predictors may help strengthen treatment effectiveness because matching the preferred and actual role preferences has been shown to improve clinical outcome.

Highlights

Patient centeredness has become increasingly important in health care delivery and is justified on both humane [1] and medico-legal grounds [2]
Little is known about the preferences for involvement and variables that could predict these preferences in patients with mental disorders
Sex, diagnosis, employment status, medical pretreatment and perceived self-efficacy were associated with the preference for involvement in the multivariate logistic model

Summary

Introduction

Patient centeredness has become increasingly important in health care delivery and is justified on both humane [1] and medico-legal grounds [2]. Physicians provide professional knowledge and clinical expertise, while the clients best know their personal values and experiences Both parties go through the process of decision-making together, sharing information and preferences so that the patients are able to evaluate the trade-offs between the advantages and disadvantages of an alternative treatment [9]. Both jointly arrive at a consensus on treatment [7, 10]. Little is known about the preferences for involvement and variables that could predict these preferences in patients with mental disorders

Methods

Results

Conclusion