Preferences For Shared Decision Research Articles

``It's My Body'': Does Patient Involvement in Decision Making Reduce Decisional Conflict?

This study explores how much people with HIV/AIDS wanted and how much they actually perceived being involved in the decision to take or not to take antiretroviral treatment (ART). The congruence between desired and perceived decisional involvement was also related to decisional conflict. Cross-sectional (N = 79), the Control Preferences Scale assessed patients' preferred versus perceived role in treatment decision making. The Decisional Conflict Scale measured patients' perceived difficulties in decision making. Although a minority of patients (32%) perceived their role as shared decision making, the majority (59%) preferred shared decision making. Some did not desire shared decision making, with 28% preferring to decide on their own versus 13% wanting their physicians to decide for them. Overall, 58% did not feel they had achieved their desired role in decision making (half of whom perceived more control and the other half less control than preferred). Participants declining ART felt more pressure to decide alone compared with those taking ART (P < 0.01). Decisional conflict was expressed by 53% and was highest when physicians unilaterally made decisions about ART for patients who preferred shared decision making (P < 0.001). In this study, most physicians do not meet their patients' desired roles in decision making. One-third of people taking ART feel less involved than they desire. More critically, half of those declining ART feel pressured to decide alone, suggesting that physicians should remain involved in the decision to reject treatment, as this requires careful monitoring and periodical revisiting. Because lack of shared decision making is related to decisional conflict, physicians may reduce decisional conflict by meeting patients' desires for shared decision making.

Shared Decision-Making Preferences of People With Severe Mental Illness

Shared Decision-Making Preferences of People With Severe Mental Illness

Shared Decision-Making Preferences of People With Severe Mental Illness

Perceived roles and preferences were explored for shared decision making among persons with severe mental illnesses. In this pilot study, 30 adult clients with severe mental illness in a community mental health center were surveyed about decision making regarding psychiatric medications, rehabilitation, and general medical care. Clients generally expressed a desire for greater participation in decisions about psychiatric care than they currently experienced. Regarding use of new psychiatric medications, 23 persons (77%) preferred autonomous or shared roles, but only 11 (37%) rated their current roles as more than passive (z=-2.83, p=.005). Clients were less likely to prefer a passive role in medication decisions about psychiatric care than about general medical care (seven persons, or 23%, versus 23 persons, or 77%; z=-3.01, p=.003). Most clients with severe mental illnesses prefer shared decision making, particularly in relation to their mental health care.

Clinical decision-making: Patients’ preferences and experiences

Objective To determine the congruence between patients’ preferred style of clinical decision-making and the style they usually experienced and whether this congruence was associated with socio-economic status and/or the perceived quality of care provided by the respondent's regular doctor. Methods Cross-sectional survey of the American public using computer-assisted telephone interviewing. Results Three thousand two hundred and nine interviews were completed (completion rate 72%). Sixty-two percent of respondents preferred shared decision-making, 28% preferred consumerism and 9% preferred paternalism. Seventy percent experienced their preferred style of clinical decision-making. Experiencing the preferred style was associated with high income (OR, 1.59; 95% CI, 1.16–2.16) and having a regular doctor who was perceived as providing excellent or very good care (OR, 2.39; 95% CI, 1.83–3.11). Conclusion Both socio-economic status and having a regular doctor whom the respondent rated highly are independently associated with patients experiencing their preferred style of clinical decision-making. Practice implications Systems which promote continuity of care and the development of an on-going doctor–patient relationship may promote equity in health care, by helping patients experience their preferred style of clinical decision-making.

Hospital patients' preferences for involvement in decision-making. A questionnaire survey of 1040 patients from a Swiss university hospital.

Assessing patients' preferences for shared decision-making and receiving information. Cross-sectional cohort study. University Hospital in Northwest Switzerland. 1825 in-patients (mean age: 58 years, 48.7% female) were asked to participate, 1040 patients responded (59%). Proportion of positive answers to two questions depicting typical elements of shared decision-making plus a question asking for patients' information needs. These questions were embedded in a questionnaire sent to patients two weeks after discharge from the hospital, asking for perceived deficits during their hospital stay and socio-demographic characteristics. 779/947 (79.1%) agreed to the statement: "One should stick to the physician's advice even if one is not fully convinced of his ideas". 620/945 (65.6%) agreed to the statement: "It should completely be left to physicians to decide on a patient's treatment." 914/952 (96%) agreed to the statement: "Even when the news is bad the patient must be informed." Older patients and less educated patients are more likely to agree with the first two statements, patients with a non-Swiss cultural background favour the information needs statement slightly less than other patients (92.4 vs 96.7% agreement). The severity of illness had no influence on agreeing or not. However, patients who disagreed on any statement were more likely to report a lack of information from the hospital. A substantial number of patients in this study wanted the physician to take medical decisions. Yet, almost all patients wanted honest information about their health status. Health professionals have to find out to what extent an individual patient wants to be involved in decision-making.

Decision-control preferences in patients with advanced cancer

8069 Background: Many argue that when patients with advanced cancer face medical decisions, the chief value that clinicians must respect is patient autonomy, and when patients cannot speak for themselves, decisions should be based on substituted judgments about patients' autonomous wishes. Others have suggested that the decision making process is more complex. Methods: We interviewed 130 patients with a ≥ 50% 2-year expected mortality (47 with advanced gastrointestinal or lung cancer, 52 with Class III-IV heart failure, and 31 with amyotrophic lateral sclerosis) at 2 teaching hospitals using a modified Decision Control Preferences Scale. We assessed the extent to which patients would involve others in medical decisions along 3 dimensions: patient-physician, patient-family, and physician-family, considering their present state and a hypothetical unconscious state. Results: A plurality of all patients (44%), presuming they were conscious, wanted to share decision making with their families. However, compared with the others, cancer patients were more likely to prefer decision making independent of their family (64% vs. 42%, P = .01). Overall, presuming they were conscious, most patients (52%) wanted to share decision making with their physicians. However, compared with others, patients with cancer preferred decision making independent of their physicians (43% vs. 29%, P = .07). Comparing decision control preferences for the unconscious with the conscious state, patients were significantly more likely to prefer that their physicians should decide based on the patient's best interest rather than on their autonomous preferences (P < .001). For the hypothetical unconscious state, few patients (19%) weigh the physician's views more than their families'. A plurality (48% overall, 53% cancer) prefer equal family/physician input. Conclusions: A plurality of patients preferred shared decision-making; a minority preferred autonomous decision-making. However, when capable, patients with cancer were more likely than others to prefer autonomous decision making. The pattern of preferences for the hypothetical unconscious state is more complicated than might be predicted by the autonomy model. No significant financial relationships to disclose.

Decision-control preferences in patients with advanced cancer

8069 Background: Many argue that when patients with advanced cancer face medical decisions, the chief value that clinicians must respect is patient autonomy, and when patients cannot speak for themselves, decisions should be based on substituted judgments about patients' autonomous wishes. Others have suggested that the decision making process is more complex. Methods: We interviewed 130 patients with a ≥ 50% 2-year expected mortality (47 with advanced gastrointestinal or lung cancer, 52 with Class III-IV heart failure, and 31 with amyotrophic lateral sclerosis) at 2 teaching hospitals using a modified Decision Control Preferences Scale. We assessed the extent to which patients would involve others in medical decisions along 3 dimensions: patient-physician, patient-family, and physician-family, considering their present state and a hypothetical unconscious state. Results: A plurality of all patients (44%), presuming they were conscious, wanted to share decision making with their families. However, compared with the others, cancer patients were more likely to prefer decision making independent of their family (64% vs. 42%, P = .01). Overall, presuming they were conscious, most patients (52%) wanted to share decision making with their physicians. However, compared with others, patients with cancer preferred decision making independent of their physicians (43% vs. 29%, P = .07). Comparing decision control preferences for the unconscious with the conscious state, patients were significantly more likely to prefer that their physicians should decide based on the patient's best interest rather than on their autonomous preferences (P < .001). For the hypothetical unconscious state, few patients (19%) weigh the physician's views more than their families'. A plurality (48% overall, 53% cancer) prefer equal family/physician input. Conclusions: A plurality of patients preferred shared decision-making; a minority preferred autonomous decision-making. However, when capable, patients with cancer were more likely than others to prefer autonomous decision making. The pattern of preferences for the hypothetical unconscious state is more complicated than might be predicted by the autonomy model. No significant financial relationships to disclose.

Patients' preferences for risk disclosure and role in decision making for invasive medical procedures.

To assess the level of involvement patients want in decision making related to the acceptance or rejection of an invasive medical intervention and whether their preference for decision making is related to their preference for qualitative (verbal) or quantitative (numeric) information about the risks of the procedure. A university-based Department of Veterans Affairs Medical Center. Cross-sectional study using structured interviews of consecutive patients seen for continuity care visits in a general medicine clinic. Four hundred and sixty-seven consecutive patients with a mean age of 65.2 years (SD 10.70 years, range 31-88 years) and with a mean of 12.6 years (SD 2.96 years, range 0-24 years) of formal education. In the context of an invasive diagnostic or therapeutic intervention, patients were asked whether they preferred patient-based, physician-based, or shared patient-physician decision making. Patients were asked to give the ratio of patient-to-physician decision making they preferred, and whether they preferred discussions using words, numbers, or both. Of 467 subjects, 318 (68%) preferred shared decision making; 100 (21.4%) preferred physician-based decision making; and 49 (10.5%) preferred patient-based decision making. In terms of risk disclosure, 436 (93.4%) preferred that their physician disclose risk information to them. Of these 436 patients, 42.7% preferred disclosure of information about the probability of adverse outcomes using qualitative (verbal) expressions of probability; 35.7% preferred disclosure in terms of quantitative (numeric) expressions of probability; and 9.8% preferred disclosure in both qualitative and quantitative terms. Younger patients (odds ratio [OR] 0.96; confidence interval [CI] 0.93, 0.99), patients who had at least one stroke (OR 3.03; CI 1.03, 8.90), and patients who preferred to discuss risk information with their physicians in terms of numbers (OR 2.39; CI 1.40, 4.06) tended to prefer patient-based or shared decision making. Male veterans consistently preferred shared patient-physician decision making in the context of invasive medical interventions.