Patient Preferences for Medical Decision Making

TLDR

Although most patients prefer to delegate decisions to physicians, preferences vary significantly by characteristics such as coping style and health value, with active copers more likely to seek an active role. The study aimed to identify determinants of patients’ preferences for participation in medical decision making using data from 2,197 chronic‑disease patients in the Medical Outcomes Study. The authors used multivariate logistic regression on this cohort to estimate how sociodemographic, clinical, psychosocial, and lifestyle factors influence decision‑making preferences. The analysis revealed that 69 % of patients preferred to defer decisions to physicians, with older age and lower education reducing the likelihood of an active role, while women, patients with depression, and those with active coping strategies were more likely to seek active participation, whereas severe diabetes, heart disease, and high health value were associated with lower likelihood; thus, patient involvement strategies must be tailored to individual characteristics.

Abstract

To identify the determinants of patient preferences for participation in medical decision making.Data were analyzed for 2,197 patients from the Medical Outcomes Study, a 4-year observational study of patients with chronic disease (hypertension, diabetes, myocardial infarction, congestive heart failure, and depression). Multivariate logistic regression models estimated the effects of patients' sociodemographic, clinical, psychosocial, and lifestyle characteristics on their decision-making preferences.A majority of the patients (69%) preferred to leave their medical decisions to their physicians. The odds for preferring an active role significantly decreased with age and increased with education. Women were more likely to be active than men (odds ratio [OR] = 1.44, P < 0.001). Compared with patients who only suffered with unsevere hypertension, those with severe diabetes (OR = 0.62, P = 0.04) and unsevere heart disease (OR = 0.45, P = 0.02) were less likely to prefer an active role. Patients with clinical depression were more likely to be active (OR = 1.64, P = 0.01). Patients pursuing active coping strategies had higher odds for an active role than "passive" copers, while those who placed higher value on their health were less likely to be active than those with low health value (OR = 0.59, P < 0.001).Although a majority of patients prefer to delegate decision making to physicians, preferences vary significantly by patient characteristics. Approaches to enhancing patient involvement will need to be flexible and accommodating to individual preferences in order to maximize the benefits of patient participation on health outcomes.