Clinical factors that influence patients' desire for participation in decisions about illness.

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. Arch Intern Med. 2000;160:2991-2996

[1]  R. Deber,et al.  What role do patients wish to play in treatment decision making? , 1996, Archives of internal medicine.

[2]  K. Gleeson,et al.  The do-not-resuscitate order. Still too little too late. , 1990, Archives of internal medicine.

[3]  E. Emanuel,et al.  Decisions at the end of life. Guided by communities of patients. , 1993, The Hastings Center report.

[4]  Barbara Gandek,et al.  Patient and Visit Characteristics Related to Physicians' Participatory Decision-Making Style: Results from the Medical Outcomes Study , 1995, Medical care.

[5]  H. Engelhardt,et al.  Advance Directives on Hospital Admission: A Survey of Patient Attitudes , 1993, Southern medical journal.

[6]  P. Cleary,et al.  Do-not-resuscitate orders for critically ill patients in the hospital. How are they used and what is their impact? , 1986, JAMA.

[7]  S. Kaplan,et al.  Expanding patient involvement in care. Effects on patient outcomes. , 1985, Annals of internal medicine.

[8]  J. Lynn,et al.  Patient Preferences for Communication with Physicians about End-of-Life Decisions , 1997, Annals of Internal Medicine.

[9]  S. Murphy,et al.  Ethnicity and attitudes toward patient autonomy. , 1995, JAMA.

[10]  David S. Krantz.  Cognitive processes and recovery from heart attack: a review and theoretical analysis. , 1980, Journal of human stress.

[11]  A. Ash,et al.  Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients. , 1989, Journal of general internal medicine.

[12]  R. Arnold,et al.  Discussions about Limiting Treatment in a Geriatric Clinic , 1993, Journal of the American Geriatrics Society.

[13]  E. Emanuel,et al.  Advance directives for medical care--a case for greater use. , 1991, The New England journal of medicine.

[14]  T. Heeren,et al.  Roles of physicians, attorneys, and illness experience in advance directives. , 1999, Southern medical journal.

[15]  C Vallbona,et al.  Patient exposition and provider explanation in routine interviews and hypertensive patients' blood pressure control. , 1987, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[16]  S. Kaplan,et al.  Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease , 1989, Medical care.

[17]  N. Hamilton,et al.  Patient preferences for control in medical decision making: a scenario-based approach. , 1996, Family medicine.

[18]  B. Elliott,et al.  Living will completion in older adults. , 1992, Archives of internal medicine.

[19]  J. Kulik,et al.  Health care involvement preferences and social-emotional recovery of male coronary-artery-bypass patients. , 1991, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[20]  S H Kaplan,et al.  Development and testing of a new measure of case mix for use in office practice. , 1995, Medical care.

[21]  E. Emanuel,et al.  How well is the Patient Self-Determination Act working?: an early assessment. , 1993, The American journal of medicine.

[22]  Nease Rf,et al.  Patient desire for information and decision making in health care decisions: the Autonomy Preference Index and the Health Opinion Survey. , 1995 .

[23]  L. Kazis,et al.  Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study. , 1998, Archives of internal medicine.