Patient preference for autonomy: does it change as risk rises?

It is unclear how patient preferences for autonomy vary given different severity of a single condition.

To assess patient preferences for autonomy in making decisions about taking medication to prevent a heart attack, across a wide range of personal calculated cardiovascular disease (CVD) 5-year risk.

Consecutive eligible patients in family practice waiting rooms in Auckland, New Zealand self-completed a questionnaire. Questions related to a hypothetical cardiovascular medication, where risks and benefits were framed from their personal predicted 5-year CVD risk. Participant preference for autonomy was measured by ranking their decision-making preference on 5-point scale from 'doctor only' to 'patient only'.

There were 934 participants, with personal predicted 5-year cardiovascular risks that ranged from 5% to 30%. Preference for autonomy decreased as CVD risk increased, after adjustment for age, gender, numeracy and ethnicity. Preference for autonomy increased independently among younger participants, women and those who were more numerate. Compared to participants of European ethnicity, those of Pacific, East Asian and Indian Asian ethnicity were more likely to want the doctor to decide.

No combination of predicted risk, demographics or attitudes strongly predicted the preference of an individual patient. Clinicians should therefore seek to understand and confirm each patient's preferences.