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Clinical Factors That Influence Patients' Desire for Participation in Decisions About Illness
Dorcas Mansell, MD, MPH;
Roy M. Poses, MD;
Lewis Kazis, ScD;
Corey A. Duefield, MPH
Arch Intern Med. 2000;160:2991-2996.
Background Clinical practice often fails to optimize patient participation in decisions about serious illness. Prior studies are unclear about whether the type of decision and prior illness experience affect the patient's preferences for participation in decision making. Most studies of patient decision making have not addressed decisions about serious illness.
Objective To determine whether the type of illness and nature of the decision predict the patient's preferences for involvement in making decisions.
Design Study of randomly selected patients' responses to vignettes about cancer, acute myocardial infarction, and diabetes coupled with cross-sectional survey and chart review.
Setting Outpatient Veterans Affairs medical clinic.
Patients A total of 255 patients with a mean age of 63.2 years (95.2% male; 61.9% married).
Main Results Patients wanted to share hypothesized major decisions with their physicians (mean score, 2.9; 1 = only physician, 5 = only patient) but wanted less involvement in hypothesized minor decisions (mean score, 2.5). Patients with recent severe heart disease (myocardial infarction, bypass surgery, angioplasty) wanted more involvement in decisions about acute myocardial infarction than did patients with stable angina or no heart disease; prior experience with diabetes did not affect decisions about diabetes. Factor analysis of the vignette items yielded 3 types of decisions that we consider to reflect major, minor, and patient behavior decisions. Mean scores were 2.9 for major decisions, 2.1 for minor decisions , and 2.7 for patient behavior decisions.
Conclusions Patients want to share in major decisions with their physicians but prefer to be less involved in minor decisions. For some illnesses, such as myocardial infarction, prior experience with the illness increases the patients' desire for participation in decision making.
From the Department of Medicine, Division of General Internal Medicine, University of Alabama School of Medicine, Birmingham (Dr Mansell); Center for Health Care Quality, Outcomes, and Economic Research, Bedford Veterans Affairs Medical Center, Bedford, Mass (Drs Mansell and Kazis); Division of General Internal Medicine, Memorial Hospital of Rhode Island, Pawtucket (Dr Poses and Mr Duefield); and Departments of Medicine and Community Health (Dr Poses and Mr Duefield) and Health Services (Dr Kazis), Brown University School of Medicine, Providence, RI.
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