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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Do patients want to participate in medical decision making?
Insights
Patients with hypertension desire more information and discussion about their treatment than clinicians assume. While many patients prefer not to make initial decisions, they wish to be involved in ongoing therapy evaluation.
Area of Science:
- Health communication
- Patient-clinician relationships
- Shared decision making
Background:
- Shared decision making (SDM) is encouraged in healthcare.
- However, patient preferences for participation and clinician awareness of these preferences are not well understood.
Purpose of the Study:
- To investigate patient preferences for participation in decision-making regarding hypertension management.
- To assess clinicians' perceptions of these patient preferences.
Main Methods:
- A questionnaire was administered to 210 hypertensive outpatients and their 50 clinicians across three practice types.
- The questionnaire assessed preferences for information, discussion, and decision-making participation.
Main Results:
- 41% of patients wanted more information about hypertension.
- Clinicians' underestimation (29%) and overestimation (11%) of patient preferences for therapy discussion were noted.
- 53% of patients preferred to participate in decision-making, contrasting with clinicians' belief that 78% desired participation.
Conclusions:
- Clinicians tend to underestimate patients' desire for information and discussion.
- Conversely, clinicians overestimate patients' desire to actively make treatment decisions.
- Recognizing these discrepancies can improve patient-clinician communication and shared decision-making processes.
Abstract:
Although shared decision making by patients and clinicians has been advocated, little is known about the degree of participation in decision making that patients actually prefer or about clinicians' appreciation of these preferences. We administered questionnaires about three aspects of decision making to 210 hypertensive outpatients and to their 50 clinicians, who represented three types of medical practices. We found that 41% of patients preferred more information about hypertension; clinicians underestimated patient preferences for discussion about therapy in 29% of cases and overestimated 11% (k = .22); and 53% of patients preferred to participate in making decisions, while clinicians believed that their patients desired to participate in 78% of cases. Many patients who preferred not to make initial therapeutic decisions did want to participate in ongoing evaluation of therapy. Thus, clinicians underestimate patients' desire for information and discussion but overestimate patients' desire to make decisions. Awareness of this discrepancy may facilitate communication and decision making.
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