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Raisa B. Deber, PhD; Nancy Kraetschmer, MSc; Jane Irvine, DPhil

Arch Intern Med. 1996;156(13):1414-1420.

Abstract
Background
Although current ideology suggests patients should be active participants in decision making about their care, the literature suggests that patients wish to be informed but not involved.

Objective
To test the hypothesis that most patients want their physicians to take the responsibility for problem solving (PS, identifying the one right answer), but that many want to be involved in decision-making (DM, selecting the most desired bundle of outcomes) tasks.

Methods
Survey responses from 300 patients undergoing angiogram at a Toronto, Ontario, hospital were analyzed (response rate, 72%). Survey items included scales to measure desire for information and participation, including Autonomy Preference Index, the Krantz Health Opinion Survey, and the Deber-Kraetschmer Problem-Solving Decision-Making Scale measured on a scale from 1 (doctor only) to 5 (patient only).

Results
Patients had a relatively high desire for information. On the Problem-Solving Decision-Making Scale, they overwhelmingly wished the PS tasks to be performed by or shared with the physician (98.4% of the 12 PS scores are between 1 and 3), but wanted to be involved in DM (78% of the 6 DM scores are between 3 and 5). Preference for handing over control to the physician was significantly greater for the vignette involving potential mortality (chest pain) than for the vignettes involving mainly morbidity (urinary problems) or quality of life (fertility).

Conclusions
Although patients do not wish to be involved in PS tasks, few wish to hand over DM control to their physician. These findings suggest 2 major roles for clinicians—assisting patients in PS to structure choices and supporting them in making often difficult decisions.

Arch Intern Med. 1996;156:1414-1420

Author Affiliations
From the Departments of Health Administration (Dr Deber and Ms Kraetschmer) and Psychiatry (Dr Irvine), University of Toronto, Toronto, Ontario.

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