Autonomy Preferences Research Articles

Professional self-employment, new power and the sharing economy: Some cautionary tales from Uber

AbstractThis article reflects on some of the major changes in the ways that people are working today, changes often driven by a preference for greater autonomy and choice, but also to work on a sharing, collaborative or networked basis. Many of the growing numbers of independent professionals are attracted by these ways of working. Developments in Information and Communication Technology have been critical, especially in enabling services, including professional services, to be delivered via internet platforms. This has created, in effect, new forms of intermediation and increasingly complex work relationships. These developments have often proved very controversial, as instanced by the disputes surrounding Uber, the international, internet-based taxi provider. Many of these changes also raise issues of accountability and work quality, along with creating new patterns of work relationships. Inevitably, the changes also highlight the role of regulation, which is the main focus of this article The topic is explored against a backdrop of much recent deregulation, challenges to so-called ‘red tape’ and laissez faire policies. The myriad of disputes and litigation involving Uber is examined and reflected upon. There are, of course, many differences between the taxi drivers of Uber and the designers, journalists, engineers and consultants, typical of independent professional working, but there are also some key parallels and experiences that provide a cautionary tale!

Subjective and objective knowledge and decisional role preferences in cerebrovascular patients compared to controls.

BackgroundRisk knowledge and active role preferences are important for patient involvement in treatment decision-making and adherence. Although knowledge about stroke warning signs and risk factors has received considerable attention, objective knowledge on secondary prevention and further self-esteem subjective knowledge have rarely been studied. The aim of our study was to investigate knowledge and treatment decisional role preferences in cerebrovascular patients compared to controls.MethodsWe performed a survey on subjective and objective stroke risk knowledge and autonomy preferences in cerebrovascular patients from our stroke outpatient clinic (n=262) and from pedestrians on the street taken as controls during a “World Stroke Day” (n=274). The questionnaire includes measures for knowledge and decisional role preferences from previously published questionnaires and newly developed measures, for example, subjective knowledge, revealed on a visual analog scale.ResultsThe overall stroke knowledge was low to moderate, with no differences between patients and controls. Knowledge about secondary prevention was particularly low. Only 10%–15% of participants correctly estimated the stroke absolute risk reduction potential of aspirin. The medical data interpretation competence was moderate in both groups. Age and basic mathematical and statistical understanding (numeracy) were the only independent predictors of objective stroke knowledge, whereas previous stroke had no impact on stroke knowledge. However, patients were thought to be better informed than controls. Approximately 60% of both patients and controls claimed to prefer a shared decision-making approach in treatment decisions.ConclusionThe level of stroke risk knowledge in patients with cerebrovascular diseases was as low as in randomly selected pedestrians, although patients felt better informed. Both groups preferred involvement in treatment decision-making. We conclude that educational concepts for increasing awareness of knowledge gaps as well as for stroke risk and for prevention strategies are needed.

Patient education programme on immunotherapy in multiple sclerosis (PEPIMS): a controlled rater-blinded study

Objective: To investigate the effectiveness of a multi-component evidence-based education programme on disease modifying therapies in multiple sclerosis. Design: Controlled trial with two consecutive patient cohorts and a gap of two months between cohorts. Setting: Three neurological rehabilitation centres. Subjects: Patients with multiple sclerosis within rehabilitation. Interventions: Control group (CG) participants were recruited and received standard information. Two months later, intervention group (IG) participants were recruited and received a six-hour nurse-led interactive group education programme consisting of two parts and a comprehensive information brochure. Main measures: Primary endpoint was “informed choice”, comprising of adequate risk knowledge in combination with congruency between attitude towards immunotherapy and actual immunotherapy uptake. Further outcomes comprised risk knowledge, decision autonomy, anxiety and depression, self-efficacy, and fatigue. Results: A total of 156 patients were included (IG=75, CG=81). The intervention led to significantly more participants with informed choice (IG: 47% vs. CG: 23%, P=0.004). The rate of persons with adequate risk knowledge was significantly higher in the IG two weeks after the intervention (IG: 54% vs. CG: 31%, P=0.007), but not after six months (IG: 48% vs. CG: 31%, P=0.058). No significant differences were shown for positive attitude towards disease modifying therapy (IG: 62% vs. CG: 71%,P=0.29) and for disease modifying therapy status after six months (IG: 61.5% vs CG: 68.6%, P=0.39). Also no differences were found for autonomy preferences and decisional conflict after six months. Conclusion: Delivering evidence-based information on multiple sclerosis disease modifying therapies within a rehabilitation setting led to a marked increase of informed choices.

Decision-making for non-invasive prenatal testing for Down syndrome: Hong Kong Chinese women's preferences for individual vs relational autonomy.

Individual autonomy in antenatal screening is internationally recognized and supported. Policy and practice guidelines in various countries place emphasis on the woman's right to make her own decision and are related to concepts such as self-determination, independence, and self-sufficiency. In contrast, the dominant perspective in Chinese medical ethics suggests that the family is pivotal in making medical decisions, hence providing support for relational autonomy. This study explored Hong Kong Chinese pregnant women's preferences for individual vs relational autonomy for non-invasive prenatal testing (NIPT) for Down syndrome. A qualitative study was carried out using semi-structured interviews with 36 women who had undertaken NIPT in Hong Kong. The findings show that most Hong Kong Chinese women valued aspects of both relational and individual autonomy in decision-making for NIPT. Women expected support from doctors as experts on the topic and wanted to involve their husband in decision-making while retaining control over the outcome. Somewhat surprisingly, the findings do not provide support for the involvement of family members in decision-making for NIPT. The adequacy of current interpretations of autonomy in prenatal testing policies as an individual approach needs discussion, where policy developers need to find a balance between individual and relational approaches.

Physical Health Decision-Making Autonomy Preferences for Adults with Severe Mental Illness in Integrated Care

ABSTRACTPeople with severe mental illness (SMI) often have physical health comorbidities that are associated with high morbidity and mortality rates. Although work is being done to integrate physical and behavioral health care in order to address the primary health-care needs of persons with SMI, very little is known about their health-care behaviors and how they make their treatment decisions. We used a cross-sectional, survey design to explore the relationship between variables related to decision-making autonomy preferences for persons with SMI (N = 95) who were seen in an integrated health-care clinic. Descriptive and bivariate analyses revealed that the majority of participants in this sample preferred shared decision making in their physical health care, that male participants desired higher autonomy in decision making, and that lower perceived autonomy support from the physician was related to higher desired autonomy in decision making The findings suggest that social workers and other mental and physical health providers should explore the unique decision-making autonomy preferences of primary care service users with SMI, as these preferences vary among clients, and that honoring individual preferences would provide a more person-centered care environment.

How the Sun Came Shining: Stevens and Wilbur on Waking Up

Awake, thou that sleepest, and arise from the dead, and Christ shall give thee light. EPHESIANS 5:14, KING JAMES VERSION In poems written throughout their careers both Wallace Stevens and Richard Wilbur use venerable tradition associating the sun with spiritual or intellectual enlightenment (the pun is nearly inevitable), and both recognize autonomy--freedom of the self--as an aspect of enlightenment. Two important examples of these poems, Stevens's Latest Freed Man and Wilbur's Love Calls Us to the Things of This World, combine the image of sunrise with the image of man waking up in order to examine the relationship between human knowing and human responsibility in the world. The question addressed by each poem is how the sun [comes] shining. (1) Despite employing similar images, the two poets start from substantially different epistemological assumptions that lead them to correspondingly different anthropological conclusions. Below I develop detailed readings of both poems as means of understanding the importance of these differences. Before turning to Stevens and Wilbur, will be useful to sketch the tradition they inherit, first in pre-modern synthesis summarized by the Dutch Reformed theologian Herman Bavinck, and then in modern versions expressed by Immanuel Kant and Henry David Thoreau. Bavinck concisely reviews the pervasiveness of sunlight as an epistemological image: Plato clarified ... scientific process [that is, knowledge confirmation] by means of beautiful and striking image. Just as the sun objectively illuminates the object and subjectively the human eye, so God, or the idea of the good, is the light by which the truth or essence of things becomes visible and by which at the same time our mind is able to see and recognize the truth. Augustine adopted this image and said, God is the sun of minds. In the unchangeable light of truth, our mind sees and makes judgments about all things. ... Just as with the physical eye we cannot see anything unless the sun sheds its rays over it, so neither can we see any truth except in the light of God, which is the sun of our knowledge. (2) Bavinck goes on to paraphrase St. Thomas Aquinas, who employs the same idea: just as we look into the natural world, not by being in the sun ourselves, but by the light of the sun that shines on us, so neither do we see things in the divine being but by the light that, originating in God, shines on our intellect. Reason in us is that divine light; is not itself the divine logos, but participates in it (232) (3) (Stevens alludes to Aquinas as doctor of the church in Latest Freed Man.) Bavinck's dense summary tacitly endorses pre-modern Western cultural syntheses of classical and Christian notions, touching on several traditionally recognized tensions that remained under scrutiny during the early twentieth century: that between and object, that between the invisible (reality, the Kantian noumena) and the visible (appearance, the Kantian phenomena), that between spiritual and physical, and so on. Bavinck's summary ofWestern tradition comes near the end of chapter that questions the epistemological priority given to autonomous reason. The chapter closes by affirming creation as a beautiful and by insisting that human reason functions reliably because of correspondence or kinship between object and subject (233) (4) Significantly, he cites the Belgic Confession as the immediate source of his phrasing: world is an embodiment of the thoughts of God; is 'a beautiful book in which all creatures, great and small, are as letters to make us ponder the invisible things of God' (art. 2, Belgic Confession) (233). His reliance on the authority of creedal document resists the modern (Enlightenment) preference for intellectual autonomy favored by Kant (among others). It will be useful to let Bavinck's comments direct our attention to Kant's best-known recommendation of autonomy in An Answer to the Question: 'What is Enlightenment? …

A human-centered approach to designing invasive species eradication programs on human-inhabited islands

Targeting human-inhabited islands for invasive species eradication campaigns layers social complexity on top of technical complexity. Attaining widespread support and cooperation for eradications requires programs designed to meet diverse stakeholder needs. The Tierra del Fuego archipelago serves as an informative case study and model for understanding and incorporating private landowner preferences into a proposed eradication program. We employed a human-centered approach to characterize landowner perceptions, preferences, and potential support for a large-scale initiative to eradicate the invasive North American beaver (Castor canadensis) from Tierra del Fuego. We used a factorial vignette survey to understand how attributes of an eradication program are related landowners' decisions to participate. Landowners rated four programs that randomly varied by contract length, required level of landowner involvement, institutional administrator, payment, social norms, and probability of a successful eradication. Landowners in Tierra del Fuego were generally more willing to participate under three conditions: (1) increased payments, (2) increased expectations of program success, and (3) low requirements for landowner involvement. Our results suggest that incorporating feedbacks into program design can increase public support, and that landowners in Tierra del Fuego may not express the same preference for autonomy that exists in other regions of the world. Understanding and incorporating stakeholder preferences, perceptions, and beliefs into management strategies is an ongoing challenge for conservation practitioners worldwide. The vignette survey approach provides a cost-effective, rapid, and scalable tool to document and incorporate local values into conservation program design. Programs built using a human-centered approach will complement landowners’ land-use objectives, increase cooperation, and ultimately improve conservation outcomes.

The power of micro-moves in cultivating regardful relationships: Implications for work–home enrichment and thriving

In this article, we highlight the power of micro-moves in cultivating positive regard from work and nonwork sources (stakeholders) and how the latter facilitates work–home enrichment (in both directions) and can foster employee thriving in the work and nonwork domains. Integrating the emerging literature on micro generative moments (Dutton & Carlsen, 2011), the Resource-Gain-Development model of enrichment (Wayne et al., 2007) and the socially embedded model of thriving (Spreitzer et al., 2005), we specify how micro-relational moves can build regardful relationships (i.e., positive regard) and how this, in turn, can foster greater work–home enrichment and thriving. Our theoretical model further suggests that employees who sense a positive regard from their managers and coworkers as well as from their relatives and friends are likely to experience significant development, affect and capital gains (high work–home enrichment), which expands opportunities to thrive (i.e., develop an enhanced capacity for learning and a sense of vitality). We also suggest that work–home enrichment fosters greater thriving in life, but that this relationship depends on personal and contextual characteristics, including people's level of mindfulness, motivation to learn, preferences for integration (personal characteristics) and job autonomy and quality of family life (contextual characteristics). We aim to advance theorizing about generative relationships and the context in which they allow individuals to experience work–home enrichment and help them to thrive and realize their full potential.

When Are Monetary Policy Preferences Egocentric? Evidence from American Surveys and an Experiment

This article enters the international/comparative political economy debate about whether individual‐level macroeconomic policy preferences are egocentric and, if so, on what basis (factors, sectors, or firms). It argues that contextual information may function as a precondition for the emergence of egocentric preferences. With a focus on the trade‐off between using monetary policy for a domestic or an international goal, it presents evidence from three original American surveys using informative vignettes to show how monetary policy preferences exhibit firm‐based egocentric variation: Individuals whose employer does most of its business in overseas markets have a lesser preference for domestic monetary autonomy. It also presents evidence from a survey experiment to show how the strength of this egocentric relationship depends on the informative power of the vignette: A more contextually informative vignette produces a stronger relationship between overseas business activity and a preference against domestic monetary autonomy.

Exploring Constructivist Perspectives in the College Classroom

The study used Explanatory Sequential Design (ESD) of Mixed-Methods to investigate college students’ and instructors’ perspectives of constructivist learning environment (CLE). Students, including graduates and undergraduates from a Midwestern university, rated their preference for personal relevance, collaboration, negotiation, and autonomy as key learning experiences embodied in CLE. Results indicated that undergraduates were more likely than graduate students to prefer collaboration and negotiation experiences. Expanding on the results of students’ quantitative ratings, students’ and instructors’ perspectives of collaboration were explored. Eight participants (four students and four instructors) participated in one-on-one interview sessions. Themes that emerged from the qualitative analysis showed that the differences in students’ preference for collaboration related to students’ perceptions of unequal opportunities to collaborate, perceived benefits, and diverse backgrounds and orientations. In addition, conditions necessary for effective collaboration in the college environment were explored. Thematic analysis produced three themes: understanding collaboration process; monitoring, assessment, and evaluation system; and group composition. Implications for practice in the college classroom have been discussed.

Factor structure of the autonomy preference index in people with severe mental illness

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.

Who Likes to Fend for Oneself? Revenue Autonomy Preferences of Subnational Politicians in Germany

In the context of German federalism and its current reform debate, this article explores the federal reform preferences of members from all sixteen German Lander parliaments. We examine the role of Lander self-interest, party ideology, and individual characteristics to understand the preferences for tax autonomy and fiscal equalization. One clear result is the joint importance of ideology and jurisdictional interests. We use the empirical results to simulate which type of reform would garner the necessary support in Germany’s upper house, the Bundesrat. Finally, we draw conclusions for federal reform strategies which could enjoy the support of veto players who feel disadvantaged.

Braving difficult choices alone: children's and adolescents' medical decision making.

ObjectiveWhat role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them.MethodsSixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice.ResultsChildren and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses.ConclusionsMinors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process.

Why are you here again? Concordance between consumers and providers about the primary concern in recurring psychiatric visits

Patient-centered care has become increasingly important over the last decade, both in physical and mental health care. In support of patient-centered care, providers need to understand consumers׳ primary concerns during treatment visits. The current study explored what primary concerns were brought to recurring psychiatric visits for a sample of adults with severe mental illness (N=164), whether these concerns were concordant with those recognized by providers, and which factors predicted concordance. We identified 17 types of primary concerns, most commonly medications and symptoms, with only 50% of visits showing evidence of at least partial agreement between consumers and providers. Contrary to expectations, consumer demographics, activation, trust, and perceptions of patient-centeredness were not predictive, while greater preferences for autonomy predicted poorer agreement. Our findings highlight the need for interventions to promote a shared understanding of primary concerns in recurring psychiatric visits. Further attention is needed to ensure the provision of patient-centered care such that consumer concerns are acknowledged and addressed within recurring psychiatric visits.

Preferences for autonomy in end-of-life decision making in modern Korean society

The demand for autonomy in medical decision making is increasing among Korean people, but it is not well known why some people prefer autonomy in decision making but others do not. The aim of this study was to determine the extent to which Korean adults wished to exercise autonomy in the process of decision making regarding end-of-life treatment and to determine whether economic issues and family functioning, in particular, were associated with preferences for participation in decision making in Korean people. This study was a cross-sectional correlational study using a survey. Data were collected using structured questionnaires from 354 patients or their families who visited ambulatory departments at two general hospitals in South Korea, recruited by the proportionate quota sampling method. Data analysis was performed using multinomial logistic regression analyses. The study was approved by the hospitals' directors and the ethics committee of Kyungpook National University Hospital. Written informed consent was given by all participants. A majority of Korean people wanted to make autonomous decisions regarding treatment at the end of life. Preferences for autonomous decision making regarding end-of-life treatment, rather than relying on family, showed a significant increase in association with poor family functioning and low income. Results of this study suggested the necessity for development of alternatives to a dominant traditional "family-centered" approach in Korean people, in order to enhance end-of-life decision making for people who wish to take an active role in the decision-making process. Healthcare providers need to examine not only patients' preferred decision-making style but also any reasons for their choice, in particular, family conflict and financial burden.

An Analysis of Java Programming Behaviors, Affect, Perceptions, and Syntax Errors among Low-Achieving, Average, and High-Achieving Novice Programmers

In this article we quantitatively and qualitatively analyze a sample of novice programmer compilation log data, exploring whether (or how) low-achieving, average, and high-achieving students vary in their grasp of these introductory concepts. High-achieving students self-reported having the easiest time learning the introductory programming topics. In a quantitative analysis, though, high-achieving and average students were: 1) more effective at debugging (on average, as quantified by Jadud's Error Quotient (EQ)) than low-achieving students; and 2) were least confused, as quantified using Lee's confusion metric. However, the differences in EQ and confusion between groups were not statistically significant. This implied that all groups struggled with programming to similar extents. This finding was further supported by was used to delineate two sets of variables. The results indicate that preference for autonomy in computer science learning positively predicts selfefficacy in learning computer science with the strongest coefficient. Computer science learner preference for teacher control is also a positive predictor. However, preference for participation in managing the computer class and preference for depending on the teacher did not play a significant role in the students' self-efficacy in learning computer science.

Exploring the Relationships between Self-Efficacy and Preference for Teacher Authority among Computer Science Majors

Teacher-centered instruction has been widely adopted in college computer science classrooms and has some benefits in training computer science undergraduates. Meanwhile, student-centered contexts have been advocated to promote computer science education. How computer science learners respond to or prefer the two types of teacher authority, student-centered versus teacher-centered, has not yet been fully examined. Therefore, the purpose of the present study is to probe how preference for teacher-centered learning or student-centered learning may affect self-efficacy in learning computer science among undergraduate computer science majors. The participants were 804 college computer science majors across Taiwan. They anonymously responded to the “Teacher Authority Scale” (with four subscales: “Preference for autonomy,” “Preference for participative management,” “Preference for dependency,” and “Preference for teacher control”) and the “Self-efficacy in Learning Computer Science Scale.” Structural equation modeling (SEM) was used to delineate two sets of variables. The results indicate that preference for autonomy in computer science learning positively predicts selfefficacy in learning computer science with the strongest coefficient. Computer science learner preference for teacher control is also a positive predictor. However, preference for participation in managing the computer class and preference for depending on the teacher did not play a significant role in the students' self-efficacy in learning computer science.

The Relationship among Autonomy, Thinking Styles and Language Learning Strategy Use in Iranian EFL Learners

The present paper aims at investigating the relationship among Iranian EFL learners’ attitudes to autonomous learning, thinking styles, and their language learning strategy use. The instruments were Cotterall’s (1995) Attitudes to Autonomous Language Learning Inventory (AALLI), Sternberg’s (1997) Thinking Styles Inventory (TSI) and Oxford's (1990) Strategy Inventory for Language Learning (SILL). The participants were 92 Iranian EFL upper-intermediate and advanced learners of Hormozgan province. The results of the Pearson Product Moment Correlation indicated that a) there is a significant relationship between self-attitude to autonomy and all the subcategories of strategy use, but there is no significant relationship between beliefs about teacher’s role and strategy use except the social strategy b) a significant relationship exists between self-attitude to autonomy and most of the subcategories of thinking styles i.e. legislative, judicial, hierarchic, global, local, internal, external and liberal thinking styles and c) there is no significant difference between males and females in the preferences for strategy use and autonomy, however significant differences were found in the preferences for legislative, judicial and internal thinking styles.

ADOLESCENT AND PARENTAL PERCEPTIONS OF MEDICAL DECISION‐MAKING IN HONG KONG

To investigate whether Chinese adolescents in Hong Kong share similar perceptions with their Western counterparts regarding their capacity for autonomous decision-making, and secondarily whether Chinese parents underestimate their adolescent children's desire and capacity for autonomous decision-making. 'Healthy Adolescents' and their parents were recruited from four local secondary schools, and 'Sick Adolescents' and their parents from the pediatric wards and outpatient clinics. Their perceptions of adolescents' understanding of illnesses and treatments, maturity in judgment, risk-taking, openness to divergent opinions, pressure from parents and doctors, submission to parental authority and preference for autonomy in medical decision-making are surveyed by a 50-item questionnaire on a five-point Likert scale. Findings indicate that Chinese adolescents aged 14-16 perceive themselves to possess the necessary cognitive abilities and maturity in judgment to be autonomous decision-makers like their Western counterparts. Paradoxically, although they hesitate to assert their autonomy, they are also unwilling to surrender that autonomy to their parents even under coercion or intimidation. Parents tend to underestimate their adolescents' preferences for making autonomous decisions and overestimate the importance of parental authority in decision-making. '14-and-above' Chinese adolescents in Hong Kong perceive themselves as capable of autonomous decision-making in medically-related matters, but hesitate to assert their autonomy, probably because of the Confucian values of parental authority and filial piety that are deeply embedded in the local culture.

Patient preference for autonomy: does it change as risk rises?

It is unclear how patient preferences for autonomy vary given different severity of a single condition. To assess patient preferences for autonomy in making decisions about taking medication to prevent a heart attack, across a wide range of personal calculated cardiovascular disease (CVD) 5-year risk. Consecutive eligible patients in family practice waiting rooms in Auckland, New Zealand self-completed a questionnaire. Questions related to a hypothetical cardiovascular medication, where risks and benefits were framed from their personal predicted 5-year CVD risk. Participant preference for autonomy was measured by ranking their decision-making preference on 5-point scale from 'doctor only' to 'patient only'. There were 934 participants, with personal predicted 5-year cardiovascular risks that ranged from 5% to 30%. Preference for autonomy decreased as CVD risk increased, after adjustment for age, gender, numeracy and ethnicity. Preference for autonomy increased independently among younger participants, women and those who were more numerate. Compared to participants of European ethnicity, those of Pacific, East Asian and Indian Asian ethnicity were more likely to want the doctor to decide. No combination of predicted risk, demographics or attitudes strongly predicted the preference of an individual patient. Clinicians should therefore seek to understand and confirm each patient's preferences.